Intramuscular pressure varies with depth. The tibialis anterior muscle studied in 12 volunteers

NASA Technical Reports Server (NTRS)

Nakhostine, M.; Styf, J. R.; van Leuven, S.; Hargens, A. R.; Gershuni, D. H.

1993-01-01

Pressures in the tibialis anterior muscle were recorded at rest and during exercise with transducer-tipped catheters in 12 volunteers while they were supine or standing. The recordings were repeated with venous stasis created by an inflated tourniquet cuff on the thigh. Catheters were placed at 3 different sites in the muscle: catheter I adjacent to the deep surface of the fascia over the anterior compartment; catheter II between the fascia and the central tendon; and catheter III deep in the muscle close to the interosseous membrane. In both the supine and standing positions the intramuscular pressure at rest and the muscle relaxation pressure during exercise, obtained by catheter II, were greater than the corresponding pressures measured by the superficially located catheter I in the normal as well as in the volume loaded limb. The same conditions for pressure measurement consistently revealed lower pressures recorded by catheter III compared to II, but the difference was not significant. Our results indicate that intramuscular pressure increases centripetally, as the centrally lying tendon is approached. We conclude that pressure measurements for diagnosis of acute and chronic compartment syndromes and in ergonomic studies should be based on recordings from a standard location of the catheter within the muscle and a standard posture of the subject.

Changes in Muscle Cell Metabolism and Mechanotransduction Are Associated with Myopathic Phenotype in a Mouse Model of Collagen VI Deficiency

PubMed Central

De Palma, Sara; Leone, Roberta; Grumati, Paolo; Vasso, Michele; Polishchuk, Roman; Capitanio, Daniele; Braghetta, Paola; Bernardi, Paolo; Bonaldo, Paolo; Gelfi, Cecilia

2013-01-01

This study identifies metabolic and protein phenotypic alterations in gastrocnemius, tibialis anterior and diaphragm muscles of Col6a1−/− mice, a model of human collagen VI myopathies. All three muscles of Col6a1−/− mice show some common changes in proteins involved in metabolism, resulting in decreased glycolysis and in changes of the TCA cycle fluxes. These changes lead to a different fate of α-ketoglutarate, with production of anabolic substrates in gastrocnemius and tibialis anterior, and with lipotoxicity in diaphragm. The metabolic changes are associated with changes of proteins involved in mechanotransduction at the myotendineous junction/costameric/sarcomeric level (TN-C, FAK, ROCK1, troponin I fast) and in energy metabolism (aldolase, enolase 3, triose phosphate isomerase, creatine kinase, adenylate kinase 1, parvalbumin, IDH1 and FASN). Together, these change may explain Ca2+ deregulation, impaired force development, increased muscle-relaxation-time and fiber damage found in the mouse model as well as in patients. The severity of these changes differs in the three muscles (gastrocnemius

Changes in muscle cell metabolism and mechanotransduction are associated with myopathic phenotype in a mouse model of collagen VI deficiency.

PubMed

De Palma, Sara; Leone, Roberta; Grumati, Paolo; Vasso, Michele; Polishchuk, Roman; Capitanio, Daniele; Braghetta, Paola; Bernardi, Paolo; Bonaldo, Paolo; Gelfi, Cecilia

2013-01-01

This study identifies metabolic and protein phenotypic alterations in gastrocnemius, tibialis anterior and diaphragm muscles of Col6a1(-/-) mice, a model of human collagen VI myopathies. All three muscles of Col6a1(-/-) mice show some common changes in proteins involved in metabolism, resulting in decreased glycolysis and in changes of the TCA cycle fluxes. These changes lead to a different fate of α-ketoglutarate, with production of anabolic substrates in gastrocnemius and tibialis anterior, and with lipotoxicity in diaphragm. The metabolic changes are associated with changes of proteins involved in mechanotransduction at the myotendineous junction/costameric/sarcomeric level (TN-C, FAK, ROCK1, troponin I fast) and in energy metabolism (aldolase, enolase 3, triose phosphate isomerase, creatine kinase, adenylate kinase 1, parvalbumin, IDH1 and FASN). Together, these change may explain Ca(2+) deregulation, impaired force development, increased muscle-relaxation-time and fiber damage found in the mouse model as well as in patients. The severity of these changes differs in the three muscles (gastrocnemius

The influence of freezing on the tensile strength of tendon grafts : a biomechanical study.

PubMed

Arnout, Nele; Myncke, Jan; Vanlauwe, Johan; Labey, Luc; Lismont, Daniel; Bellemans, Johan

2013-08-01

We investigated the influence of freezing on the tensile strength of fresh frozen tendon grafts. The biomechanical characteristics of tendons that are less commonly used in knee surgery (tibialis anterior, tibialis posterior, peroneus longus and medial and lateral half of Achilles tendons) were compared to those of a semitendinosus and gracilis graft harvested from the same 10 multi-organ donors. All right side tendons constituted the study group and were frozen at -80 degrees C and thawed at room temperature 5 times. All left side tendons were frozen at -80 degrees C and thawed at room temperature once. There were 59 tendons in the control group and 56 in the study group. The looped grafts were clamped at one side using a custom-made freeze clamp and loaded until failure on an Instron 4505 testing machine. The average ultimate failure load was not significantly different between the control and the study group (p > 0.05). The failure load of the medial tendon Achilles was the lowest in both study and control group (p < 0.001). There was no significant difference in maximum stress, maximum displacement, maximum strain and stiffness between the control and study group (p > 0.05). From our study, we conclude that freezing tendons at -80 degrees C and thawing several times does not influence the maximum load, maximum stress, maximum displacement, maximum strain and stiffness. The medial half of the Achilles tendon is clearly the weakest tendon (p < 0.001). These findings show that tendon grafts can be frozen at -80 degrees C and thawed at room temperature several times without altering their biomechanical properties.

[The operative treatment of the degenerative rupture of the anterior tibialis tendon].

PubMed

Schneppendahl, J; Gehrmann, S V; Stosberg, U; Regenbrecht, B; Windolf, J; Wild, M

2010-05-01

A degenerative tear of the anterior tibial tendon is a rare event compared to other tendons. The purpose of this study was to evaluate the functional results after surgical refixation. In a retrospective study, we report the functional outcome of five consecutive operatively treated patients suffering from a tear close to the insertion site of the anterior tibial tendon. All patients were assessed postoperatively, the AOFAS and Richter scores were obtained and the range of motion in the ankle joint was evaluated. Preoperatively all patients presented with a significant walking impairment due to a reduced active dorsiflexion, so the decision for surgical refixation was made. In all cases an MRI scan was performed preoperatively. Postoperative immobilisation without weight-bearing was done for six weeks. All patients returned to their former activity level, were satisfied with the postoperative result and had a normal gait in the follow-up examination. The range of motion was equal on both sides, the median AOFAS score was 86 and the median Richter score was 90 out of 100. There were no postoperative complications. Untreated tears of the anterior tibial tendon lead to significant impairment of the ankle joint and deformities of the foot. There is no consensus about the treatment with recommendations for operative and non-operative treatment. Various surgical procedures have been described. The surgical reconstruction of the tendon leads to a restored function of the ankle joint and allows a normal gait and is therefore desirable. Due to the loss of function and the good results after surgical treatment in our study, the non-operative treatment is not advisable. Surgical repair of degenerative tears of the anterior tibial tendon leads to very good functional results and high patient satisfaction.

Achilles tendon vibration-induced changes in plantar flexor corticospinal excitability.

PubMed

Lapole, Thomas; Temesi, John; Gimenez, Philippe; Arnal, Pierrick J; Millet, Guillaume Y; Petitjean, Michel

2015-02-01

Daily Achilles tendon vibration has been shown to increase muscle force, likely via corticospinal neural adaptations. The aim of the present study was to determine the extent by which corticospinal excitability is influenced during direct Achilles tendon vibration. Motor-evoked potentials (MEPs) were elicited in the soleus (SOL), gastrocnemius medialis (GM) and tibialis anterior (TA) by transcranial magnetic stimulation of the motor cortical area of the leg with and without Achilles tendon vibration at various frequencies (50, 80 and 110 Hz). Contralateral homologues were also investigated. SOL and GM MEP amplitude significantly increased by 226 ± 188 and 66 ± 39%, respectively, during Achilles tendon vibration, without any difference between the tested frequencies. No MEP changes were reported for TA or contralateral homologues. Increased SOL and GM MEP amplitude suggests increased vibration-induced corticospinal excitability independent of vibration frequency.

The effect of different decline angles on the biomechanics of double limb squats and the implications to clinical and training practice.

PubMed

Richards, Jim; Selfe, James; Sinclair, Jonathan; May, Karen; Thomas, Gavin

2016-09-01

Bilateral decline squatting has been well documented as a rehabilitation exercise, however, little information exists on the optimum angle of decline. The aim of this study was to determine the ankle and knee angle, moments, the patellofemoral joint load, patellar tendon load and associated muscle activity while performing a double limb squat at different decline angles and the implications to rehabilitation. Eighteen healthy subjects performed double limb squats at 6 angles of declination: 0, 5, 10, 15, 20 and 25 degrees. The range of motion of the knee and ankle joints, external moments, the patellofemoral/patellar tendon load and integrated EMG of gastrocnemius, tibialis anterior, rectus femoris and biceps femoris were evaluated. As the decline angle increased up to 20 degrees, the range of motion possible at the ankle and knee increased. The joint moments showed a decrease at the ankle up to 15 degrees and an increase at the knee up to 25 degrees, indicating a progressive reduction in loading around the ankle with a corresponding increase of the load in the patellar tendon and patellofemoral joint. These trends were supported by a decrease in tibialis anterior activity and an increase in the rectus femoris activity up to 15 degrees declination. However, gastrocnemius and biceps femoris activity increased as the decline angle increased above 15 degrees. The action of gastrocnemius and biceps femoris stabilises the knee against an anterior displacement of the femur on the tibia. These findings would suggest that there is little benefit in using a decline angle greater than 15-20 degrees unless the purpose is to offer an additional stability challenge to the knee joint.

The effect of different decline angles on the biomechanics of double limb squats and the implications to clinical and training practice

PubMed Central

Richards, Jim; Selfe, James; Sinclair, Jonathan; May, Karen; Thomas, Gavin

2016-01-01

Abstract Bilateral decline squatting has been well documented as a rehabilitation exercise, however, little information exists on the optimum angle of decline. The aim of this study was to determine the ankle and knee angle, moments, the patellofemoral joint load, patellar tendon load and associated muscle activity while performing a double limb squat at different decline angles and the implications to rehabilitation. Eighteen healthy subjects performed double limb squats at 6 angles of declination: 0, 5, 10, 15, 20 and 25 degrees. The range of motion of the knee and ankle joints, external moments, the patellofemoral/patellar tendon load and integrated EMG of gastrocnemius, tibialis anterior, rectus femoris and biceps femoris were evaluated. As the decline angle increased up to 20 degrees, the range of motion possible at the ankle and knee increased. The joint moments showed a decrease at the ankle up to 15 degrees and an increase at the knee up to 25 degrees, indicating a progressive reduction in loading around the ankle with a corresponding increase of the load in the patellar tendon and patellofemoral joint. These trends were supported by a decrease in tibialis anterior activity and an increase in the rectus femoris activity up to 15 degrees declination. However, gastrocnemius and biceps femoris activity increased as the decline angle increased above 15 degrees. The action of gastrocnemius and biceps femoris stabilises the knee against an anterior displacement of the femur on the tibia. These findings would suggest that there is little benefit in using a decline angle greater than 15-20 degrees unless the purpose is to offer an additional stability challenge to the knee joint. PMID:28149400

Os tibiale externum or sesamoid in the tendon of tibialis posterior.

PubMed

Bareither, D J; Muehleman, C M; Feldman, N J

1995-01-01

From a total of 165 foot and lower leg cadaveric specimens, 38 specimens were selected by palpation of the region of the tuberosity of the navicular for the possible presence of an accessory bone. Specimens were radiographed and dissected to reveal the presence of an accessory bone and its relationship to the tibialis posterior tendon. Nineteen of the specimens exhibited hypertrophy of the tibialis posterior tendon and 19 specimens exhibited an accessory bone. Specimens exhibiting an accessory bone were divided into two categories. In one group, the accessory bone was located in the tibialis posterior tendon prior to its division and was separated from the tuberosity by at least 3 mm. In the other group, the accessory bone was located in the main segment of the tibialis posterior tendon, connected to the tuberosity of the navicular by fibrous tissue, and, in some cases, exhibited a central cavity between the accessory bone and tuberosity. The accessory bone of specimens in the first group was considered to be a sesamoid in the tibialis posterior tendon and the accessory bone in the second group was an ossicle considered to be the os tibiale externum. Linking the os tibiale externum to the tibiale component of the primitive tetrapod foot rather than to the prehallux component eliminates the use of the term "prehallux" as an alternative name for this ossicle.

Acute effects of Achilles tendon vibration on soleus and tibialis anterior spinal and cortical excitability.

PubMed

Lapole, Thomas; Deroussen, François; Pérot, Chantal; Petitjean, Michel

2012-08-01

Prolonged vibration is known to alter muscle performance. Attenuation of Ia afferent efficacy is the main mechanism suggested. However, changes in motor cortex excitability could also be hypothesized. The purpose of the present study was therefore to analyze the acute and outlasting effects of 1 h of Achilles tendon vibration (frequency, 50 Hz) on the soleus (SOL) and tibialis anterior (TA) neuromuscular excitability. Spinal excitability was investigated by means of H-reflexes and F-waves while cortical excitability was characterized by motor evoked potentials (MEPs) obtained by transcranial magnetic stimulation. Twelve subjects performed the experimental procedures 3 times: at the beginning of the testing session (PRE), immediately after 1 h of Achilles tendon vibration (POST), and 1 h after the end of vibration (POST-1H). Prolonged vibration led to acute reduced H-reflex amplitudes for SOL only (46.9% ± 7.7% vs. 32.8% ± 7%; p = 0.006). Mainly presynaptic inhibition mechanisms were thought to be involved because of unchanged F-wave persistence and amplitude mean values, suggesting unaffected motoneuronal excitability. While no acute effects were reported for SOL and TA cortical excitability, both muscles were characterized by an outlasting increase in their MEP amplitude (0.64 ± 0.2 mV vs. 0.43 ± 0.18 mV and 2.17 ± 0.56 mV vs. 1.26 ± 0.36 mV, respectively; p < 0.05). The high modulation of Ia afferent input by vibration led to changes in motor cortex excitability that could contribute to the enhancement in muscular activation capacities reported after chronic use of tendon vibration.

Ultrasound Imaging of Muscle Contraction of the Tibialis Anterior in Patients with Facioscapulohumeral Dystrophy.

PubMed

Gijsbertse, Kaj; Goselink, Rianne; Lassche, Saskia; Nillesen, Maartje; Sprengers, André; Verdonschot, Nico; van Alfen, Nens; de Korte, Chris

2017-11-01

A need exists for biomarkers to diagnose, quantify and longitudinally follow facioscapulohumeral muscular dystrophy (FSHD) and many other neuromuscular disorders. Furthermore, the pathophysiological mechanisms leading to muscle weakness in most neuromuscular disorders are not completely understood. Dynamic ultrasound imaging (B-mode image sequences) in combination with speckle tracking is an easy, applicable and patient-friendly imaging tool to visualize and quantify muscle deformation. This dynamic information provides insight in the pathophysiological mechanisms and may help to distinguish the various stages of diseased muscle in FSHD. In this proof-of-principle study, we applied a speckle tracking technique to 2-D ultrasound image sequences to quantify the deformation of the tibialis anterior muscle in patients with FSHD and in healthy controls. The resulting deformation patterns were compared with muscle ultrasound echo intensity analysis (a measure of fat infiltration and dystrophy) and clinical outcome measures. Of the four FSHD patients, two patients had severe peroneal weakness and two patients had mild peroneal weakness on clinical examination. We found a markedly varied muscle deformation pattern between these groups: patients with severe peroneal weakness showed a different motion pattern of the tibialis anterior, with overall less displacement of the central tendon region, while healthy patients showed a non-uniform displacement pattern, with the central aponeurosis showing the largest displacement. Hence, dynamic muscle ultrasound of the tibialis anterior muscle in patients with FSHD revealed a distinctively different tissue deformation pattern among persons with and without tibialis anterior weakness. These findings could clarify the understanding of the pathophysiology of muscle weakness in FSHD patients. In addition, the change in muscle deformation shows good correlation with clinical measures and quantitative muscle ultrasound measurements. In conclusion, dynamic ultrasound in combination with speckle tracking allows the study of the effects of muscle pathology in relation to strength, force transmission and movement generation. Although further research is required, this technique can develop into a biomarker to quantify muscle disease severity. Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

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.

A novel miniature in-line load-cell to measure in-situ tensile forces in the tibialis anterior tendon of rats

PubMed Central

Unger, Ewald; Bijak, Manfred; Stoiber, Martin; Lanmüller, Hermann; Jarvis, Jonathan Charles

2017-01-01

Direct measurements of muscular forces usually require a substantial rearrangement of the biomechanical system. To circumvent this problem, various indirect techniques have been used in the past. We introduce a novel direct method, using a lightweight (~0.5 g) miniature (3 x 3 x 7 mm) in-line load-cell to measure tension in the tibialis anterior tendon of rats. A linear motor was used to produce force-profiles to assess linearity, step-response, hysteresis and frequency behavior under controlled conditions. Sensor responses to a series of rectangular force-pulses correlated linearly (R2 = 0.999) within the range of 0–20 N. The maximal relative error at full scale (20 N) was 0.07% of the average measured signal. The standard deviation of the mean response to repeated 20 N force pulses was ± 0.04% of the mean response. The step-response of the load-cell showed the behavior of a PD2T2-element in control-engineering terminology. The maximal hysteretic error was 5.4% of the full-scale signal. Sinusoidal signals were attenuated maximally (-4 dB) at 200 Hz, within a measured range of 0.01–200 Hz. When measuring muscular forces this should be of minor concern as the fusion-frequency of muscles is generally much lower. The newly developed load-cell measured tensile forces of up to 20 N, without inelastic deformation of the sensor. It qualifies for various applications in which it is of interest directly to measure forces within a particular tendon causing only minimal disturbance to the biomechanical system. PMID:28934327

A novel miniature in-line load-cell to measure in-situ tensile forces in the tibialis anterior tendon of rats.

PubMed

Schmoll, Martin; Unger, Ewald; Bijak, Manfred; Stoiber, Martin; Lanmüller, Hermann; Jarvis, Jonathan Charles

2017-01-01

Direct measurements of muscular forces usually require a substantial rearrangement of the biomechanical system. To circumvent this problem, various indirect techniques have been used in the past. We introduce a novel direct method, using a lightweight (~0.5 g) miniature (3 x 3 x 7 mm) in-line load-cell to measure tension in the tibialis anterior tendon of rats. A linear motor was used to produce force-profiles to assess linearity, step-response, hysteresis and frequency behavior under controlled conditions. Sensor responses to a series of rectangular force-pulses correlated linearly (R2 = 0.999) within the range of 0-20 N. The maximal relative error at full scale (20 N) was 0.07% of the average measured signal. The standard deviation of the mean response to repeated 20 N force pulses was ± 0.04% of the mean response. The step-response of the load-cell showed the behavior of a PD2T2-element in control-engineering terminology. The maximal hysteretic error was 5.4% of the full-scale signal. Sinusoidal signals were attenuated maximally (-4 dB) at 200 Hz, within a measured range of 0.01-200 Hz. When measuring muscular forces this should be of minor concern as the fusion-frequency of muscles is generally much lower. The newly developed load-cell measured tensile forces of up to 20 N, without inelastic deformation of the sensor. It qualifies for various applications in which it is of interest directly to measure forces within a particular tendon causing only minimal disturbance to the biomechanical system.

Repair of Chronic Tibialis Anterior Tendon Rupture With a Major Defect Using Gracilis Allograft.

PubMed

Burton, Alex; Aydogan, Umur

2016-08-01

Tibialis anterior tendon (TAT) rupture is an uncommon injury, however, it can cause substantial deficit. Diagnosis is often delayed due to lack of initial symptoms; yet loss of function over time typically causes the patient to present for treatment. This delay usually ends up with major defects creating a great technical challenge for the operating surgeon. We present a novel technique and operative algorithm for the management of chronic TAT ruptures with a major gap after a delayed diagnosis not otherwise correctable with currently described techniques in the literature. This technique has been performed in 4 cases without any complications with fairly successful functional outcomes. For the reconstruction of chronic TAT rupture with an average delay of nine weeks after initial injury and gap of greater than 10 cm, a thorough operative algorithm was implemented in 4 patients using a double bundle gracilis allograft. Patients were then kept nonweightbearing for 6 weeks followed by weightbearing as tolerated. They began physical therapy with a focus on ankle exercises and gradual return to normal activity at 8 weeks, with resistance training exercises allowed at 12 weeks. At a mean follow-up time of 24.5 months, all patients reported significant pain relief with normal gait pattern. There were no reported intra- or postoperative complications. The average Foot and Ankle Ability Measure score increased to 90 from 27.5 in the postoperative period. All patients were able to return their previous activity levels. Gracilis allograft reconstruction as used in this study is a viable and reproducible alternative to primary repair with postoperative results being favorable without using complex tendon transfer techniques or autograft use necessitating the functional sacrifice of transferred or excised tendon. To the best of our knowledge, this is the first study demonstrating a successful technique and operative algorithm of gracilis allograft reconstruction of the TAT with a substantial deficit of greater than 10 cm with favorable results. Level IV: Operative algorithm with case series. © 2016 The Author(s).

Incidence and Association of CT Findings of Ankle Tendon Injuries in Patients Presenting With Ankle and Hindfoot Fractures.

PubMed

Golshani, Ashkahn; Zhu, Liang; Cai, Chunyan; Beckmann, Nicholas M

2017-02-01

Tendon injuries are a commonly encountered finding in ankle CT examinations performed for fractures. This study was designed to identify the incidence and associations of tendon injuries in ankle CT examinations performed for fractures. A retrospective review was performed of 410 patients who underwent ankle CT during a 6-year period. Tendon injuries were common, seen in 25% of all ankle CT examinations. Tendon subluxation-dislocation accounted for most of the tendon injuries (77 of 196 total injuries). Pilon fractures carried 2.2 times increased risk of tibialis posterior tendon injury (p = 0.0094). Calcaneus fractures carried 11.86 times increased risk of peroneus brevis tendon and 10.71 times increased risk of peroneus longus tendon injury (p < 0.0001). Calcaneus fractures also carried 5.21 times increased risk of flexor hallucis longus tendon injury (p = 0.0024). Talus fracture was associated with injury to all flexor compartment tendons. Talus fractures carried 3.43 times increased risk of tibialis posterior tendon injury (p < 0.0001), 4.51 times increased risk of flexor digitorum longus tendon injury (p = 0.0005), and 6.97 times increased risk of flexor hallucis longus tendon injury (p < 0.0001). Calcaneal fractures are prone to peroneal tendon injury, and talus fractures are prone to flexor tendon injury. In patients with pilon fractures, it is important to look for tibialis posterior tendon injury, specifically for entrapment. Overall, the most common type of injury is tendon malalignment, so it is imperative to know the normal tendon paths and associated bony landmarks to identify tendon injury.

IS THERE ANY ROOM FOR TENDOSCOPY IN THE SURGICAL TREATMENT OF POSTERIOR TIBIAL TENDON INSUFFICIENCY?

PubMed

Bojanić, Ivan; Dimnjaković, Damjan; Mahnik, Alan; Smoljanović, Tomislav

2016-05-01

Posterior tibial tendon insufficiency (PTTI) is nowadays considered to be the main cause of adult-acquired flatfoot deformity (AAFD). The purpose of this study is to report the outcomes of tendoscopic treatment of tibialis poste- rior tendon (TP) in eleven patients with stage 1 or 2 PTTI and failed prior conservative treatment. Tendoscopy was carried out as a solitary procedure in 8 patients, while in 3 patients additional procedures such as ,,mini-open" tubularization of TP or anterior ankle arthroscopy were necessary. In a single patient transfer of flexor digitorum longus tendon was performed as a second stage surgery due to complete rupture of TP. Related with tendoscopic procedure, no complications were re- ported. TP tendoscopy is a useful and beneficial minimally invasive procedure to treat TP pathology at earlier stages of PTTI. It is a technically demanding procedure that requires extensive experience in arthroscopic management of small ioints and excellent knowledge of repional anatomy.

A Biomechanical Comparison of Allograft Tendons for Ligament Reconstruction.

PubMed

Palmer, Jeremiah E; Russell, Joseph P; Grieshober, Jason; Iacangelo, Abigail; Ellison, Benjamin A; Lease, T Dylan; Kim, Hyunchul; Henn, R Frank; Hsieh, Adam H

2017-03-01

Allograft tendons are frequently used for ligament reconstruction about the knee, but they entail availability and cost challenges. The identification of other tissues that demonstrate equivalent performance to preferred tendons would improve limitations. Hypothesis/Purpose: We compared the biomechanical properties of 4 soft tissue allograft tendons: tibialis anterior (TA), tibialis posterior (TP), peroneus longus (PL), and semitendinosus (ST). We hypothesized that allograft properties would be similar when standardized by the looped diameter. Controlled laboratory study. This study consisted of 2 arms evaluating large and small looped-diameter grafts: experiment A consisted of TA, TP, and PL tendons (n = 47 each) with larger looped diameters of 9.0 to 9.5 mm, and experiment B consisted of TA, TP, PL, and ST tendons (n = 53 each) with smaller looped diameters of 7.0 to 7.5 mm. Each specimen underwent mechanical testing to measure the modulus of elasticity (E), ultimate tensile force (UTF), maximal elongation at failure, ultimate tensile stress (UTS), and ultimate tensile strain (UTε). Experiment A: No significant differences were noted among tendons for UTF, maximal elongation at failure, and UTϵ. UTS was significantly higher for the PL (54 MPa) compared with the TA (44 MPa) and TP (43 MPa) tendons. E was significantly higher for the PL (501 MPa) compared with the TP (416 MPa) tendons. Equivalence testing showed that the TP and PL tendon properties were equivalent or superior to those of the TA tendons for all outcomes. Experiment B: All groups exhibited a similar E. UTF was again highest in the PL tendons (2294 N) but was significantly different from only the ST tendons (1915 N). UTϵ was significantly higher for the ST (0.22) compared with the TA (0.19) and TP (0.19) tendons. Equivalence testing showed that the TA, TP, and PL tendon properties were equivalent or superior to those of the ST tendons. Compared with TA tendons, TP and PL tendons of a given looped diameter exhibited noninferior initial biomechanical strength and stiffness characteristics. ST tendons were mostly similar to TA tendons but exhibited a significantly higher elongation/UTϵ and smaller cross-sectional area. For smaller looped-diameter grafts, all tissues were noninferior to ST tendons. In contrast to previous findings, PL tendons proved to be equally strong. The results of this study should encourage surgeons to use these soft tissue allografts interchangeably, which is important as the number of ligament reconstructions performed with allografts continues to rise.

Dynamic effect of the tibialis posterior muscle on the arch of the foot during cyclic axial loading.

PubMed

Kamiya, Tomoaki; Uchiyama, Eiichi; Watanabe, Kota; Suzuki, Daisuke; Fujimiya, Mineko; Yamashita, Toshihiko

2012-11-01

The most common cause of acquired flatfoot deformity is tibialis posterior tendon dysfunction. The present study compared the change in medial longitudinal arch height during cyclic axial loading with and without activated tibialis posterior tendon force. Fourteen normal, fresh frozen cadaveric legs were used. A total of 10,000 cyclic axial loadings of 500 N were applied to the longitudinal axis of the tibia. The 32-N tibialis posterior tendon forces were applied to the specimens of the active group (n=7). Specimens of another group (non-active group, n=7) were investigated without the tibialis posterior tendon force. The bony arch index was calculated from the displacement of the navicular height. The mean initial bony arch indexes with maximal weightbearing were 0.239 (SD 0.009) in active group and 0.239 (SD 0.014) in non-active group. After 7000 cycles, the bony arch indexes with maximal weightbearing were significantly greater in the active group (mean 0.214, SD 0.013) than in the non-active group (mean 0.199, SD 0.013). The mean bony arch indexes with maximal weightbearing after 10,000 cycles were 0.212 (SD 0.011) in the active group and 0.196 (SD 0.015) in the non-active group. The passive supportive structures were inadequate, and the tibialis posterior muscle was essential to maintain the medial longitudinal arch of the foot in the dynamic weightbearing condition. The findings underscore that physical therapy and arch supportive equipments are important to prevent flatfoot deformity in the condition of weakness or dysfunction of the tibialis posterior muscle. Copyright © 2012 Elsevier Ltd. All rights reserved.

Comparison of Gait Aspects According to FES Stimulation Position Applied to Stroke Patients

PubMed Central

Mun, Byeong-mu; Kim, Tae-ho; Lee, Jin-hwan; Lim, Jin-youg; Seo, Dong-kwon; Lee, Dong-jin

2014-01-01

[Purpose] This study sought to identify the gait aspects according to the FES stimulation position in stroke patients during gait training. [Subjects and Methods] To perform gait analysis, ten stroke patients were grouped based on 4 types of gait conditions: gait without FES stimulation (non-FES), gait with FES stimulation on the tibialis anterior (Ta), gait with FES stimulation on the tibialis anterior and quadriceps (TaQ), and gait with FES stimulation on the tibialis anterior and gluteus medius (TaGm). [Results] Based on repeated measures analysis of variance of measurements of gait aspects comprised of gait speed, gait cycle, and step length according to the FES stimulation position, the FES stimulation significantly affected gait aspects. [Conclusion] In conclusion, stimulating the tibialis anterior and quadriceps and stimulating the tibialis anterior and gluteus medius are much more effective than stimulating only the tibialis anterior during gait training in stroke patients using FES. PMID:24764634

Measuring tendon properties in mdx mice: cell viability and viscoelastic characteristics.

PubMed

Rizzuto, E; Musarò, A; Catizone, A; Del Prete, Z

2009-10-16

Muscular dystrophy is a genetic disorder of skeletal muscle characterized by progressive muscle weakness. Here we assessed whether muscle wasting affects cell viability and mechanical properties of extensor digitorum longus (EDL) and of tibialis anterior (TA) tendons from mdx dystrophic mice compared to wild type (WT) mice. mdx mice represent the classical animal model for human Duchenne muscular dystrophy, and show several signs of the pathology, including a decrease in specific force and an increase of fibrotic index. Cell viability of tendons was evaluated by histological analysis, and viscoelastic properties have been assessed by a rapid measurement protocol that allowed us to compute, at the same time, tissue complex compliance for all the frequencies of interest. Confocal microscopy and mechanical properties measurements revealed that mdx tendons, compared to WT ones, have an increase in the number of dead cells and a significant reduction in tissue elasticity for all the frequencies that were tested. These findings indicate a reduced quality of the tissue. Moreover, mdx tendons have an increase in the viscous response, indicating that during dynamic loading, they dissipate more energy compared to WT. Our results demonstrate that muscular dystrophy involves not only muscle wasting, but also alteration in the viscoelastic properties of tendons, suggesting a paracrine effect of altered skeletal muscle on tendinous tissue.

The biomechanical effects of limb lengthening and botulinum toxin type A on rabbit tendon.

PubMed

Olabisi, Ronke M; Best, Thomas M; Hurschler, Christof; Vanderby, Ray; Noonan, Kenneth J

2010-12-01

Numerous studies have examined the effects of distraction osteogenesis (DO) on bone, but relatively fewer have explored muscle adaptation, and even less have addressed the concomitant alterations that occur in the tendon. The purpose herein was to characterize the biomechanical properties of normal and elongated rabbit (N = 20) tendons with and without prophylactic botulinum toxin type A (BTX-A) treatment. Elastic and viscoelastic properties of Achilles and Tibialis anterior (TA) tendons were evaluated through pull to failure and stress relaxation tests. All TA tendons displayed nonlinear viscoelastic responses that were strain dependent. A power law formulation was used to model tendon viscoelastic responses and tendon elastic responses were fit with a microstructural model. Distraction-elongated tendons displayed increases in compliance and stress relaxation rates over undistracted tendons; BTX-A administration offset this result. The elastic moduli of distraction-lengthened TA tendons were diminished (p = 0.010) when distraction was combined with gastrocnemius (GA) BTX-A administration, elastic moduli were further decreased (p = 0.004) and distraction following TA BTX-A administration resulted in TA tendons with moduli not different from contralateral control (p > 0.05). Compared to contralateral control, distraction and GA BTX-A administration displayed shortened toe regions, (p = 0.031 and 0.038, respectively), while tendons receiving BTX-A in the TA had no differences in the toe region (p > 0.05). Ultimate tensile stress was unaltered by DO, but stress at the transition from the toe to the linear region of the stress-stretch curve was diminished in all distraction-elongated TA tendons (p < 0.05). The data suggest that prophylactic BTX-A treatment to the TA protects some tendon biomechanical properties. Copyright © 2010 Elsevier Ltd. All rights reserved.

Intravital multiphoton imaging of mouse tibialis anterior muscle

PubMed Central

Lau, Jasmine; Goh, Chi Ching; Devi, Sapna; Keeble, Jo; See, Peter; Ginhoux, Florent; Ng, Lai Guan

2016-01-01

ABSTRACT Intravital imaging by multiphoton microscopy is a powerful tool to gain invaluable insight into tissue biology and function. Here, we provide a step-by-step tissue preparation protocol for imaging the mouse tibialis anterior skeletal muscle. Additionally, we include steps for jugular vein catheterization that allow for well-controlled intravenous reagent delivery. Preparation of the tibialis anterior muscle is minimally invasive, reducing the chances of inducing damage and inflammation prior to imaging. The tibialis anterior muscle is useful for imaging leukocyte interaction with vascular endothelium, and to understand muscle contraction biology. Importantly, this model can be easily adapted to study neuromuscular diseases and myopathies. PMID:28243520

A case of adult-onset reducing body myopathy presenting a novel clinical feature, asymmetrical involvement of the sternocleidomastoid and trapezius muscles.

PubMed

Fujii, Takayuki; Hayashi, Shintaro; Kawamura, Nobutoshi; Higuchi, Masa-Aki; Tsugawa, Jun; Ohyagi, Yasumasa; Hayashi, Yukiko K; Nishino, Ichizo; Kira, Jun-Ichi

2014-08-15

We herein report a 32-year-old woman with adult-onset reducing body myopathy (RBM) who had a mutation in the four-and-a-half LIM domain 1 gene (FHL1) and showed a marked asymmetrical involvement of sternocleidomastoid and trapezius muscles. At 30 years of age she noticed bilateral foot drop, and over the next two years developed difficulty raising her right arm. At 32 years of age she was admitted to our hospital for a diagnostic evaluation. Neurological examination showed moderate weakness and atrophy of her right sternocleidomastoid muscle, right trapezius muscle, and bilateral upper proximal muscles. There were severe weakness and atrophy of her bilateral tibialis anterior muscles. Her deep tendon reflexes were hypoactive in her upper extremities. Her serum creatine kinase level was mildly increased. Muscle biopsy specimens from the left tibialis anterior muscle revealed marked variation in fiber size, some necrotic or regenerating fibers, and reducing bodies. Gene analysis of FHL1 demonstrated a mutation: a heterozygous missense mutation of c.377G>A (p. C126T) in FHL1. Compared with previous adult-onset RBM cases harboring mutations in FHL1, our case was characterized by asymmetrical atrophy of the sternocleidomastoid and trapezius muscles. Copyright © 2014 Elsevier B.V. All rights reserved.

Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial [NCT00279630

PubMed Central

Kulig, Kornelia; Pomrantz, Amy B; Burnfield, Judith M; Reischl, Stephen F; Mais-Requejo, Susan; Thordarson, David B; Smith, Ronald W

2006-01-01

Background Posterior tibialis tendon dysfunction (PTTD) is a common cause of foot pain and dysfunction in adults. Clinical observations strongly suggest that the condition is progressive. There are currently no controlled studies evaluating the effectiveness of exercise, orthoses, or orthoses and exercise on Stage I or IIA PTTD. Our study will explore the effectiveness of an eccentric versus concentric strengthening intervention to results obtained with the use of orthoses alone. Findings from this study will guide the development of more efficacious PTTD intervention programs and contribute to enhanced function and quality of life in persons with posterior tibialis tendon dysfunction. Methods/design This paper presents the rationale and design for a randomized clinical trial evaluating the effectiveness of a treatment regime for the non-operative management of Stage I or IIA PTTD. Discussion We have presented the rationale and design for an RCT evaluating the effectiveness of a treatment regimen for the non-operative management of Stage I or IIA PTTD. The results of this trial will be presented as soon as they are available. PMID:16756656

Effects of Achilles tendon vibration, surface and visual conditions on lower leg electromyography in young adults with and without recurrent ankle sprains.

PubMed

Lubetzky, Anat V; Price, Robert; McCoy, Sarah W

2016-07-01

Functional ankle instability is associated with decreased ankle muscle function. Compliant surfaces and eyes-closed training are commonly used for rehabilitation and prevention of ankle sprains. Brief Achilles tendon vibration is commonly used in the study of postural control. To test the level of activation of tibialis anterior (TIB) and fibularis longus (FIB), bilateral Achilles tendon vibration was applied for the middle 20 s in a series of 60-s trials, when 10 healthy young adults and 10 adults with history of repeated ankle sprains were standing bipedal: on floor, on memory foam, or on a Both Sides Up (BOSU) ball, with eyes open, and on floor and foam with eyes closed. Differences in Integrated surface electromyography (IEMG) of TIB and FIB were significant for both groups pre, during, and post vibration (Friedman Tests, p < 0.001 for all). In both groups, the highest IEMG for TIB was obtained during vibration when standing on foam with eyes closed, whereas the highest IEMG for FIB was obtained during vibration when standing on the BOSU. Bipedal stance on BOSU and brief Achilles tendon vibration may be a useful intervention when a session's goal is to facilitate lower leg muscles activation. Future research should explore training effects as well as the effect of FIB tendon vibration. Copyright © 2016 Elsevier Ltd. All rights reserved.

Changes in the estimated time course of the motoneuron afterhyperpolarization induced by tendon vibration.

PubMed

MacDonell, Christopher W; Ivanova, Tanya D; Garland, S Jayne

2010-12-01

Group Ia afferents are activated vigorously with high-frequency tendon vibration and provide excitatory input to the agonist muscle and inhibitory input to the antagonist muscle group via inhibitory interneurons. The purpose of this experiment was to determine whether the afterhyperpolarization (AHP) time course in humans is altered in response to tendon vibration. The AHP time course is estimated using the interval death rate (IDR) analysis, a transform of the motor unit action potential train. Single motor units from tibialis anterior (TA) were recorded as subjects held low force dorsiflexor contractions for 600 s with and without vibration. The vibratory stimulus was superimposed on the low force contraction either to the tendon of the TA or the antagonist Achilles tendon. During TA tendon vibration, the time course of the AHP, as expressed by its time constant (τ), decreased from 35.5 ms in the previbration control condition to 31.3 ms during the vibration (P = 0.003) and returned to 36.3 ms after the vibration was removed (P = 0.002). The AHP τ during vibration of the antagonist Achilles tendon (38.6 ms) was greater than the previbration control condition (33.6 ms; P = 0.001). It is speculated that the reduction in AHP time constant with TA vibration may have resulted alone or in combination with a modulation of motoneuron gain, an alteration of persistent inward currents and/or the restructuring of synaptic noise. A decrease in firing probability, possibly reflecting Ia reciprocal inhibition, may have been responsible for the larger AHP time constant.

The Influence of a Cognitive Task on the Postural Phase of Gait Initiation in Parkinson's Disease: An Electromyographic-Based Analysis.

PubMed

Fernandes, Ângela; Sousa, Andreia S P; Rocha, Nuno; Tavares, João Manuel R S

2017-07-01

The aim of this study was to compare postural control strategies during gait initiation in single- and dual-task conditions in individuals in early stages of Parkinson's Disease (PD). The activation timing of tibialis anterior occurred significantly later in the individuals with PD than in the controls (p = .05), and a significant interaction between the groups, conditions and limbs was found (p = .027). Differences between the single- and dual-task conditions were observed for the activation timing of the tibialis anterior (p = .042) and for the magnitude of soleus (p = .007), with lower values for the dual-task condition. Furthermore, not all the individuals followed the previously reported pattern of soleus inhibition followed by tibialis anterior activation. The duration of the mediolateral displacement of the center of pressure was longer in the individuals with PD than in the controls (p = .019). The anticipatory postural adjustments during gait initiation are impaired in PD and are expressed by an activation failure of tibialis anterior in both single- and dual-task conditions. Hence, it is important that during rehabilitation, intervention should concentrate on the tibialis anterior TA.

Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability.

PubMed

Bruyn, George A W; Hanova, Petra; Iagnocco, Annamaria; d'Agostino, Maria-Antonietta; Möller, Ingrid; Terslev, Lene; Backhaus, Marina; Balint, Peter V; Filippucci, Emilio; Baudoin, Paul; van Vugt, Richard; Pineda, Carlos; Wakefield, Richard; Garrido, Jesus; Pecha, Ondrej; Naredo, Esperanza

2014-11-01

To develop the first ultrasound scoring system of tendon damage in rheumatoid arthritis (RA) and assess its intraobserver and interobserver reliability. We conducted a Delphi study on ultrasound-defined tendon damage and ultrasound scoring system of tendon damage in RA among 35 international rheumatologists with experience in musculoskeletal ultrasound. Twelve patients with RA were included and assessed twice by 12 rheumatologists-sonographers. Ultrasound examination for tendon damage in B mode of five wrist extensor compartments (extensor carpi radialis brevis and longus; extensor pollicis longus; extensor digitorum communis; extensor digiti minimi; extensor carpi ulnaris) and one ankle tendon (tibialis posterior) was performed blindly, independently and bilaterally in each patient. Intraobserver and interobserver reliability were calculated by κ coefficients. A three-grade semiquantitative scoring system was agreed for scoring tendon damage in B mode. The mean intraobserver reliability for tendon damage scoring was excellent (κ value 0.91). The mean interobserver reliability assessment showed good κ values (κ value 0.75). The most reliable were the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior tendons. An ultrasound reference image atlas of tenosynovitis and tendon damage was also developed. Ultrasound is a reproducible tool for evaluating tendon damage in RA. This study strongly supports a new reliable ultrasound scoring system for tendon damage. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Tibialis anterior volumes and areas in ACL-injured limbs compared with unimpaired.

PubMed

Binder-Macleod, Benjamin I; Buchanan, Thomas S

2006-09-01

Past research has shown that subjects with ACL injuries show activation differences and atrophy in the muscles that cross the knee, including the gastrocnemii, which predominately act at the ankle. However, it is not known how the other ankle muscles that do not cross the knee are affected. We focused on the two muscles that control the ankle, the soleus and tibialis anterior muscles, to see how they were affected by an ACL injury. We hypothesized that the ankle muscles of subjects with ACL injuries that did not require surgery (copers) would be more like normals and that the muscles of subjects with ACL injuries who required surgery to return to normal activity (noncopers) would atrophy. Twenty-seven subjects were divided into three even categories: unimpaired subjects, copers, and noncopers. Axial spin-echo T1-weighted MRI images were used to digitally reconstruct the tibialis anterior and the soleus. We used the digitally reconstructed muscles to determine the peak cross-sectional area and volume of each muscle. The copers' tibialis anterior muscles were similar to the unimpaired subjects, but, surprisingly, the noncoper's tibialis anterior muscles of the injured leg were larger than those of their uninjured legs (P < 0.05). In the soleus, the results showed a trend of not being affected. The increase in size of the tibialis anterior in noncopers may have been caused by altered gait patterns in noncopers. We believe this is due to either an ankle-stiffening strategy during heel strike or from the inversion of the foot causing external rotation of the tibia as a stabilizing technique for the knee.

Modified Kidner procedure utilizing a Mitek bone anchor.

PubMed

Dawson, D M; Julsrud, M E; Erdmann, B B; Jacobs, P M; Ringstrom, J B

1998-01-01

The recent development of small bone suture anchors has created several potential applications in reconstructive surgery of the foot. Mitek bone anchors are simple to insert, require less aggressive dissection and surgical time than reefing of the redundant posterior tibial tendon, and are a reliable method of tendon-to-bone fixation. Mitek bone anchors are an excellent technique for the treatment of redundant tibialis posterior tendon following a modified Kidner procedure. In modified Kidner procedures involving an excessively large os tibiale externum, Mitek anchoring of the redundant tibialis posterior tendon to the navicular bone is an excellent means for secure plication of the posterior tibial tendon in cases involving intraoperative tendon laxity. A description of the Mitek Anchor System and technique of application in a modified Kinder procedure is presented. The purpose of this study was to describe patient satisfaction and long-term clinical outcomes of the modified Kinder procedure with and without the Mitek bone anchoring system. A retrospective study of the modified Kinder procedure was performed with 13 patients being evaluated, seven with Mitek anchoring and six without. The University of Maryland 100-point Painful Foot Center Scoring System was modified to be more specific to the modified Kinder procedure for assessment of subjective long-term results. Patient overall satisfaction was rated good to excellent by 85.6% of patients in the Mitek group and by 100% of patients in the non-Mitek group. Use of the Mitek anchor allowed for quicker postoperative recovery to resumption of ambulation without assistive devices (average of 3 weeks vs. 4.42 weeks) and a quicker return to pain-free ambulation in normal shoegear (average of 4 weeks vs. 6 weeks). Mitek anchoring of the tibialis posterior tendon, theoretically, increases medial arch support as evidenced by 14% of the Mitek group and 67% of the non-Mitek group requiring postoperative orthotics.

Cytoplasm-to-myonucleus ratios following microgravity.

PubMed

Kasper, C E; Xun, L

1996-10-01

The cytoplasmic volume-to-myonucleus ratio in the tibialis anterior and gastrocnemius muscles of juvenile rats after 5.4 days of microgravity was studied. Three groups of rats (n = 8 each) were used. The experimental group (space rats) was flown aboard the space shuttle Discovery (NASA, STS-48), while two ground-based groups, one hindlimb suspended (suspended rats), one non-suspended (control), served as controls. Single fibre analysis revealed a significant decrease in cross-sectional area (microns2) in the gastrocnemius for both the space and the suspended rats; in the tibialis anterior only the suspended rats showed a significant decrease. Myonuclei counts (myonuclei per mm) in both the tibialis anterior and gastrocnemius were significantly increased in the space rats but not in the suspended rats. The mean myonuclear volume (individual nuclei: microns3) in tibialis anterior fibres from the space rats, and in gastrocnemius fibres from both the space and the suspended rats, was significantly lower than that in the respective control group. Estimation of the total myonuclear volume (microns3 per.mm), however, revealed no significant differences between the three groups in either the tibialis anterior or gastrocnemius. The described changes in the cross-sectional area and myonuclei numbers resulted in significant decreases in the cytoplasmic volume-to-myonucleus ratio (microns3 x 10(3)) in both muscles and for both space and suspended rats (tibialis anterior; 15.6 +/- 0.6 (space), 17.2 +/- 1.0 (suspended), 20.8 +/- 0.9 (control): gastrocnemius; 13.4 +/- 0.4 (space) and 14.9 +/- 1.1 (suspended) versus 18.1 +/- 1.1 (control)). These results indicate that even short periods of unweighting due to microgravity or limb suspension result in changes in skeletal muscle fibres which lead to significant decreases in the cytoplasmic volume-to-myonucleus ratio.

Changes in recruitment of Rhesus soleus and gastrocnemius muscles following a 14 day spaceflight

NASA Technical Reports Server (NTRS)

Hodgson, J. A.; Bodine-Fowler, S. C.; Roy, R. R.; De Leon, R. D.; De Guzman, C. P.; Koslovskaia, I.; Sirota, M.; Edgerton, V. R.

1991-01-01

The effect of microgravity on the recruitment patterns of the soleus, gastrocnemius, and tibialis-anterior muscles was investigated by comparing electromyograms (EMGs) of these muscles of Rhesus monkeys implanted with EMG electrodes, taken before and after a 14-day flight on board Cosmos 2044. It was found that the EMG amplitude values in the soleus muscle decreased after the spaceflight but returned to normal values over the 2-wk recovery period. The medial amplitudes of gastrocnemius and tibialis anterior were not changed by flight. Joint probability density distributions displayed changes after flight in both the soleus and gastrocnemius muscles, but not in tibialis anterior.

Action of vanillin (Vanilla planifolia) on the morphology of tibialis anterior and soleus muscles after nerve injury

PubMed Central

Peretti, Ana Luiza; Antunes, Juliana Sobral; Lovison, Keli; Kunz, Regina Inês; Castor, Lidyane Regina Gomes; Brancalhão, Rose Meire Costa; Bertolini, Gladson Ricardo Flor; Ribeiro, Lucinéia de Fátima Chasko

2017-01-01

ABSTRACT Objective To evaluate the action of vanillin (Vanilla planifolia) on the morphology of tibialis anterior and soleus muscles after peripheral nerve injury. Methods Wistar rats were divided into four groups, with seven animals each: Control Group, Vanillin Group, Injury Group, and Injury + Vanillin Group. The Injury Group and the Injury + Vanillin Group animals were submitted to nerve injury by compression of the sciatic nerve; the Vanillin Group and Injury + Vanillin Group, were treated daily with oral doses of vanillin (150mg/kg) from the 3rd to the 21st day after induction of nerve injury. At the end of the experiment, the tibialis anterior and soleus muscles were dissected and processed for light microscopy and submitted to morphological analysis. Results The nerve compression promoted morphological changes, typical of denervation, and the treatment with vanillin was responsible for different responses in the studied muscles. For the tibialis anterior, there was an increase in the number of satellite cells, central nuclei and fiber atrophy, as well as fascicular disorganization. In the soleus, only increased vascularization was observed, with no exacerbation of the morphological alterations in the fibers. Conclusion The treatment with vanillin promoted increase in intramuscular vascularization for the muscles studied, with pro-inflammatory potential for tibialis anterior, but not for soleus muscle. PMID:28767917

Kinesthetic illusions attenuate experimental muscle pain, as do muscle and cutaneous stimulation.

PubMed

Gay, André; Aimonetti, Jean-Marc; Roll, Jean-Pierre; Ribot-Ciscar, Edith

2015-07-30

In the present study, muscle pain was induced experimentally in healthy subjects by administrating hypertonic saline injections into the tibialis anterior (TA) muscle. We first aimed at comparing the analgesic effects of mechanical vibration applied to either cutaneous or muscle receptors of the TA or to both types simultaneously. Secondly, pain alleviation was compared in subjects in whom muscle tendon vibration evoked kinesthetic illusions of the ankle joint. Muscle tendon vibration, which primarily activated muscle receptors, reduced pain intensity by 30% (p<0.01). In addition, tangential skin vibration reduced pain intensity by 33% (p<0.01), primarily by activating cutaneous receptors. Concurrently stimulating both sensory channels induced stronger analgesic effects (-51%, p<0.01), as shown by the lower levels of electrodermal activity. The strongest analgesic effects of the vibration-induced muscle inputs occurred when illusory movements were perceived (-38%, p=0.01). The results suggest that both cutaneous and muscle sensory feedback reduce muscle pain, most likely via segmental and supraspinal processes. Further clinical trials are needed to investigate these new methods of muscle pain relief. Copyright © 2015 Elsevier B.V. All rights reserved.

Between-day reliability of MyotonPRO for the non-invasive measurement of muscle material properties in the lower extremities of patients with a chronic spinal cord injury.

PubMed

Ko, Chang-Yong; Choi, Hyuk-Jae; Ryu, Jeicheong; Kim, Gyoosuk

2018-05-17

Measuring the muscle properties of patients with spinal cord injuries (SCIs) is important to better understand their biomechanical features. In this study, we sought to evaluate the between-day reliability of MyotonPRO, a handheld device that can measure muscle mechanical properties, and assess whether it is reliable to measure muscle properties over time in patients with SCI. Thirteen men with complete SCIs (age 53.9 ± 6.3 years, height 171.0 ± 5.2 cm, weight 66.1 ± 5.8 kg), and injury levels ranging from L1 to T12, were enrolled. Oscillation frequency; logarithmic decrement; dynamic stiffness; mechanical stress relaxation time; and creep of the biceps femoris, medial and lateral gastrocnemius, rectus femoris, tibialis anterior, and Achilles tendon were measured on consecutive days using MyotonPRO. The intraclass coefficient for most muscles and the Achilles tendon ranged from 0.53 to 0.99 for all parameters. The percentage standard error of the measurement for many parameters in most muscles and the Achilles tendon was less than 10%. Bland-Altman analysis showed a high agreement for all mechanical properties. No significant differences were observed in any muscle or Achilles tendon properties between days (all p > 0.05). These results indicate that the MyotonPRO is reliable for between-day measurements of the mechanical properties of lower limb muscles and Achilles tendon in patients with SCI. Copyright © 2018 Elsevier Ltd. All rights reserved.

High Prevalence of Obesity and Female Gender Among Patients With Concomitant Tibialis Posterior Tendonitis and Plantar Fasciitis.

PubMed

Reb, Christopher W; Schick, Faith A; Karanjia, Homyar N; Daniel, Joseph N

2015-10-01

The link between increased body weight and hindfoot complaints is largely based on correlation to single foot pathology. We retrospectively reviewed 6879 patients with tibialis posterior tendonitis (TPT), plantar fasciitis (PF), or both. Among patients with either TPT or PF, 1 in 11 (9%) had both. We then compared age, gender, and body mass index among these groups. Patients with both diagnoses were neither statistically older nor more obese than patients with single diagnoses. However, they were statistically more female. Given the overall high prevalence of obesity in the study population, we feel these data support the link between obesity and multiple foot pathology. Prognostic, Level IV: Case series. © 2015 The Author(s).

Long latency postural responses are functionally modified by cognitive set.

PubMed

Beckley, D J; Bloem, B R; Remler, M P; Roos, R A; Van Dijk, J G

1991-10-01

We examined how cognitive set influences the long latency components of normal postural responses in the legs. We disturbed the postural stability of standing human subjects with sudden toe-up ankle rotations. To influence the subjects' cognitive set, we varied the rotation amplitude either predictably (serial 4 degrees versus serial 10 degrees) or unpredictably (random mixture of 4 degrees and 10 degrees). The subjects' responses to these ankle rotations were assessed from the EMG activity of the tibialis anterior, the medial gastrocnemius, and the vastus lateralis muscles of the left leg. The results indicate that, when the rotation amplitude is predictable, only the amplitude of the long latency (LL) response in tibialis anterior and vastus lateralis varied directly with perturbation size. Furthermore, when the rotation amplitude is unpredictable, the central nervous system selects a default amplitude for the LL response in the tibialis anterior. When normal subjects are exposed to 2 perturbation amplitudes which include the potential risk of falling, the default LL response in tibialis anterior appropriately anticipates the larger amplitude perturbation rather than the smaller or an intermediate one.

Function-sparing tibialis anterior pivoted muscle flap for reconstruction of post-burn and post-traumatic middle-third leg defects with exposed tibia

PubMed Central

Megahed, M.A.

2011-01-01

Summary Reconstruction of the middle third of the leg is a challenging procedure. The tibialis anterior muscle flap can be useful in reconstruction of the middle third of the leg with exposed tibia. The aim of this work was to evaluate the efficacy of tibialis anterior pivoted muscle flap for reconstruction of the middle third of the leg with functional preservation. This study, performed in the Plastic, Reconstructive and Burn Unit, Menoufiya University Hospital, Egypt, included 16 patients (13 males and 3 females) during the period February 2007/May 2010: seven post-burn and nine post-traumatic patients with post-burn middle-third leg defects with exposed tibia. Their ages ranged from 14 to 67 years. A function-sparing lateral split tibialis anterior pivoted muscle flap was used in all the patients. Follow-up ranged from six months to two years. Partial flap loss occurred in one patient (6.25%), there was no post-operative haematoma or infection, and only one case of wound dehiscence (6.25%), managed by secondary suture. No donor site morbidity or any significant functional impairment was observed, and the subjective aesthetic results were satisfactory. Lateral split tibialis anterior pivoted muscle flap is a useful, simple technique, allowing rapid, durable and reliable coverage of middle-third leg defects without significant impairment of function and without sacrificing major nerves or vessels in the foot, and without any donor site morbidity. PMID:22262962

Effect of eccentric exercise program for early tibialis posterior tendinopathy.

PubMed

Kulig, Kornelia; Lederhaus, Eric S; Reischl, Steve; Arya, Shruti; Bashford, Greg

2009-09-01

Morphology and vascularization of painful tibialis posterior (TP) tendons before and after an intervention targeting the degenerated tendon were examined. Functional status and pain level were also assessed. A10-week twice daily, progressive eccentric tendon loading, calf stretching program with orthoses was implemented with ten, early stage TP tendinopathy subjects. TP tendons were imaged by grayscale and Doppler ultrasound at INITIAL and POST evaluations to assess the tendon's morphology and signs of neovascularization. The Foot Functional Index (FFI), Physical Activity Scale (PAS), 5-Minute Walk Test, and single heel raise (SHR) test were completed at INITIAL and POST evaluations. The Global Rating Scale (GRS) was completed at 6 months followup. One-way ANOVA was used to compare the FFI at INITIAL, POST, and 6-MONTH time points. Paired t-tests were used to compare means between the remaining variables. The level of significance was p = 0.05. There was a significant difference in FFI total, pain, and disability at the three time-points. Post-hoc paired t-tests revealed that the FFI scores were lower for the total score and pain and disability subcategories when comparing from INITIAL to POST and INITIAL to 6-MONTH evaluations (p < 0.05 for all). The number of SHR increased significantly on the involved side from INITIAL to POST evaluation (p = 0.041). The GRS demonstrated minimum clinically important differences for improvements in symptoms at 6-MONTH. Tendon morphology and vascularization remained abnormal following the intervention. A 10-week tendon specific eccentric program resulted in improvements in symptoms and function without changes in tendon morphology or neovascularization.

[Influence of the posterior tibial tendon on the medial arch of the foot: an in vitro kinetic and kinematic study].

PubMed

Emmerich, J; Wülker, N; Hurschler, C

2003-04-01

The respective contributions of the active and passive structures of the foot to the stability of the medical arch were investigated using an in vitro kinetic and kinematic model. The effect of the tibialis posterior tendon on foot and ankle movements, and plantar pressure distribution of the foot were tested in a cadaveric human foot. The stance phase from heel-contact to toe-off of normal walking gait and after tibialis posterior tendon rupture was simulated in eight roentenographically normal human feet (age 66 +/- 19 years, males). Ground reaction force and tibial inclination was simulated by means of a tilting angle and force-controlled translation stage. Plantar pressure was measured using a pressure-measuring platform. The force developed by the flexors and extensor muscles of the foot were simulated via cables attached to 7 force-controlled hydraulic cylinders. Tibial rotation was produced by an electric servo-motor, and foot movements measured with an ultrasonic analysis system. The model was verified against the plantar distribution and kinematics of healthy subjects measured during normal gait. Tibialis posterior deficit did not result in any detectable changes in pressure or force-time integral in the medial regions of the foot--a common sign of flat foot (pressure: midfoot 0.2 < or = 0.9; medial forefoot 0.5 < or = p < or = 0.9; hallux 0.5 < or = p < or = 0.9; force-time integral: midfoot p = 0-871; medial forefoot p = 0.632; hallux p = 0.068). Only small tendential changes in the kinematics of the talus and calcaneus were observed in dorsiflexion (0-58 sec; talus 0.1 < or = p < or = 0.6; calcaneus 0.4 < or = p < or = 0.06) and eversion (talus: 0-60 sec. 0.1 < or = p < or = 0.6; calcaneus: 37-60 sec. 0.2 < or = p < or = 0.7). The results of this in vitro study show that defective tibialis posterior alone does not produce significant changes in the kinetics or kinematics of the stance phase of normal gait. This suggests that the development of flat foot observed in degeneration of the tibialis posterior tendon occurs only after fatigue of the passive structures of the foot.

Relative changes with contraction in the central excitability state of the tibialis anterior and calf muscles.

PubMed Central

Fisher, M A

1980-01-01

F responses were recorded from the surface of the tibialis muscle and medial aspect of the soleus muscle in 14 normal subjects. The persistence (that is the fraction of measurable F responses found with a series of supramaximal stimuli) and average F amplitudes (measured peak-to-peak and based on at least five F responses) were determined both at rest and with isometric contraction with the ankle maintained at 90 degrees. Although the persistence at rest was significantly less in the tibialis anterior soleus than the (p less than 0.001), no significant difference was found with the muscles contracted. This was associated with a significant increase in both average F amplitudes and average F amplitude/direct motor response ratios in the tibialis anterior in comparison to the soleus. In four of the subjects, studies were also performed when the H reflex in the soleus muscle was eliminated by thigh compression. Comparable changes in both F response persistence and average F amplitude were found with and without an H reflex. These data indicate that, in contrast to the situation at rest, with isometric contraction the "central excitatory state" of the tibialis anterior is at least as great as in its antagonist antigravity muscles and that this is not due simply to increased large fiber reflex input associated with agonist contraction. PMID:7373321

Kinetics and Kinematics after the Bridle Procedure for Treatment of Traumatic Foot Drop

PubMed Central

Hastings, Mary K.; Sinacore, David R.; Woodburn, James; Paxton, E. Scott; Klein, Sandra E.; McCormick, Jeremy J.; Bohnert, Kathryn L.; Beckert, Krista S.; Stein, Michelle L.; Strube, Michael J; Johnson, Jeffrey E.

2014-01-01

Background The Bridle procedure restores active ankle dorsiflexion through a tri-tendon anastamosis of the tibialis posterior, transferred to the dorsum of the foot, with the peroneus longus and tibialis anterior tendon. Inter-segmental foot motion after the Bridle procedure has not been measured. The purpose of this study is to report kinetic and kinematic variables during walking and heel rise in patients after the Bridle procedure. Methods 18 Bridle and 10 control participants were studied. Walking and heel rise kinetic and kinematic variables were collected and compared using an ANOVA. Findings During walking the Bridle group, compared with controls, had reduced ankle power at push off [2.3 (SD 0.7) W/kg, 3.4 (SD 0.6) W/kg, respectively, P<.01], less hallux extension during swing [−13 (SD 7)°, 15 (SD6)°, respectively, P<.01] and slightly less ankle dorsiflexion during swing [6 (SD4)°, 9 (SD 2)°, respectively, P=.03]. During heel rise the Bridle group had 4 (SD 6)° of forefoot on hindfoot dorsiflexion compared to 8 (SD 3)° of plantarflexion in the controls (P<.01). Interpretation This study provides evidence that the Bridle procedure restores the majority of dorsiflexion motion during swing. However, plantarflexor function during push off and hallux extension during swing were reduced during walking in the Bridle group. Abnormal mid-tarsal joint motion, forefoot on hindfoot dorsiflexion instead of plantarflexion, was identified in the Bridle group during the more challenging heel rise task. Intervention after the Bridle procedure must maximize ankle plantarflexor function and midfoot motion should be examined during challenging tasks. PMID:23684087

Relationship between metabolic cost and muscular coactivation across running speeds.

PubMed

Moore, Isabel S; Jones, Andrew M; Dixon, Sharon J

2014-11-01

Muscular coactivation can help stabilise a joint, but contrasting results in previous gait studies highlight that it is not clear whether this is metabolically beneficial. The aim was to assess the relationship between the metabolic cost of running and muscular coactivation across different running speeds, in addition to assessing the reliability and precision of lower limb muscular coactivation. Eleven female recreational runners visited the laboratory on two separate occasions. On both occasions subjects ran at three speeds (9.1, 11 and 12 km h(-1)) for six minutes each. Oxygen consumption and electromyographic data were simultaneously recorded during the final two minutes of each speed. Temporal coactivations of lower limb muscles during the stance phase were calculated. Five muscles were assessed: rectus femoris, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius lateralis. Nonparametric correlations revealed at least one significant, positive association between lower limb muscular coactivation and the metabolic cost of running for each speed. The length of tibialis anterior activation and muscular coactivation of the biceps femoris-tibialis anterior and gastrocnemius lateralis-tibialis anterior decreased with speed. These results show that longer coactivations of the proximal (rectus femoris-biceps femoris and vastus lateralis-biceps femoris) and leg extensor (rectus femoris-gastrocnemius lateralis) muscles were related to a greater metabolic cost of running, which could be detrimental to performance. The decrease in coactivation in the flexor and distal muscles at faster speeds occurs due to the shorter duration of tibialis anterior activation as speed increases, yet stability may be maintained. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review.

PubMed

Mariscalco, Michael W; Magnussen, Robert A; Mehta, Divyesh; Hewett, Timothy E; Flanigan, David C; Kaeding, Christopher C

2014-02-01

An autograft has traditionally been the gold standard for anterior cruciate ligament reconstruction (ACLR), but the use of allograft tissue has increased in recent years. While numerous studies have demonstrated that irradiated allografts are associated with increased failure rates, some report excellent results after ACLR with nonirradiated allografts. The purpose of this systematic review was to determine whether the use of nonirradiated allograft tissue is associated with poorer outcomes when compared with autografts. Patients undergoing ACLR with autografts versus nonirradiated allografts will demonstrate no significant differences in graft failure risk, laxity on postoperative physical examination, or differences in patient-oriented outcome scores. Systematic review. A systematic review was performed to identify prospective or retrospective comparative studies (evidence level 1, 2, or 3) of autografts versus nonirradiated allografts for ACLR. Outcome data included graft failure based on clinical findings and instrumented laxity, postoperative laxity on physical examination, and patient-reported outcome scores. Studies were excluded if they did not specify whether the allograft had been irradiated. Quality assessment and data extraction were performed by 2 examiners. Nine studies comparing autografts and nonirradiated allografts were included. Six of the 9 studies compared bone-patellar tendon-bone (BPTB) autografts with BPTB allografts. Two studies compared hamstring tendon autografts to hamstring tendon allografts, and 1 study compared hamstring tendon autografts to tibialis anterior allografts. The mean patient age in 7 of 9 studies ranged from 24.5 to 32 years, with 1 study including only patients older than 40 years and another not reporting patient age. The mean follow-up duration was 24 to 94 months. Six of 9 studies reported clinical graft failure rates, 8 of 9 reported postoperative instrumented laxity measurements, 7 of 9 reported postoperative physical examination findings, and all studies reported patient-reported outcome scores. This review demonstrated no statistically significant difference between autografts and nonirradiated allografts in any outcome measure. No significant differences were found in graft failure rate, postoperative laxity, or patient-reported outcome scores when comparing ACLR with autografts to nonirradiated allografts in this systematic review. These findings apply to patients in their late 20s and early 30s. Caution is advised when considering extrapolation of these findings to younger, more active cohorts.

Short-Term effects of neuromuscular electrical stimulation on muscle architecture of the tibialis anterior and gastrocnemius in children with cerebral palsy: preliminary results of a prospective controlled study.

PubMed

Karabay, İlkay; Öztürk, Gökhan Tuna; Malas, Fevziye Ünsal; Kara, Murat; Tiftik, Tülay; Ersöz, Murat; Özçakar, Levent

2015-09-01

The aim of this study was to explore the short-term effects of neuromuscular electrical stimulation application on tibialis anterior (stimulated muscle) and gastrocnemius (antagonist) muscles' size and architecture in children with cerebral palsy by using ultrasound. This prospective, controlled study included 28 children diagnosed with spastic diplegic cerebral palsy. Participants were treated either with neuromuscular electrical stimulation application and conventional physiotherapy (group A) or with conventional physiotherapy alone (group B). Outcome was evaluated by clinical (gross motor function, selective motor control, range of motion, spasticity) and ultrasonographic (cross-sectional area, pennation angle, fascicle length of tibialis anterior and gastrocnemius muscles) measurements before and after treatment in both groups. Cross-sectional area values of tibialis anterior (238.7 ± 61.5 vs. 282.0 ± 67.1 mm) and gastrocnemius (207.9 ± 48.0 vs. 229.5 ± 52.4 mm) (P < 0.001 and P = 0.008, respectively) muscles were increased after treatment in group A. Cross-sectional area values of tibialis anterior muscle were decreased (257.3 ± 64.7 vs. 239.7 ± 60.0 mm) after treatment in group B (P < 0.001), and the rest of the measurements were found not to have changed significantly in either group. These results have shown that cross-sectional area of both the agonist and antagonist muscles increased after 20 sessions of neuromuscular electrical stimulation treatment. Future studies with larger samples and longer follow-up are definitely awaited for better evaluation of neuromuscular electrical stimulation application on muscle architecture and its possible correlates in clinical/functional outcome.

Doppler ultrasonography of the anterior knee tendons in elite badminton players: colour fraction before and after match.

PubMed

Koenig, M J; Torp-Pedersen, S; Boesen, M I; Holm, C C; Bliddal, H

2010-02-01

Anterior knee tendon problems are seldom reported in badminton players although the game is obviously stressful to the lower extremities. Painful anterior knee tendons are common among elite badminton players. The anterior knee tendons exhibit colour Doppler activity. This activity increases after a match. Painful tendons have more Doppler activity than tendons without pain. Cohort study. 72 elite badminton players were interviewed about training, pain and injuries. The participants were scanned with high-end ultrasound equipment. Colour Doppler was used to examine the tendons of 64 players before a match and 46 players after a match. Intratendinous colour Doppler flow was measured as colour fraction (CF). The tendon complex was divided into three loci: the quadriceps tendon, the proximal patellar tendon and the insertion on the tibial tuberosity. Interview: Of the 72 players, 62 players had problems with 86 tendons in the lower extremity. Of these 86 tendons, 48 were the anterior knee tendons. Ultrasound: At baseline, the majority of players (87%) had colour Doppler flow in at least one scanning position. After a match, the percentage of the knee complexes involved did not change. CF increased significantly in the dominant leg at the tibial tuberosity; single players had a significantly higher CF after a match at the tibial tuberosity and in the patellar tendon both before and after a match. Painful tendons had the highest colour Doppler activity. Most elite badminton players had pain in the anterior knee tendons and intratendinous Doppler activity both before and after match. High levels of Doppler activity were associated with self-reported ongoing pain.

A Patient-Specific Foot Model for the Estimate of Ankle Joint Forces in Patients with Juvenile Idiopathic Arthritis.

PubMed

Prinold, Joe A I; Mazzà, Claudia; Di Marco, Roberto; Hannah, Iain; Malattia, Clara; Magni-Manzoni, Silvia; Petrarca, Maurizio; Ronchetti, Anna B; Tanturri de Horatio, Laura; van Dijkhuizen, E H Pieter; Wesarg, Stefan; Viceconti, Marco

2016-01-01

Juvenile idiopathic arthritis (JIA) is the leading cause of childhood disability from a musculoskeletal disorder. It generally affects large joints such as the knee and the ankle, often causing structural damage. Different factors contribute to the damage onset, including altered joint loading and other mechanical factors, associated with pain and inflammation. The prediction of patients' joint loading can hence be a valuable tool in understanding the disease mechanisms involved in structural damage progression. A number of lower-limb musculoskeletal models have been proposed to analyse the hip and knee joints, but juvenile models of the foot are still lacking. This paper presents a modelling pipeline that allows the creation of juvenile patient-specific models starting from lower limb kinematics and foot and ankle MRI data. This pipeline has been applied to data from three children with JIA and the importance of patient-specific parameters and modelling assumptions has been tested in a sensitivity analysis focused on the variation of the joint reaction forces. This analysis highlighted the criticality of patient-specific definition of the ankle joint axes and location of the Achilles tendon insertions. Patient-specific detection of the Tibialis Anterior, Tibialis Posterior, and Peroneus Longus origins and insertions were also shown to be important.

The effect of subtalar inversion/eversion on the dynamic function of the tibialis anterior, soleus, and gastrocnemius during the stance phase of gait.

PubMed

Wang, Ruoli; Gutierrez-Farewik, Elena M

2011-05-01

The purpose of this study was to determine how gait deviation in one plane (i.e. excessive subtalar inversion/eversion) can affect the dynamic function of the tibialis anterior, gastrocnemius, and soleus to accelerate the subtalar, ankle, knee and hip joints, as well as the body center of mass. Induced acceleration analysis was performed based on a subject-specific three-dimensional linkage model configured by stance phase gait data and driven by one unit of muscle force. Eight healthy adult subjects were examined in gait analysis. The subtalar inversion/eversion was modeled by offsetting up to 20° from the normal subtalar angle while other configurations remained unaltered. This study showed that the gastrocnemius, soleus and tibialis anterior generally functioned as their anatomical definition in normal gait, but counterintuitive function was occasionally found in the bi-articular gastrocnemius. The plantarflexors play important roles in the body support and forward progression. Excessive subtalar eversion was found to enlarge the plantarflexors and tibialis anterior's function. Induced acceleration analysis demonstrated its ability to isolate the contributions of individual muscle to a given factor, and as a means of studying effect of pathological gait on the dynamic muscle functions. Copyright © 2011 Elsevier B.V. All rights reserved.

Age-related motor unit remodeling in the Tibialis Anterior.

PubMed

Siddiqi, Ariba; Kumar, Dinesh; Arjunan, Sridhar

2015-01-01

Limited studies exist on the use of surface electromyogram (EMG) signal features to detect age-related motor unit remodeling in the Tibialis Anterior. Motor unit remodeling leads to declined muscle strength and force steadiness during submaximal contractions which are factors for risk of falls in the elderly. This study investigated the remodeling phenomena in the Tibialis Anterior using sample entropy and higher order statistics. Eighteen young (26.1 ± 2.9 years) and twelve elderly (68.7 ± 9.0 years) participants performed isometric dorsiflexion of the ankle at 20% maximal voluntary contraction (MVC) and their Tibialis Anterior (TA) EMG was recorded. Sample entropy, Gaussianity and Linearity Test statistics were calculated from the recorded EMG for each MVC. Shapiro-Wilk test was used to determine normality, and either a two-tail student t-test or Wilcoxon rank sum test was performed to determine significant difference in the EMG features between the young and old cohorts. Results show age-related motor unit remodeling to be depicted by decreased sample entropy (p <; 0.1), increased non-Gaussianity (p <; 0.05) and lesser degree of linearity in the elderly. This is due to the increased sparsity of the MUAPs as a result of the denervation-reinnervation process, and the decrease in total number of motor units.

Soft-tissue allografts terminally sterilized with an electron beam are biomechanically equivalent to aseptic, nonsterilized tendons.

PubMed

Elenes, Egleide Y; Hunter, Shawn A

2014-08-20

Allograft safety is contingent on effective sterilization. However, current sterilization methods have been associated with decreased biomechanical strength and higher failure rates of soft-tissue allografts. In this study, electron beam (e-beam) sterilization was explored as an alternative sterilization method to preserve biomechanical integrity. We hypothesized that e-beam sterilization would not significantly alter the biomechanical properties of tendon allograft compared with aseptic, nonsterilized controls and gamma-irradiated grafts. Separate sets of forty fresh-frozen tibialis tendon allografts (four from each of ten donors) and forty bisected bone-patellar tendon-bone (BTB) allografts (four from each of ten donors) were randomly assigned to four study groups. One group received a 17.1 to 21.0-kGy gamma radiation dose; two other groups were sterilized with an e-beam at either a high (17.1 to 21.0-kGy) or low (9.2 to 12.2-kGy) dose. A fourth group served as nonsterilized controls. Each graft was cyclically loaded to 200 N of tension for 2000 cycles at a frequency of 2 Hz, allowed to relax for five minutes, and then tested in tension until failure at a 100%/sec strain rate. One-way analysis of variance testing was used to identify significant differences. Tibialis tendons sterilized with both e-beam treatments and with gamma irradiation exhibited values for cyclic tendon elongation, maximum load, maximum displacement, stiffness, maximum stress, maximum strain, and elastic modulus that were not significantly different from those of nonsterilized controls. BTB allografts sterilized with the high e-beam dose and with gamma irradiation were not significantly different in cyclic tendon elongation, maximum load, maximum displacement, stiffness, maximum stress, maximum strain, and elastic modulus from nonsterilized controls. BTB allografts sterilized with the e-beam at the lower dose were significantly less stiff than nonsterilized controls (p = 0.014) but did not differ from controls in any other properties. The difference in stiffness likely resulted from variations in tendon size rather than the treatments, as the elastic moduli of the groups were similar. The biomechanical properties of tibialis and BTB allografts sterilized with use of an e-beam at a dose range of 17.1 to 21.0 kGy were not different from those of aseptic, nonsterilized controls or gamma-irradiated allografts. E-beam sterilization can be a viable method to produce safe and biomechanically uncompromised soft-tissue allografts. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Acute Tears of the Tibialis Posterior Tendon Following Ankle Sprain.

PubMed

Jackson, Lyle T; Dunaway, Linda J; Lundeen, Gregory A

2017-07-01

Traumatic tears of the tibialis posterior (TP) tendon following an ankle sprain are rare. The purpose of this study was to report our case series of TP tendon tears following an ankle sprain. Patients with persistent TP tendon pain after an ankle sprain were retrospectively identified over a 4-year period and reviewed. A comparison of magnetic resonance imaging (MRI) interpretations by a radiologist and surgeon was made. Patients failing conservative management underwent operative repair of the TP tendon tear and concomitant pathology. Failure of the index surgery was defined as TP tendinosis, which was treated with excision and flexor digitorum longus tendon transfer. Outcomes were measured with the Foot Function Index (FFI) and American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scores. Thirteen patients were found to have a TP tendon tear following an ankle sprain. The incidence for TP tears with sprains presented to our clinic was 1.04%. MRI identified TP tendon pathology in 4 patients by a radiologist review and in 11 patients by a surgeon review. The most common concomitant pathology was a talar osteochondral defect in 13 of 13 patients and ligament instability in 12 of 13 patients (5/13 lateral, 3/13 medial, 4/13 multidirectional instability). Four of 13 patients failed the index surgery. Of the 9 remaining patients, 4 had clinical follow-up at an average of 4.6 years postoperatively. The average FFI subscale scores were the following: pain, 40.4; disability, 28.9; and activity, 23.6. The average AOFAS hindfoot score was 68.8. Despite being rare, a TP tendon tear should be included in the differential diagnosis for persistent medial-sided pain following an ankle sprain. MRI findings can be subtle. Associated pathology was very common and likely confounded the diagnosis and outcomes. Patients should be counseled on the possibility of poor outcomes and long-term pain. Level IV, case series.

Tensile properties of a morphologically split supraspinatus tendon.

PubMed

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

2014-07-01

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

Hamstring tendon versus patellar tendon anterior cruciate ligament reconstruction using biodegradable interference fit fixation: a prospective matched-group analysis.

PubMed

Wagner, Michael; Kääb, Max J; Schallock, Jessica; Haas, Norbert P; Weiler, Andreas

2005-09-01

There are still controversies about graft selection for primary anterior cruciate ligament reconstruction, especially with respect to knee stability and functional outcome. Biodegradable interference screw fixation of hamstring tendon grafts provides clinical results similar to those achieved with identical fixation of bone-patellar tendon-bone grafts. Cohort study; Level of evidence, 2. In 1996 and 1997, primary isolated anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft was performed in 72 patients. Since 1998, hamstring tendons were used as routine grafts. Matched patients with a hamstring tendon graft were selected from a database (n = 284). All patients were followed prospectively for a minimum of 2 years with KT-1000 arthrometer testing, International Knee Documentation Committee score, and Lysholm score. In the bone-patellar tendon-bone group, 9 patients were excluded because of bilateral rupture of the anterior cruciate ligament, 3 patients (4.2%) had a graft rupture, and 4 patients were lost to follow-up (follow-up rate, 92.1%), leaving 56 patients for a matched-group analysis. In the hamstring tendon database, the graft rupture rate was 5.6% (P = .698). The Lysholm score was 89.7 in the patellar tendon group and 94 in the hamstring tendon group (P = .003). The KT-1000 arthrometer side-to-side difference was 2.6 mm for the patellar tendon group and 2.1 mm for the hamstring tendon group (P = .041). There were significantly less positive pivot-shift test results in the hamstring tendon group (P = .005), and hamstring tendon patients showed lower thigh atrophy (P = .024) and patellofemoral crepitus (P = .003). Overall International Knee Documentation Committee scores were better (P = .001) in the hamstring tendon group (hamstring tendon: 34 x A, 21 x B, 0 x C, 0 x D; bone-patellar tendon-bone: 17 x A, 32 x B, 6 x C, 0 x D). In this comparison of anterior cruciate ligament reconstruction with bone-patellar tendon-bone and anatomical hamstring tendon grafts, the hamstring tendon graft was superior in knee stability and function. These findings are partially contrary to previous studies and might be attributable to the use of an anatomical joint line fixation for hamstring tendon grafts. Thus, hamstring tendons are the authors' primary graft choice for anterior cruciate ligament reconstruction, even in high-level athletes.

Effects of regular Tai Chi practice and jogging on neuromuscular reaction during lateral postural control in older people.

PubMed

Wang, Shao-Jun; Xu, Dong-Qing; Li, Jing-Xian

2017-01-01

This study examined the effects of regular Tai Chi practice and jogging on the neuromuscular activity of the trunk, hip, and ankle joint muscles of older people during lateral postural perturbation. A total of 42 older people participated in the study and formed the Tai Chi, jogging, and sedentary control groups. Electromyography signals were collected from the peroneus longus, anterior tibialis, gluteus medius, and erector spinae during unpredictable mediolateral perturbation. The Tai Chi group exhibited significantly faster latencies of the tibialis anterior and erector spinae than the control group. The jogging group showed a significantly shorter neuromuscular reaction time of the erector spinae than the control group. No significant difference was observed between the Tai Chi and jogging groups. Long-term regular Tai Chi practice enhanced the neuromuscular reaction of the erector spinae and tibialis anterior to lateral perturbation and will help timely posture correction when lateral postural distributions occur.

Age-related differences in muscle activity patterns during walking in healthy individuals.

PubMed

Van Criekinge, Tamaya; Saeys, Wim; Hallemans, Ann; Van de Walle, Patricia; Vereeck, Luc; De Hertogh, Willem; Truijen, Steven

2018-05-26

To examine how muscle activity over the entire gait cycle changes with increasing age. Electromyography data of the erector spinae, rectus femoris, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius muscles were collected by an instrumented gait analysis during over ground walking in healthy adults aged between 20 and 89 years. Participants were categorized per decade (n = 105, 15 per decade, decades 3-9). Normalized integrated linear envelopes of the electromyographic signal were calculated for one stride. A one way ANOVA using spm1d statistics explored the differences between age groups, followed by a post hoc analysis. While initiation of decline commenced at the age of 60 for erector spinae and tibialis anterior, age-related changes are most pronounced after the age of 80. Concerning timing of muscle activity, subjects in decade 7-9 had prolonged activity and/or early activity of the erector spinae, vastus lateralis, biceps femoris, tibialis anterior and gastrocnemius compared to other decades. Regarding amplitude of muscle activity, decreased peak amplitudes of the erector spinae, rectus femoris, vastus lateralis and gastrocnemius were observed in decades 7-9 compared to other decades. Both timing and amplitude of muscle activation patterns need to be considered to understand the aging process. Regarding the erector spinae, tibialis anterior and vastus lateralis, a decrease in muscle activation coincides with prolonged activity, compared to the gastrocnemius where decreased muscle activation is associated with early activation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Regional strain variations in the human patellar tendon.

PubMed

Pearson, Stephen J; Ritchings, Tim; Mohamed, Azlan S A

2014-07-01

Characteristics of localized tendon strain in vivo are largely unknown. The present study examines local tendon strain between the deep, middle, and surface structures at the proximal and distal aspects of the patellar tendon during ramped isometric contractions. Male subjects (age 28.0 ± 6.3 yr) were examined for patellar tendon excursion (anterior, midsection, and posterior) during ramped isometric voluntary contractions using real-time B-mode ultrasonography and dynamometry. Regional tendon excursion measurements were compared using an automated pixel tracking method. Strain was determined from the tendon delta length normalized to initial/resting segment length. Strain increased from 10% to 100% of force for all regions. Significantly greater mean strain was seen for the anterior proximal region compared to the posterior and mid layer of the tendon (7.5% ± 1.1% vs 3.7% ± 0.5% vs 5.5% ± 1.0%; P < 0.05). Similarly, the distal posterior region showed greater mean strain compared to the mid and anterior regions (7.9% ± 0.6% vs 5.0% ± 0.6% vs 5.4% ± 0.6%; P < 0.05). Relative changes in strain differences from 50% to 100% of force for the proximal region were greatest for the anterior to midline regions (4.6% ± 0.6% and 5.6% ± 0.6%, respectively) and those for the distal region were also greatest for the anterior to midline regions (4.4% ± 0.2% and 5.3% ± 0.2%, respectively). The largest mean strain for the proximal region was at the anterior layer (7.5% ± 1.1%) and that for the distal tendon region was at the posterior layer (7.9% ± 0.9%). This study shows significant regional differences in strain during ramped isometric contractions for the patellar tendon. Lower proximal strains in the posterior tendon compared to the anterior region may be associated with the suggestion of "stress shielding" as an etiological factor in insertional tendinopathy.

Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction.

PubMed

Todor, Adrian; Caterev, Sergiu; Nistor, Dan Viorel; Khallouki, Youssef

2016-06-01

The most commonly used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and hamstring tendons. Each has its advantages and limitations. The bone-patellar tendon-bone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.

Center of Pressure Displacement of Standing Posture during Rapid Movements Is Reorganised Due to Experimental Lower Extremity Muscle Pain.

PubMed

Shiozawa, Shinichiro; Hirata, Rogerio Pessoto; Graven-Nielsen, Thomas

2015-01-01

Postural control during rapid movements may be impaired due to musculoskeletal pain. The purpose of this study was to investigate the effect of experimental knee-related muscle pain on the center of pressure (CoP) displacement in a reaction time task condition. Nine healthy males performed two reaction time tasks (dominant side shoulder flexion and bilateral heel lift) before, during, and after experimental pain induced in the dominant side vastus medialis or the tibialis anterior muscles by hypertonic saline injections. The CoP displacement was extracted from the ipsilateral and contralateral side by two force plates and the net CoP displacement was calculated. Compared with non-painful sessions, tibialis anterior muscle pain during the peak and peak-to-peak displacement for the CoP during anticipatory postural adjustments (APAs) of the shoulder task reduced the peak-to-peak displacement of the net CoP in the medial-lateral direction (P<0.05). Tibialis anterior and vastus medialis muscle pain during shoulder flexion task reduced the anterior-posterior peak-to-peak displacement in the ipsilateral side (P<0.05). The central nervous system in healthy individuals was sufficiently robust in maintaining the APA characteristics during pain, although the displacement of net and ipsilateral CoP in the medial-lateral and anterior-posterior directions during unilateral fast shoulder movement was altered.

PT-12, a putative ras-activated proliferation-dependent gene, is expressed in patellar tendon and not in anterior cruciate ligament.

PubMed

Goomer, R S; Maris, T; Ostrander, R; Amiel, D

1999-09-01

We describe a gene (PT-12) that is expressed in the patellar tendon and not in the anterior cruciate ligament. We used a recently developed polymerase chain reaction-based subtractive cDNA analysis to discover genes that are overexpressed in the patellar tendon but not expressed in the anterior cruciate ligament; the long-term objective was to find genes that are central to the self-repair of the patellar tendon, in contrast with the inability of the anterior cruciate ligament to launch a repair response following injury. PT-12 is a homologue of human S2 or mouse LLRep3 ribosomal genes, which are known to be overexpressed in highly proliferating cells. This study opens a new vista to the development of techniques and reagents to study the differences between two periarticular tissues (i.e., the patellar tendon and anterior cruciate ligament) that differ primarily in their ability to self-repair.

Magnetic resonance anatomy of the superior part of the rotator cuff in normal shoulders, assessment and practical implication.

PubMed

Michelin, Paul; Trintignac, Adrien; Dacher, Jean Nicolas; Carvalhana, Gilbert; Lefebvre, Valentin; Duparc, Fabrice

2014-12-01

The superior part of the rotator cuff consists of the anterior (SSa) and posterior (SSp) parts of the supraspinatus tendon, the infraspinatus (IS) tendon plus the articular capsule. An overlap of the distal SSp tendon by the anterior part of the IS one has been anatomically demonstrated; the insertion area of the IS is more anterior than currently believed. The aim of our study was to assess this complex architecture through standard MRI scans. Twenty-five healthy volunteers underwent a shoulder MRI. Three planes T2 fat saturation sequences were read in consensus by two radiologists. The SSa, the SSp, the IS tendons and the articular capsule were assessed for visibility. The patterns of demarcation of each structure from adjacent ones were assessed. The width and the thickness of each tendinous band were measured on sagittal images. The SSa, the SSp and the IS tendons were distinguishable in all patients. The anterior part of the IS tendon overlapped the SSp tendon to reach a quite anterior insertion into the greater tuberosity of the humerus. The SSa, the SSp and the IS tendons were 6.5-3.4, 15.1-2.8 and 26.8-2.2 mm wide and thick, respectively. MR images of the normal superior rotator cuff are consistent with latest anatomical descriptions. The distal superposition of the IS over the SSp tendon should be considered regarding the linear increased signal areas and the commonly named "partial thickness ruptures" of the superior rotator cuff as well as the fatty infiltration of the IS muscle.

Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy.

PubMed

Festa, Anthony; Allert, Jesse; Issa, Kimona; Tasto, James P; Myer, Jonathan J

2014-11-01

To quantify the amount of the extra-articular long head of the biceps tendon (LHBT) seen during intra-articular shoulder arthroscopy by pulling the tendon into the joint with a probe through an anterior portal while viewing through a standard posterior portal. Intra-articular shoulder arthroscopy was performed on 10 forequarter cadaveric specimens. The extra-articular portion of the LHBT was evaluated by pulling the tendon into the joint with an arthroscopic probe inserted through an anterior portal. The tendon was marked at the pulley insertion on the humerus with a vascular clip before and after the tendon was pulled into the joint. An open deltopectoral approach was performed, and the amount of extra-articular tendon visualized was calculated as an absolute amount and in relation to nearby anatomic structures. An additional 1.9 cm (range, 1.4 to 2.6 cm) of extra-articular LHBT was viewed by pulling the tendon into the joint with an arthroscopic probe through an anterior portal during shoulder arthroscopy. This represented 30.8% of the extra-articular portion of the tendon, 47.7% of tendon in the bicipital groove, and 76.3% of the tendon that lies under the area from the pulley insertion to the distal edge of the transverse humeral ligament. During intra-articular shoulder arthroscopy, the extra-articular portion of the LHBT is incompletely visualized by pulling the tendon into the joint with a probe placed through an anterior portal while viewing through a standard posterior portal. An additional extra-articular portion of the LHBT may be viewed by pulling the tendon into the joint with an arthroscopic probe during shoulder arthroscopy. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

An increased response to experimental muscle pain is related to psychological status in women with chronic non-traumatic neck-shoulder pain

PubMed Central

2011-01-01

Background Neck-shoulder pain conditions, e.g., chronic trapezius myalgia, have been associated with sensory disturbances such as increased sensitivity to experimentally induced pain. This study investigated pain sensitivity in terms of bilateral pressure pain thresholds over the trapezius and tibialis anterior muscles and pain responses after a unilateral hypertonic saline infusion into the right legs tibialis anterior muscle and related those parameters to intensity and area size of the clinical pain and to psychological factors (sleeping problems, depression, anxiety, catastrophizing and fear-avoidance). Methods Nineteen women with chronic non-traumatic neck-shoulder pain but without simultaneous anatomically widespread clinical pain (NSP) and 30 age-matched pain-free female control subjects (CON) participated in the study. Results NSP had lower pressure pain thresholds over the trapezius and over the tibialis anterior muscles and experienced hypertonic saline-evoked pain in the tibialis anterior muscle to be significantly more intense and locally more widespread than CON. More intense symptoms of anxiety and depression together with a higher disability level were associated with increased pain responses to experimental pain induction and a larger area size of the clinical neck-shoulder pain at its worst. Conclusion These results indicate that central mechanisms e.g., central sensitization and altered descending control, are involved in chronic neck-shoulder pain since sensory hypersensitivity was found in areas distant to the site of clinical pain. Psychological status was found to interact with the perception, intensity, duration and distribution of induced pain (hypertonic saline) together with the spreading of clinical pain. The duration and intensity of pain correlated negatively with pressure pain thresholds. PMID:21992460

Activity of Lower Limb Muscles During Squat With and Without Abdominal Drawing-in and Pilates Breathing.

PubMed

Barbosa, Alexandre C; Martins, Fábio M; Silva, Angélica F; Coelho, Ana C; Intelangelo, Leonardo; Vieira, Edgar R

2017-11-01

Barbosa, AC, Martins, FM, Silva, AF, Coelho, AC, Intelangelo, L, and Vieira, ER. Activity of lower limb muscles during squat with and without abdominal drawing-in and Pilates breathing. J Strength Cond Res 31(11): 3018-3023, 2017-The purpose of this study was to assess the effects of abdominal drawing-in and Pilates breathing on the activity of lower limb muscles during squats. Adults (n = 13, 22 ± 3 years old) with some Pilates experience performed three 60° squats under each of the following conditions in a random order: (I) normal breathing, (II) drawing-in maneuver with normal breathing, and (III) drawing-in maneuver with Pilates breathing. Peak-normalized surface electromyography of the rectus femoris, biceps femoris, gastrocnemius medialis, and tibialis anterior during the knee flexion and extension phases of squat exercises was analyzed. There were significant differences among the conditions during the knee flexion phase for the rectus femoris (p = 0.001), biceps femoris (p = 0.038), and tibialis anterior (p = 0.001), with increasing activation from conditions I to III. For the gastrocnemius medialis, there were significant differences among the conditions during the knee extension phase (p = 0.023), with increased activity under condition I. The rectus and biceps femoris activity was higher during the extension vs. flexion phase under conditions I and II. The tibialis anterior activity was higher during the flexion compared with the extension phase under all conditions, and the medial gastrocnemius activity was higher during the extension phase under condition I. Doing squats with abdominal drawing-in and Pilates breathing resulted in increased rectus, biceps femoris, and tibialis anterior activity during the flexion phase, increasing movement stability during squat exercises.

Stretch-sensitive paresis and effort perception in hemiparesis.

PubMed

Vinti, Maria; Bayle, Nicolas; Hutin, Emilie; Burke, David; Gracies, Jean-Michel

2015-08-01

In spastic paresis, stretch applied to the antagonist increases its inappropriate recruitment during agonist command (spastic co-contraction). It is unknown whether antagonist stretch: (1) also affects agonist recruitment; (2) alters effort perception. We quantified voluntary activation of ankle dorsiflexors, effort perception, and plantar flexor co-contraction during graded dorsiflexion efforts at two gastrocnemius lengths. Eighteen healthy (age 41 ± 13) and 18 hemiparetic (age 54 ± 12) subjects performed light, medium and maximal isometric dorsiflexion efforts with the knee flexed or extended. We determined dorsiflexor torque, Root Mean Square EMG and Agonist Recruitment/Co-contraction Indices (ARI/CCI) from the 500 ms peak voluntary agonist recruitment in a 5-s maximal isometric effort in tibialis anterior, soleus and medial gastrocnemius. Subjects retrospectively reported effort perception on a 10-point visual analog scale. During gastrocnemius stretch in hemiparetic subjects, we observed: (1) a 25 ± 7 % reduction of tibialis anterior voluntary activation (maximum reduction 98 %; knee extended vs knee flexed; p = 0.007, ANOVA); (2) an increase in dorsiflexion effort perception (p = 0.03, ANCOVA). Such changes did not occur in healthy subjects. Effort perception depended on tibialis anterior recruitment only (βARI(TA) = 0.61, p < 0.01) in healthy subjects (not on gastrocnemius medialis co-contraction) while it depended on both tibialis anterior agonist recruitment (βARI(TA) = 0.41, p < 0.001) and gastrocnemius medialis co-contraction (βCCI(MG) = 0.43, p < 0.001) in hemiparetic subjects. In hemiparesis, voluntary ability to recruit agonist motoneurones is impaired--sometimes abolished--by antagonist stretch, a phenomenon defined here as stretch-sensitive paresis. In addition, spastic co-contraction increases effort perception, an additional incentive to evaluate and treat this phenomenon.

Rupture of the anterior tibial tendon: three clinical cases, anatomical study, and literature review.

PubMed

Anagnostakos, Konstantinos; Bachelier, Felix; Fürst, Oliver Alexander; Kelm, Jens

2006-05-01

We report three cases of anterior tibial tendon ruptures and the results of an anatomical study in regard to the tendon's insertion site and a literature review. Three patients were referred to our hospital with anterior tibial tendon ruptures. In the anatomical study, 53 feet were dissected, looking in particular for variants of the bony insertion of the tendon. Two patients had surgical treatment (one primary repair and one semimembranosus tendon graft) and one conservative treatment. After a mean followup of 14 weeks all patients had satisfactory outcomes. In the anatomical study, we noted three different insertion sites: in 36 feet the tendon inserted into the medial side of the cuneiform and the base of the first metatarsal bone and in 13 feet only into the medial side of the cuneiform bone. In the remaining four feet the tendon inserted into the cuneiform and the first metatarsal bone, but an additional tendon was noted taking its origin from the anterior tibial tendon near its insertion into the medial cuneiform and attaching to the proximal part of the first metatarsal. According to literature, surgical repair is the treatment of choice for acute ruptures and for patients with high activity levels. For chronic ruptures and patients with low demands, conservative management may lead to an equally good outcome. Knowledge of the anatomy in this region may be helpful for diagnosis and for the interpretation of intraoperative findings and choosing the most appropriate surgical procedure.

Neuromuscular Characteristics of Individuals Displaying Excessive Medial Knee Displacement

PubMed Central

Padua, Darin A.; Bell, David R.; Clark, Micheal A.

2012-01-01

Context Knee-valgus motion is a potential risk factor for certain lower extremity injuries, including anterior cruciate ligament injury and patellofemoral pain. Identifying neuromuscular characteristics associated with knee-valgus motion, such as hip and lower leg muscle activation, may improve our ability to prevent lower extremity injuries. Objective We hypothesized that hip and lower leg muscle-activation amplitude would differ among individuals displaying knee valgus (medial knee displacement) during a double-legged squat compared with those who did not display knee valgus. We further suggested that the use of a heel lift would alter lower leg muscle activation and frontal-plane knee motion in those demonstrating medial knee displacement. Design Descriptive laboratory study. Setting Research laboratory. Patients or Other Participants A total of 37 healthy participants were assigned to the control (n = 19) or medial-knee-displacement (n = 18) group based on their double-legged squat performance. Main Outcome Measure(s) Muscle-activation amplitude for the gluteus maximus, gluteus medius, adductor magnus, medial and lateral gastrocnemius, and tibialis anterior was measured during 2 double-legged squat tasks. The first task consisted of performing a double-legged squat without a heel lift; the second consisted of performing a double-legged squat task with a 2-in (5.08-cm) lift under the heels. Results Muscle-activation amplitude for the hip adductor, gastrocnemius, and tibialis anterior was greater in those who displayed knee valgus than in those who did not (P < .05). Also, use of heel lifts resulted in decreased activation of the gluteus maximus, hip adductor, gastrocnemius, and tibialis anterior muscles (P < .05). Use of heel lifts also eliminated medially directed frontal-plane knee motion in those displaying medial knee displacement. Conclusions Medial knee displacement during squatting tasks appears to be associated with increased hip-adductor activation and increased coactivation of the gastrocnemius and tibialis anterior muscles. PMID:23068590

Functioning of peripheral Ia pathways in infants with typical development: responses in antagonist muscle pairs

PubMed Central

Ulrich, Beverly D.; Martin, Bernard

2015-01-01

In muscle responses of proprioceptive origin, including the stretch/tendon reflex (T-reflex), the corresponding reciprocal excitation and irradiation to distant muscles have been described from newborn infants to older adults. However, the functioning of other responses mediated primarily by Ia-afferents has not been investigated in infants. Understanding the typical development of these multiple pathways is critical to determining potential problems in their development in populations affected by neurological disease, such as spina bifida or cerebral palsy. Hence, the goal of the present study was to quantify the excitability of Ia-mediated responses in lower limb muscles of infants with typical development. These responses were elicited by mechanical stimulation applied to the distal tendons of the gastrocnemius-soleus (GS), tibialis anterior (TA) and quadriceps (QAD) muscles of both legs in twelve 2- to 10-month-old infants and recorded simultaneously in antagonist muscle pairs by surface EMG. Tendon taps alone elicited responses in either, both or neither muscle. The homonymous response (T-reflex) was less frequent in the TA than the GS or QAD muscle. An 80 Hz vibration superimposed on tendon taps induced primarily an inhibition of monosynaptic responses; however, facilitation also occurred in either muscle of the recorded pair. These responses were not influenced significantly by age or gender. Vibration alone produced a tonic reflex response in the vibrated muscle (TVR) and/or the antagonist muscle (AVR). However, for the TA muscle the TVR was more frequently elicited in older than younger infants. High variability was common to all responses. Overall, the random distribution and inconsistency of muscle responses suggests that the gain of Ia-mediated feedback is unstable. We propose that during infancy the central nervous system needs to learn to set stable feedback gain, or destination of proprioceptive assistance, based on their use during functional movements. This will tailor the neuromuscular connectivity to support adaptive motor behaviors. PMID:21140137

Augmentation of autologous hamstring graft during anterior cruciate ligament reconstruction using the bone chip technique.

PubMed

Nha, Kyung Wook; Shetty, Gautam M; Ahn, Jin Hwan; Lee, Yong Seuk; Chae, Dong Ju; Nam, Hyok Woo; Lee, Dae Hee

2010-01-01

The use of autologous quadrupled hamstring tendon graft is a well-known technique for anterior cruciate ligament reconstruction. In cases where the diameter of the graft is inadequate, the stability of graft fixation and subsequent bone to tendon healing may be compromised. We describe a new technique to augment the autologous double looped hamstring tendon graft during anterior cruciate ligament reconstruction using cancellous bone chips. This simple technique effectively enhances graft fixation and stability.

UCP2 muscle gene transfer modifies mitochondrial membrane potential.

PubMed

Marti, A; Larrarte, E; Novo, F J; Garcia, M; Martinez, J A

2001-01-01

The aim of this work was to evaluate the effect of uncoupling protein 2 (UCP2) muscle gene transfer on mitochondrial activity. Five week-old male Wistar rats received an intramuscular injection of plasmid pXU1 containing UCP2 cDNA in the right tibialis anterior muscles. Left tibialis anterior muscles were injected with vehicle as control. Ten days after DNA injection, tibialis anterior muscles were dissected and muscle mitochondria isolated and analyzed. There were two mitochondrial populations in the muscle after UCP2 gene transfer, one of low fluorescence and complexity and the other, showing high fluorescence and complexity. UCP2 gene transfer resulted in a 3.6 fold increase in muscle UCP2 protein levels compared to control muscles assessed by Western blotting. Furthermore, a significant reduction in mitochondria membrane potential assessed by spectrofluorometry and flow cytometry was observed. The mitochondria membrane potential reduction might account for a decrease in fluorescence of the low fluorescence mitochondrial subpopulation. It has been demonstrated that UCP2 muscle gene transfer in vivo is associated with a lower mitochondria membrane potential. Our results suggest the potential involvement of UCP2 in uncoupling respiration. International Journal of Obesity (2001) 25, 68-74

Computational model to investigate the relative contributions of different neuromuscular properties of tibialis anterior on force generated during ankle dorsiflexion.

PubMed

Siddiqi, Ariba; Poosapadi Arjunan, Sridhar; Kumar, Dinesh Kant

2018-01-16

This study describes a new model of the force generated by tibialis anterior muscle with three new features: single-fiber action potential, twitch force, and pennation angle. This model was used to investigate the relative effects and interaction of ten age-associated neuromuscular parameters. Regression analysis (significance level of 0.05) between the neuromuscular properties and corresponding simulated force produced at the footplate was performed. Standardized slope coefficients were computed to rank the effect of the parameters. The results show that reduction in the average firing rate is the reason for the sharp decline in the force and other factors, such as number of muscle fibers, specific force, pennation angle, and innervation ratio. The fast fiber ratio affects the simulated force through two significant interactions. This study has ranked the individual contributions of the neuromuscular factors to muscle strength decline of the TA and identified firing rate decline as the biggest cause followed by decrease in muscle fiber number and specific force. The strategy for strength preservation for the elderly should focus on improving firing rate. Graphical abstract Neuromuscular properties of Tibialis Anterior on force generated during ankle dorsiflexion.

Effects of balance training by knee joint motions on muscle activity in adult men with functional ankle instability.

PubMed

Nam, Seung-Min; Kim, Won-Bok; Yun, Chang-Kyo

2016-05-01

[Purpose] This study examined the effects of balance training by applying knee joint movements on muscle activity in male adults with functional ankle instability. [Subjects and Methods] 28 adults with functional ankle instability, divided randomly into an experimental group, which performed balance training by applying knee joint movements for 20 minutes and ankle joint exercises for 10 minutes, and a control group, which performed ankle joint exercise for 30 minutes. Exercises were completed three times a week for 8 weeks. Electromyographic values of the tibialis anterior, peroneus longus, peroneus brevis, and the lateral gastrocnemius muscles were obtained to compare and analyze muscle activity before and after the experiments in each group. [Results] The experimental group had significant increases in muscle activity in the tibialis anterior, peroneus longus, and lateral gastrocnemius muscles, while muscle activity in the peroneus brevis increased without significance. The control group had significant increases in muscle activity in the tibialis anterior and peroneus longus, while muscle activity in the peroneus brevis and lateral gastrocnemius muscles increased without significance. [Conclusion] In conclusion, balance training by applying knee joint movements can be recommended as a treatment method for patients with functional ankle instability.

Do Australian Football players have sensitive groins? Players with current groin pain exhibit mechanical hyperalgesia of the adductor tendon.

PubMed

Drew, Michael K; Lovell, Gregory; Palsson, Thorvaldur S; Chiarelli, Pauline E; Osmotherly, Peter G

2016-10-01

This is the first study to evaluate the mechanical sensitivity, clinical classifications and prevalence of groin pain in Australian football players. Case-control. Professional (n=66) and semi-professional (n=9) Australian football players with and without current or previous groin injuries were recruited. Diagnoses were mapped to the Doha Agreement taxonomy. Point and career prevalence of groin pain was calculated. Pressure pain thresholds (PPTs) were assessed at regional and distant sites using handheld pressure algometry across four sites bilaterally (adductor longus tendon, pubic bone, rectus femoris, tibialis anterior muscle). To assess the relationship between current groin pain and fixed effects of hyperalgesia of each site and a history of groin pain, a mixed-effect logistic regression model was utilised. Receiver Operator Characteristic (ROC) curve were determined for the model. Point prevalence of groin pain in the preseason was 21.9% with a career prevalence of 44.8%. Adductor-related groin pain was the most prevalent classification in the pre-season period. Hyperalgesia was observed in the adductor longus tendon site in athletes with current groin pain (OR=16.27, 95% CI 1.86 to 142.02). The ROC area under the curve of the regression model was fair (AUC=0.76, 95% CI 0.54 to 0.83). Prevalence data indicates that groin pain is a larger issue than published incidence rates imply. Adductor-related groin pain is the most common diagnosis in pre-season in this population. This study has shown that hyperalgesia exists in Australian football players experiencing groin pain indicating the value of assessing mechanical pain sensitivity as a component of the clinical assessment. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Sensitivity of subject-specific models to Hill muscle-tendon model parameters in simulations of gait.

PubMed

Carbone, V; van der Krogt, M M; Koopman, H F J M; Verdonschot, N

2016-06-14

Subject-specific musculoskeletal (MS) models of the lower extremity are essential for applications such as predicting the effects of orthopedic surgery. We performed an extensive sensitivity analysis to assess the effects of potential errors in Hill muscle-tendon (MT) model parameters for each of the 56 MT parts contained in a state-of-the-art MS model. We used two metrics, namely a Local Sensitivity Index (LSI) and an Overall Sensitivity Index (OSI), to distinguish the effect of the perturbation on the predicted force produced by the perturbed MT parts and by all the remaining MT parts, respectively, during a simulated gait cycle. Results indicated that sensitivity of the model depended on the specific role of each MT part during gait, and not merely on its size and length. Tendon slack length was the most sensitive parameter, followed by maximal isometric muscle force and optimal muscle fiber length, while nominal pennation angle showed very low sensitivity. The highest sensitivity values were found for the MT parts that act as prime movers of gait (Soleus: average OSI=5.27%, Rectus Femoris: average OSI=4.47%, Gastrocnemius: average OSI=3.77%, Vastus Lateralis: average OSI=1.36%, Biceps Femoris Caput Longum: average OSI=1.06%) and hip stabilizers (Gluteus Medius: average OSI=3.10%, Obturator Internus: average OSI=1.96%, Gluteus Minimus: average OSI=1.40%, Piriformis: average OSI=0.98%), followed by the Peroneal muscles (average OSI=2.20%) and Tibialis Anterior (average OSI=1.78%) some of which were not included in previous sensitivity studies. Finally, the proposed priority list provides quantitative information to indicate which MT parts and which MT parameters should be estimated most accurately to create detailed and reliable subject-specific MS models. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Achilles Tendon Insertion is Crescent-shaped: An In Vitro Anatomic Investigation

PubMed Central

Arentz, Sabine; Nauck, Tanja; Dorn-Lange, Nadja V.; Konerding, Moritz A.

2008-01-01

Anatomic and operative textbooks and current literature do not clearly describe the Achilles tendon interface to the calcaneal tuberosity. We dissected 51 specimens to identify the detailed anatomy of the Achilles tendon insertion. Achilles tendon fascicles expanded from the anterior aspect of the distal Achilles tendon over the retrocalcaneal bursa to the anterior part of the Haglund’s tuberosity in nearly half of the specimens. The insertion of the transverse section of the Achilles tendon regularly had a crescent-shape corresponding to the posterior calcaneal prominence. In transverse sections, all specimens had a curved appearance with a radius of curvature ranging from 13.8 mm to 43.6 mm (mean, 20.4 mm) and Achilles tendon extensions to the lateral and medial calcaneal surfaces reached 1.0 mm (mean) and 3.5 mm (mean) anterior in relation to the most posterior point of the calcaneal tuberosity. Knowledge of the arcuate configuration and of the medial and lateral extensions of the plantaris and the Achilles tendon insertion with respect to the transverse plane is important to avoid iatrogenic complications during resection of Haglund’s tuberosity. PMID:18506561

Action of vanillin (Vanilla planifolia) on the morphology of tibialis anterior and soleus muscles after nerve injury.

PubMed

Peretti, Ana Luiza; Antunes, Juliana Sobral; Lovison, Keli; Kunz, Regina Inês; Castor, Lidyane Regina Gomes; Brancalhão, Rose Meire Costa; Bertolini, Gladson Ricardo Flor; Ribeiro, Lucinéia de Fátima Chasko

2017-01-01

To evaluate the action of vanillin (Vanilla planifolia) on the morphology of tibialis anterior and soleus muscles after peripheral nerve injury. Wistar rats were divided into four groups, with seven animals each: Control Group, Vanillin Group, Injury Group, and Injury + Vanillin Group. The Injury Group and the Injury + Vanillin Group animals were submitted to nerve injury by compression of the sciatic nerve; the Vanillin Group and Injury + Vanillin Group, were treated daily with oral doses of vanillin (150mg/kg) from the 3rd to the 21st day after induction of nerve injury. At the end of the experiment, the tibialis anterior and soleus muscles were dissected and processed for light microscopy and submitted to morphological analysis. The nerve compression promoted morphological changes, typical of denervation, and the treatment with vanillin was responsible for different responses in the studied muscles. For the tibialis anterior, there was an increase in the number of satellite cells, central nuclei and fiber atrophy, as well as fascicular disorganization. In the soleus, only increased vascularization was observed, with no exacerbation of the morphological alterations in the fibers. The treatment with vanillin promoted increase in intramuscular vascularization for the muscles studied, with pro-inflammatory potential for tibialis anterior, but not for soleus muscle. Avaliar a ação da vanilina (Vanilla planifolia) sobre a morfologia dos músculos tibial anterior e sóleo após lesão nervosa periférica. Ratos Wistar foram divididos em quatro grupos, com sete animais cada, sendo Grupo Controle, Grupo Vanilina, Grupo Lesão e Grupo Lesão + Vanilina. Os animais dos Grupos Lesão e Grupo Lesão + Vanilina foram submetidos à lesão nervosa por meio da compressão do nervo isquiático, e os Grupos Vanilina e Grupo Lesão + Vanilina foram tratados diariamente com doses orais de vanilina (150mg/kg) do 3o ao 21o dia após a indução da lesão nervosa. Ao término do experimento, os músculos tibial anterior e sóleo foram dissecados e seguiram o processamento de rotina em microscopia de luz, para posterior análise morfológica. A compressão nervosa promoveu alterações morfológicas características de denervação, sendo que o tratamento com vanilina foi responsável por respostas distintas nos músculos estudados. Para o tibial anterior, houve aumento do número de células satélites, núcleos centrais e atrofia das fibras, bem como desorganização fascicular. Já no sóleo, houve apenas aumento da vascularização, sem exacerbação das alterações morfológicas nas fibras. O tratamento com vanilina promoveu o aumento da vascularização intramuscular para os músculos estudados, com potencial pró-inflamatório para o tibial anterior, o que não ocorreu no músculo sóleo.

Posterior Displacement of Supraspinatus Central Tendon Observed on Magnetic Resonance Imaging: A Useful Preoperative Indicator of Rotator Cuff Tear Characteristics.

PubMed

Updegrove, Gary F; Armstrong, April D; Mosher, Timothy J; Kim, H Mike

2015-11-01

To characterize the orientation of the normal supraspinatus central tendon and describe the displacement patterns of the central tendon in rotator cuff tears using a magnetic resonance imaging (MRI)-based method. We performed a retrospective MRI and chart review of 183 patients with a rotator cuff tear (cuff tear group), 52 with a labral tear but no rotator cuff tear (labral tear group), and 74 with a normal shoulder (normal group). The orientation of the supraspinatus central tendon relative to the bicipital groove was evaluated based on axial MRI and was numerically represented by the shortest distance from the lateral extension line of the central tendon to the bicipital groove. Tear size, fatty degeneration, and involvement of the anterior supraspinatus were evaluated to identify the factors associated with orientation changes. The mean distance from the bicipital groove to the central tendon line was 0.7 mm and 1.3 mm in the normal group and labral tear group, respectively. Full-thickness cuff tears involving the anterior supraspinatus showed a significantly greater distance (17.7 mm) than those sparing the anterior supraspinatus (4.9 mm, P = .001). Fatty degeneration of the supraspinatus was significantly correlated with the distance (P = .006). Disruption of the anterior supraspinatus and fatty degeneration of the supraspinatus were independent predictors of posterior displacement. The supraspinatus central tendon has a constant orientation toward the bicipital groove in normal shoulders, and the central tendon is frequently displaced posteriorly in full-thickness rotator cuff tears involving the anterior leading edge of the supraspinatus. The degree of posterior displacement is proportional to tear size and severity of fatty degeneration of the supraspinatus muscle. A simple and quick assessment of the central tendon orientation on preoperative MRI can be a useful indicator of tear characteristics, potentially providing insight into the intraoperative repair strategy. Level IV, diagnostic case-control study. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Limb girdle muscular dystrophy type 2G with myopathic-neurogenic motor unit potentials and a novel muscle image pattern.

PubMed

Cotta, Ana; Paim, Julia Filardi; da-Cunha-Junior, Antonio Lopes; Neto, Rafael Xavier; Nunes, Simone Vilela; Navarro, Monica Magalhaes; Valicek, Jaquelin; Carvalho, Elmano; Yamamoto, Lydia U; Almeida, Camila F; Braz, Shelida Vasconcelos; Takata, Reinaldo Issao; Vainzof, Mariz

2014-01-01

Limb girdle muscular dystrophy type 2G (LGMD2G) is a subtype of autosomal recessive muscular dystrophy caused by mutations in the telethonin gene. There are few LGMD2G patients worldwide reported, and this is the first description associated with early tibialis anterior sparing on muscle image and myopathic-neurogenic motor unit potentials. Here we report a 31 years old caucasian male patient with progressive gait disturbance, and severe lower limb proximal weakness since the age of 20 years, associated with subtle facial muscle weakness. Computed tomography demonstrated soleus, medial gastrocnemius, and diffuse thigh muscles involvement with tibialis anterior sparing. Electromyography disclosed both neurogenic and myopathic motor unit potentials. Muscle biopsy demonstrated large groups of atrophic and hypertrophic fibers, frequent fibers with intracytoplasmic rimmed vacuoles full of autophagic membrane and sarcoplasmic debris, and a total deficiency of telethonin. Molecular investigation identified the common homozygous c.157C > T in the TCAP gene. This report expands the phenotypic variability of telethoninopathy/ LGMD2G, including: 1) mixed neurogenic and myopathic motor unit potentials, 2) facial weakness, and 3) tibialis anterior sparing. Appropriate diagnosis in these cases is important for genetic counseling and prognosis.

Different corticospinal control between discrete and rhythmic movement of the ankle.

PubMed

Goto, Yumeno; Jono, Yasutomo; Hatanaka, Ryota; Nomura, Yoshifumi; Tani, Keisuke; Chujo, Yuta; Hiraoka, Koichi

2014-01-01

We investigated differences in corticospinal and spinal control between discrete and rhythmic ankle movements. Motor evoked potentials (MEPs) in the tibialis anterior and soleus muscles and soleus H-reflex were elicited in the middle of the plantar flexion phase during discrete ankle movement or in the initial or later cycles of rhythmic ankle movement. The H-reflex was evoked at an intensity eliciting a small M-wave and MEPs were elicited at an intensity of 1.2 times the motor threshold of the soleus MEPs. Only trials in which background EMG level, ankle angle, and ankle velocity were similar among the movement conditions were included for data analysis. In addition, only trials with a similar M-wave were included for data analysis in the experiment evoking H-reflexes. Results showed that H reflex and MEP amplitudes in the soleus muscle during discrete movement were not significantly different from those during rhythmic movement. MEP amplitude in the tibialis anterior muscle during the later cycles of rhythmic movement was significantly larger than that during the initial cycle of the rhythmic movement or during discrete movement. Higher corticospinal excitability in the tibialis anterior muscle during the later cycles of rhythmic movement may reflect changes in corticospinal control from the initial cycle to the later cycles of rhythmic movement.

Different corticospinal control between discrete and rhythmic movement of the ankle

PubMed Central

Goto, Yumeno; Jono, Yasutomo; Hatanaka, Ryota; Nomura, Yoshifumi; Tani, Keisuke; Chujo, Yuta; Hiraoka, Koichi

2014-01-01

We investigated differences in corticospinal and spinal control between discrete and rhythmic ankle movements. Motor evoked potentials (MEPs) in the tibialis anterior and soleus muscles and soleus H-reflex were elicited in the middle of the plantar flexion phase during discrete ankle movement or in the initial or later cycles of rhythmic ankle movement. The H-reflex was evoked at an intensity eliciting a small M-wave and MEPs were elicited at an intensity of 1.2 times the motor threshold of the soleus MEPs. Only trials in which background EMG level, ankle angle, and ankle velocity were similar among the movement conditions were included for data analysis. In addition, only trials with a similar M-wave were included for data analysis in the experiment evoking H-reflexes. Results showed that H reflex and MEP amplitudes in the soleus muscle during discrete movement were not significantly different from those during rhythmic movement. MEP amplitude in the tibialis anterior muscle during the later cycles of rhythmic movement was significantly larger than that during the initial cycle of the rhythmic movement or during discrete movement. Higher corticospinal excitability in the tibialis anterior muscle during the later cycles of rhythmic movement may reflect changes in corticospinal control from the initial cycle to the later cycles of rhythmic movement. PMID:25126066

The effects of a multisensory dynamic balance training on the thickness of lower limb muscles in ultrasonography in children with spastic diplegic cerebral palsy.

PubMed

Nam, Seung-Min; Kim, Won-Hyo; Yun, Chang-Kyo

2017-04-01

[Purpose] This study aimed to investigate the effects of multisensory dynamic balance training on muscles thickness such as rectus femoris, anterior tibialis, medial gastrocnemius, lateral gastrocnemius in children with spastic diplegic cerebral palsy by using ultrasonography. [Subjects and Methods] Fifteen children diagnosed with spastic diplegic cerebral palsy were divided randomly into the balance training group and control group. The experimental group only received a multisensory dynamic balance training, while the control group performed general physiotherapy focused balance and muscle strengthening exercise based Neurodevelopmental treatment. Both groups had a therapy session for 30 minutes per day, three times a week for six weeks. The ultrasonographic muscle thickness were obtained in order to compare and analyze muscle thickness before and after in each group. [Result] The experimental group had significant increases in muscle thickness in the rectus femoris, tibialis anterior, medial gastrocnemius and lateral gastrocnemius muscles. The control group had significant increases in muscle thickness in the tibialis anterior. The test results of the rectus femoris, medial gastrocnemius and lateral gastrocnemius muscle thickness values between the groups showed significant differences. [Conclusion] In conclusion, a multisensory dynamic balance training can be recommended as a treatment method for patients with spastic diplegic cerebral palsy.

Effect of altering starting length and activation timing of muscle on fiber strain and muscle damage.

PubMed

Butterfield, Timothy A; Herzog, Walter

2006-05-01

Muscle strain injuries are some of the most frequent injuries in sports and command a great deal of attention in an effort to understand their etiology. These injuries may be the culmination of a series of subcellular events accumulated through repetitive lengthening (eccentric) contractions during exercise, and they may be influenced by a variety of variables including fiber strain magnitude, peak joint torque, and starting muscle length. To assess the influence of these variables on muscle injury magnitude in vivo, we measured fiber dynamics and joint torque production during repeated stretch-shortening cycles in the rabbit tibialis anterior muscle, at short and long muscle lengths, while varying the timing of activation before muscle stretch. We found that a muscle subjected to repeated stretch-shortening cycles of constant muscle-tendon unit excursion exhibits significantly different joint torque and fiber strains when the timing of activation or starting muscle length is changed. In particular, measures of fiber strain and muscle injury were significantly increased by altering activation timing and increasing the starting length of the muscle. However, we observed differential effects on peak joint torque during the cyclic stretch-shortening exercise, as increasing the starting length of the muscle did not increase torque production. We conclude that altering activation timing and muscle length before stretch may influence muscle injury by significantly increasing fiber strain magnitude and that fiber dynamics is a more important variable than muscle-tendon unit dynamics and torque production in influencing the magnitude of muscle injury.

The Effect of Velocity of Joint Mobilization on Corticospinal Excitability in Individuals With a History of Ankle Sprain.

PubMed

Fisher, Beth E; Piraino, Andrew; Lee, Ya-Yun; Smith, Jo Armour; Johnson, Sean; Davenport, Todd E; Kulig, Kornelia

2016-07-01

Study Design Controlled laboratory study. Background Joint mobilization and manipulation decrease pain and improve patient function. Yet, the processes underlying these changes are not well understood. Measures of corticospinal excitability provide insight into potential mechanisms mediated by the central nervous system. Objectives To investigate the differential effects of joint mobilization and manipulation at the talocrural joint on corticospinal excitability in individuals with resolved symptoms following ankle sprain. Methods Twenty-seven participants with a history of ankle sprain were randomly assigned to the control, joint mobilization, or thrust manipulation group. The motor-evoked potential (MEP) and cortical silent period (CSP) of the tibialis anterior and gastrocnemius were obtained with transcranial magnetic stimulation at rest and during active contraction of the tibialis anterior. The slopes of MEP/CSP input/output curves and the maximal MEP/CSP values were calculated to indicate corticospinal excitability. Behavioral measures, including ankle dorsiflexion and dynamic balance, were evaluated. Results A repeated-measures analysis of variance of the MEP slope showed a significant group-by-time interaction for the tibialis anterior at rest (P = .002) and during active contraction (P = .042). After intervention, the thrust manipulation group had an increase in corticospinal excitability, while the corticospinal excitability decreased in the mobilization group. The thrust manipulation group, but not other groups, also demonstrated a significant increase in the maximal MEP amplitude of the tibialis anterior after intervention. Conclusion The findings suggest that joint manipulation and mobilization have different effects on corticospinal excitability. The increased corticospinal excitability following thrust manipulation may provide a window for physical therapists to optimize muscle recruitment and subsequently movement. The trial was registered at ClinicalTrials.gov (NCT00847769). J Orthop Sports Phys Ther 2016;46(7):562-570. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6602.

Relative strengths of the calf muscles based on MRI volume measurements.

PubMed

Jeng, Clifford L; Thawait, Gaurav K; Kwon, John Y; Machado, Antonio; Boyle, James W; Campbell, John; Carrino, John A

2012-05-01

In 1985, Silver et al. published a cadaver study which determined the relative order of strength of the muscles in the calf. Muscle strength, which is proportional to volume, was obtained by dissecting out the individual muscles, weighing them, and then multiplying by the specific gravity. No similar studies have been performed using {\\it in vivo} measurements of muscle volume. Ten normal subjects underwent 3-Tesla MRI's of both lower extremities using non-fat-saturated T2 SPACE sequences. The volume for each muscle was determined by tracing the muscle contour on sequential axial images and then interpolating the volume using imaging software. The results from this study differ from Silver's original article. The lateral head of the gastrocnemius was found to be stronger than the tibialis anterior muscle. The FHL and EDL muscles were both stronger than the peroneus longus. There was no significant difference in strength between the peroneus longus and brevis muscles. This revised order of muscle strengths in the calf based on in vivo MRI findings may assist surgeons in determining the optimal tendons to transfer in order to address muscle weakness and deformity.

Postural adjustments associated with voluntary contraction of leg muscles in standing man.

PubMed

Nardone, A; Schieppati, M

1988-01-01

The postural adjustments associated with a voluntary contraction of the postural muscles themselves have been studied in the legs of normal standing men. We focussed on the following questions. Do postural adjustments precede the focal movement as in the case of movements of the upper limb? Which muscle(s) are involved in the task of stabilizing posture? Can the same postural muscle be activated in postural stabilization and in voluntary movement at the same time, in spite of the opposite changes in activity possibly required by these conditions? Six subjects standing on a dynamometric platform were asked to rise onto the tips their toes by contracting their soleus muscles, or to rock on their heels by contracting their tibialis anterior muscles. The tasks were made in a reaction time (RT) situation or in a self-paced mode, standing either freely or holding onto a stable structure. Surface EMGs of leg and thigh muscles, and the foot-floor reaction forces were recorded. The following results were obtained in the RT mode, standing freely. 1. Rising onto toe tips: a striking silent period in soleus preceded its voluntary activation; during this silent period, a tibialis anterior burst could be observed in three subjects; these anticipatory activities induced a forward sway, as monitored by a change in the force exerted along the x axis of the platform. 2. Rocking on heels: an enhancement in tonic EMG of soleus was observed before tibialis anterior voluntary burst, at a mean latency from the go-signal similar to that of the silent period; this anticipatory activity induced a backward body sway. 3. Choice RT conditions showed that the above anticipatory patterns in muscle activity were pre-programmed, specific for the intended tasks, and closely associated with the focal movement. When both tasks were performed in a self-paced mode, all the above EMG and mechanical features were more pronounced and unfolded in time. If the subjects held onto the frame, the early features in the soleus or tibialis anterior EMG were absent, and the corresponding changes in the foot-floor reaction forces were lacking. The anticipatory phenomena observed are considered postural adjustments because they appear only in the free-standing situation, and induce a body sway in the appropriate direction to counteract the destabilizing thrust due to the voluntary contraction of soleus or tibialis anterior. The central organization and descending control of posture and movements are briefly discussed in the light of the short latency of the anticipatory phenomena and of their close association with the focal movement.

Partial supraspinatus tears are associated with tendon lengthening.

PubMed

Farshad-Amacker, Nadja A; Buck, Florian M; Farshad, Mazda; Pfirrmann, Christian W A; Gerber, Christian

2015-02-01

Tendon tear may result in muscular retraction with the loss of contractile amplitude and strength of the rotator cuff muscles. Currently, neither a validated method of measuring supraspinatus tendon length nor normal values are known. It was therefore the purpose of this study to measure the normal length of the supraspinatus tendon and to determine whether partial tears are associated with changes in tendon length. MR examinations of 49 asymptomatic volunteers and 37 patients with arthroscopically proven, isolated partial tears of the supraspinatus tendon were compared. The ratio of the extramuscular tendon length to the distance between the footprint and the glenoid surface was calculated (TL/FG ratio). Tendon length measurements were taken by two independent readers at the bursal and articular surfaces at the anterior, the central and the posterior parts of the tendon. TL/FG ratios at the bursal surface of tendons with partial tears were significantly higher than those in the control group [anterior: 0.78 ± 0.20 vs. 0.66 ± 0.15 (p < 0.05); central: 0.61 ± 0.13 vs. 0.52 ± 0.10 (p < 0.05); posterior: 0.57 ± 0.15 vs. 0.52 ± 0.10 (p < 0.05)]. At the articular surface, differences were significant only anteriorly [0.60 ± 0.13, vs. 0.54 ± 0.10 (p < 0.05)]. A cut-off TL/FG ratio of 0.63 for measurements at the bursal surface in the center of the tendon achieved a sensitivity of 46 % and a specificity of 92 % for the identification of partial cuff tearing. A reproducible method for measurement of extramuscular supraspinatus tendon length is described. Partial tearing of the supraspinatus tendon is associated with significant tendon lengthening, suggesting failure in continuity, and this is most reliably measured on the bursal surface. III.

Cosmos 2044

NASA Technical Reports Server (NTRS)

Lowry, Oliver H.; Krasnov, Igor; Kakueva, E. Ilyina; Nemeth, Patti M.; Mcdougal, David B., Jr.; Choksi, Rati; Carter, Joyce G.; Chi, Maggie M. Y.; Manchester, Jill K.; Pusateri, Mary Ellen

1990-01-01

The effects of microgravity and hind limb suspension on the enzyme patterns are assessed within a slow twitch muscle (soleus) and a fast twitch muscle (tibialis anterior). Studies were made on 95 soleus fibers and about 300 tibialis anterior (TA) fibers. Over 2200 individual enzyme measurements were made. Six key metabolic enzymes (hexokinase, pyruvate kinease, citrate kinase, beta-hydroxyacyl CoA dehydrogenase, glucose-6-P dehydrogenase, and aspartate aminotransferase) plus glutaminase and glutamate decarboxylase, as well as glutamate, aspartate, and GABA, were measured in 11 regions of the hippocampal formation of synchronous, flight, and tail suspension rats. Major differences were observed in the normal distribution of each enzyme and amine acid, but no substantive effects of either microgravity or tail suspension on these patterns were clearly demonstrated.

Does Additional Biceps Augmentation Improve Rotator Cuff Healing and Clinical Outcomes in Anterior L-Shaped Rotator Cuff Tears? Clinical Comparisons With Arthroscopic Partial Repair.

PubMed

Jeon, Yoon Sang; Lee, Juyeob; Kim, Rag Gyu; Ko, Young-Won; Shin, Sang-Jin

2017-11-01

The repair of anterior L-shaped tears is usually difficult because of the lack of anterior rotator cuff tendon to cover the footprint. The biceps tendon is usually exposed from the retracted anterolateral corner of the torn tendon and can be easily used to augment rotator cuff repair. Hypothesis/Purpose: This study compared the clinical outcomes of the biceps augmentation technique with those of partial tendon repair for the arthroscopic treatment of large anterior L-shaped rotator cuff tears to evaluate the role of additional biceps augmentation in tendon healing. We hypothesized that the biceps augmentation technique would lead to a lower rotator cuff tendon retear rate and provide satisfactory functional outcomes. Cohort study; Level of evidence, 3. This study included 64 patients with anterior L-shaped rotator cuff tears who underwent arthroscopic repair. Patients were divided into 2 groups: group A (31 patients) underwent repair of an anterior L-shaped tear combined with biceps augmentation, and group B (33 patients) had a partially repaired tendon whose footprint was exposed after repair without undue tension on the retracted tendon. Clinical evaluations were performed using the American Shoulder and Elbow Surgeons (ASES) score, Constant score, muscle strength, visual analog scale for pain, and patient satisfaction. Magnetic resonance imaging (MRI) was performed for tendon integrity at 6 months postoperatively. The mean period of follow-up was 29.1 ± 3.5 months (range, 24-40 months). The mean ASES and Constant scores significantly improved from 52.8 ± 10.6 and 43.2 ± 9.9 preoperatively to 88.2 ± 6.9 and 86.8 ± 6.2 at final follow-up in group A ( P < .001) and from 53.0 ± 11.8 and 44.3 ± 11.3 preoperatively to 87.4 ± 7.2 and 87.9 ± 7.3 at final follow-up in group B ( P < .001). Overall muscle strength (given as % of the other side's strength) significantly increased from preoperatively to final follow-up in group A (forward flexion [FF]: 62.0 ± 8.2 to 89.0 ± 8.6; external rotation [ER]: 57.5 ± 9.9 to 86.8 ± 9.3; internal rotation [IR]: 68.1 ± 10.8 to 88.1 ± 8.4; P < .001) and group B (FF: 59.9 ± 9.6 to 87.7 ± 9.0; ER: 58.6 ± 9.3 to 86.2 ± 7.5; IR: 70.0 ± 9.3 to 87.0 ± 8.4; P < .001). Twenty-one patients (67.7%) in group A and 20 patients (60.6%) in group B showed a healed rotator cuff tendon on postoperative MRI. The retear rate between the 2 groups showed no significant difference ( P = .552). Regarding clinical outcomes, both groups had no significant difference in the ASES score ( P = .901), Constant score ( P = .742), and muscle strength. There was no significant difference in the clinical outcomes and retear rate of anterior L-shaped tears between biceps augmentation and partial tendon repair. Additional biceps augmentation proved to have no enhancement in tendon healing. A precise method such as only partial tendon repair for reducing the footprint exposure without undue tension may be considered as one of the treatment options for large anterior L-shaped rotator cuff tears.

Aquarium Portal Technique for PASTA Lesion Repair.

PubMed

Meyer, Dominik C; Gerber, Christian; Familiari, Filippo

2017-10-01

The simultaneous arthroscopic exposure of the subacromial and intra-articular space of the shoulder is challenging in the presence of only partial-thickness rotator cuff tears. We present our experience and method of entering the joint through the opened rotator cuff interval from an anterosuperior portal between the coracoid process and anterior acromion. With moderate (approximately 30°) abduction and external rotation, the rotator interval opens readily, offering a view with the camera toward the anterior edge of the supraspinatus tendon. An anterior view on the anterior leading edge of the supraspinatus tendon is obtained, showing the subacromial space above and the glenohumeral space below the tendon, similar to the view in an aquarium. The rotator cuff can be elevated using a rod inserted intra-articularly from posterior, whereas anchors and other instruments may be inserted from lateral. This approach offers the advantages of full exposure of the posterior undersurface of the rotator cuff insertion; a convenient approximately 90° angle between the camera and instruments; and no need to change portals for anchor placement, tendon stitching, or suture handling. The objective of this Technical Note is to describe our arthroscopic repair approach (aquarium technique) to PASTA (partial articular supraspinatus tendon avulsion) lesions.

Motor evoked potentials and compound muscle action potentials as prognostic tools for neonates with spina bifida.

PubMed

Cuppen, Inge; Geerdink, Niels; Rotteveel, Jan J; Mullaart, Reinier; Roeleveld, Nel; Pasman, Jaco W

2013-03-01

MEPs and CMAPs as prognostic tools for spina bifida. The aim of this prospective study was to determine the prognostic value of neurophysiological investigations compared to clinical neurological examination in infants with spina bifida. Thirty-six neonates born with spina bifida between 2002 and 2007 were evaluated and followed for 2 years. Lumbar motor evoked potentials (MEPs) and compound muscle action potentials (CMAPs) were obtained at the median age of 2 days old before surgical closure of the spinal anomaly. MEPs were recorded from the quadriceps femoris, tibialis anterior, and gastrocnemius muscles and CMAPs from the latter two muscles. Areas under the curve and latencies of the MEPs and CMAPs were measured. Clinical neurological outcome at the age of 2 years was described using Muscle Function Classes (MFCs) and ambulation status. The areas under the curve of MEPs and CMAPs in the legs were associated with lower neonatal levels of motor and sensory impairment. Better muscle function class of the lower limbs at 2 years of age was associated with larger MEP and CMAP areas of the gastrocnemius and tibialis anterior muscles at neonatal age. MEPs and CMAPs of the gastrocnemius and tibialis anterior muscles are of prognostic value for clinical neurological outcome in neonates born with spina bifida. Copyright © 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Tissue oxygen partial pressure in the tibialis anterior muscle in patients with claudication before, during and after a two-stage treadmill stress test.

PubMed

Jung, F; Krüger, A; Pindur, G; Sternitzky, R; Franke, R P; Gori, T

2014-01-01

The role of the microcirculation in the pathophysiology and symptoms of peripheral arterial obliterative disease (PAOD) has been progressively emphasized during the past decades. Under resting conditions, already, the tissue oxygen partial pressure in the m. tibialis anterior (pO2im) is reduced to about 50% compared to healthy subjects. In the framework of this study the pO2im of patients with PAOD stage II according to Fontaine (n=16) in the m. tibialis anterior was measured under resting conditions and during walking on a treadmill in comparison to healthy subjects (n=10). Under resting conditions the pO2im only marginally differed between PAOD patients and healthy subjects. But during exercise the pO2im dropped significantly more severely in PAOD patients and a return to baseline values could only be reached when the treadmill was stopped and the patients stood still. The pO2im minima correlated clearly with the clinical symptom of calf pain. The data revealed that the pO2im values were lower in PAOD patients and dropped significantly faster during walking compared to the pO2im values in healthy subjects. The pO2im decrease correlated with the calf pain occurring when the pO2im values approached or fell below 10 mmHg.

Use of three-dimensional finite element models of the lateral ankle ligaments to evaluate three surgical techniques

PubMed Central

Wang, Cheng-Wei; Muheremu, Aikeremujiang; Bai, Jing-Ping

2017-01-01

Objective To compare three surgical techniques for lateral ankle ligament reconstruction using finite element (FE) models. Methods A three-dimensional FE model of the left foot of a healthy volunteer and lateral collateral ligament injury models were developed. Three tendons [one-half of the autologous peroneus longus tendon (PLT), one-half of the peroneus brevis tendon (PBT), and an allogeneic tendon] were used for lateral collateral ligament reconstruction. The ankle varus stress and anterior drawer tests were performed to compare the three surgical techniques. Results The ankle varus stress test showed that the equivalent stresses of the anterior talofibular ligament (ATFL) (84.00 MPa) and calcaneofibular ligament (CFL) (27.01 MPa) were lower in allogeneic tendon reconstruction than in the other two techniques but similar to those of normal individuals (138.48 and 25.90 MPa, respectively). The anterior drawer test showed that the equivalent stresses of the ATFL and CFL in autologous PLT reconstruction (31.31 and 28.60 MPa, respectively) and PBT reconstruction (31.47 and 29.07 MPa, respectively) were lower than those in allogeneic tendon reconstruction (57.32 and 52.20 MPa, respectively). Conclusions The allogeneic tendon reconstruction outcome was similar to normal individuals. Allogeneic tendon reconstruction may be superior for lateral ankle ligament reconstruction without considering its complications. PMID:29239256

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. Copyright © 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Hydroxyapatite-doped polycaprolactone nanofiber membrane improves tendon-bone interface healing for anterior cruciate ligament reconstruction.

PubMed

Han, Fei; Zhang, Peng; Sun, Yaying; Lin, Chao; Zhao, Peng; Chen, Jiwu

2015-01-01

Hamstring tendon autograft is a routine graft for anterior cruciate ligament (ACL) reconstruction. However, ways of improving the healing between the tendon and bone is often overlooked in clinical practice. This issue can be addressed by using a biomimetic scaffold. Herein, a biomimetic nanofiber membrane of polycaprolactone/nanohydroxyapatite/collagen (PCL/nHAp/Col) is fabricated that mimics the composition of native bone tissue for promoting tendon-bone healing. This membrane has good cytocompatibility, allowing for osteoblast cell adhesion and growth and bone formation. As a result, MC3T3 cells reveal a higher mineralization level in PCL/nHAp/Col membrane compared with PCL membrane alone. Further in vivo studies in ACL reconstruction in a rabbit model shows that PCL/nHAp/Col-wrapped tendon may afford superior tissue integration to nonwrapped tendon in the interface between the tendon and host bone as well as improved mechanical strength. This study shows that PCL/nHAp/Col nanofiber membrane wrapping of autologous tendon is effective for improving tendon healing with host bone in ACL reconstruction.

Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft.

PubMed

Shin, Sang-Jin; Campbell, Sean; Scott, Jonathan; McGarry, Michelle H; Lee, Thay Q

2014-09-01

The purpose of this study was to introduce a novel surgical technique for simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft and to compare its biomechanical characteristics to those of a coracoid cerclage reconstruction of the coracoclavicular ligaments. Six matched pairs of human acromioclavicular joints with an average age of 54.8 ± 7.8 years were used. One shoulder from each pair received the single tendon acromioclavicular-coracoclavicular reconstruction; the contralateral shoulder received the coracoid cerclage reconstruction. Bovine extensor tendon was used for both techniques. The single tendon acromioclavicular-coracoclavicular reconstruction technique provided anatomic restoration of the two coracoclavicular ligaments and the superior and inferior acromioclavicular ligaments simultaneously using one coracoid hole, one acromion hole, and two clavicular holes with interference screws. Anterior-posterior and superior-inferior translations were quantified for all specimens before and after reconstruction, followed by load to failure testing. Following coracoid cerclage reconstruction, total anterior-posterior translation was significantly greater than intact (10.0 ± 5.7 mm; p = 0.008). Following single tendon acromioclavicular-coracoclavicular reconstruction, there was no significant difference in anterior-posterior translation compared to intact (-1.6 ± 2.2 mm; n.s.). The coracoid cerclage technique demonstrated significantly greater anterior-posterior translation than the single tendon acromioclavicular-coracoclavicular technique (p = 0.007). Both techniques restored superior-inferior translation to the intact condition (n.s.). Ultimate load, deformation at ultimate load, and energy absorbed at ultimate load were significantly greater after acromioclavicular-coracoclavicular reconstruction than after coracoid cerclage reconstruction (p < 0.05). This novel single tendon anatomic acromioclavicular-coracoclavicular reconstruction provided greater stability and stronger load to failure characteristics than the isolated coracoid cerclage reconstruction. A simultaneous acromioclavicular-coracoclavicular reconstruction technique using a single free tendon graft provided anatomic reconstruction of the conoid, trapezoid, and superior and inferior acromioclavicular ligaments and may reduce postoperative subluxation.

Conservative treatment of tibialis posterior tendon dysfunction--a review.

PubMed

Bowring, Beverly; Chockalingam, Nachiappan

2010-03-01

Appropriate conservative treatment is considered essential to address symptoms associated with tibialis posterior tendon dysfunction (TPTD) and prevent its potential long-term disabling consequences. The main aim of this review, undertaken in 2007, was to evaluate the evidence from studies for the effects of conservative treatment modalities in the management of TPTD. This evidence could then be used as a basis for the development of a clinical guideline for the management of the condition. Studies were selected according to specific criteria and evaluated for methodological quality. As preliminary literature searches had identified no randomised controlled trials at the time of the review, studies of lower hierarchy were included. Five uncontrolled observational studies evaluating the outcomes of various orthotic treatments alone or in combination with other therapies were included in the review. Different study designs, methodological quality, population characteristics, interventions and outcome measures were found. Limited and poor quality evidence was found in this review regarding the conservative treatment of TPTD. Thus a cause-effect relationship between intervention and outcome could not be established nor an optimal conservative treatment regime for the condition. Further better quality research is warranted in this area to inform practice, particularly as there is no consensus in the literature regarding treatment of this condition. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Electromechanical delay of the knee flexor muscles is impaired after harvesting hamstring tendons for anterior cruciate ligament reconstruction.

PubMed

Ristanis, Stavros; Tsepis, Elias; Giotis, Dimitrios; Stergiou, Nicholas; Cerulli, Guiliano; Georgoulis, Anastasios D

2009-11-01

Changes in electromechanical delay during muscle activation are expected when there are substantial alterations in the structural properties of the musculotendinous tissue. In anterior cruciate ligament reconstruction, specific tendons are being harvested for grafts. Thus, there is an associated scar tissue development at the tendon that may affect the corresponding electromechanical delay. This study was conducted to investigate whether harvesting of semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction will affect the electromechanical delay of the knee flexors. Case-control study; Level of evidence, 3. The authors evaluated 12 patients with anterior cruciate ligament reconstruction with a semitendinosus and gracilis autograft, 2 years after the reconstruction, and 12 healthy controls. Each participant performed 4 maximally explosive isometric contractions with a 1-minute break between contractions. The surface electromyographic activity of the biceps femoris and the semitendinosus was recorded from both legs during the contractions. The statistical comparisons revealed significant increases of the electromechanical delay of the anterior cruciate ligament-reconstructed knee for both investigated muscles. Specifically, the electromechanical delay values were increased for both the biceps femoris (P = .029) and the semitendinosus (P = .005) of the reconstructed knee when compared with the intact knee. Comparing the anterior cruciate ligament-reconstructed knee against healthy controls revealed similar significant differences for both muscles (semitendinosus, P = .011; biceps femoris, P = .024). The results showed that harvesting the semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction significantly increased the electromechanical delay of the knee flexors. Increased hamstring electromechanical delay might impair knee safety and performance by modifying the transfer time of muscle tension to the tibia and therefore affecting muscle response during sudden movements in athletic activities. However, further investigation is required to identify whether the increased electromechanical delay of the hamstrings can actually influence optimal sports performance and increase the risk for knee injury in athletes with anterior cruciate ligament reconstructions.

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

PubMed

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

2011-01-01

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

Effect of diabetic neuropathy severity classified by a fuzzy model in muscle dynamics during gait

PubMed Central

2014-01-01

Background Electromyography (EMG) alterations during gait, supposedly caused by diabetic sensorimotor polyneuropathy, are subtle and still inconsistent, due to difficulties in defining homogeneous experimental groups with a clear definition of disease stages. Since evaluating these patients involve many uncertainties, the use of a fuzzy model could enable a better discrimination among different stages of diabetic polyneuropathy and lead to a clarification of when changes in muscle activation start occurring. The aim of this study was to investigate EMG patterns during gait in diabetic individuals with different stages of DSP severity, classified by a fuzzy system. Methods 147 subjects were divided into a control group (n = 30) and four diabetic groups: absent (n = 43), mild (n = 30), moderate (n = 16), and severe (n = 28) neuropathy, classified by a fuzzy model. The EMG activity of the vastus lateralis, tibialis anterior, and gastrocnemius medialis were measured during gait. Temporal and relative magnitude variables were compared among groups using ANOVA tests. Results Muscle activity changes are present even before an established neural involvement, with delay in vastus lateralis peak and lower tibialis anterior relative magnitude. These alterations suggest an impaired ankle shock absorption mechanism, with compensation at the knee. This condition seems to be more pronounced in higher degrees of neuropathy, as there is an increased vastus lateralis activity in the mild and severe neuropathy groups. Tibialis anterior onset at terminal stance was anticipated in all diabetic groups; at higher degrees of neuropathy, the gastrocnemius medialis exhibited activity reduction and peak delay. Conclusion EMG alterations in the vastus lateralis and tibialis anterior occur even in the absence of diabetic neuropathy and in mild neuropathic subjects, seemingly causing changes in the shock absorption mechanisms at the heel strike. These changes increase with the onset of neural impairments, and the gastrocnemius medialis starts presenting altered activity in the later stages of the disease (moderate and severe neuropathy). The degree of severity of diabetic neuropathy must be taken into account when analyzing diabetic patients’ biomechanical patterns of locomotion; we recommend the use of a fuzzy model for classification of disease stages. PMID:24507153

Full-thickness tears of the supraspinatus tendon: A three-dimensional finite element analysis.

PubMed

Quental, C; Folgado, J; Monteiro, J; Sarmento, M

2016-12-08

Knowledge regarding the likelihood of propagation of supraspinatus tears is important to allow an early identification of patients for whom a conservative treatment is more likely to fail, and consequently, to improve their clinical outcome. The aim of this study was to investigate the potential for propagation of posterior, central, and anterior full-thickness tears of different sizes using the finite element method. A three-dimensional finite element model of the supraspinatus tendon was generated from the Visible Human Project data. The mechanical behaviour of the tendon was fitted from experimental data using a transversely isotropic hyperelastic constitutive model. The full-thickness tears were simulated at the supraspinatus tendon insertion by decreasing the interface area. Tear sizes from 10% to 90%, in 10% increments, of the anteroposterior length of the supraspinatus footprint were considered in the posterior, central, and anterior regions of the tendon. For each tear, three finite element analyses were performed for a supraspinatus force of 100N, 200N, and 400N. Considering a correlation between tendon strain and the risk of tear propagation, the simulated tears were compared qualitatively and quantitatively by evaluating the volume of tendon for which a maximum strain criterion was not satisfied. The finite element analyses showed a significant impact of tear size and location not only on the magnitude, but also on the patterns of the maximum principal strains. The mechanical outcome of the anterior full-thickness tears was consistently, and significantly, more severe than that of the central or posterior full-thickness tears, which suggests that the anterior tears are at greater risk of propagating than the central or posterior tears. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Effect of Lateral Ankle Ligament Repair in Muscle Reaction Time in Patients with Mechanical Ankle Instability.

PubMed

Li, H-Y; Zheng, J-J; Zhang, J; Hua, Y-H; Chen, S-Y

2015-11-01

Studies have shown that functional ankle instability can result in prolonged muscle reaction time. However, the deficit in muscle reaction time in patients with mechanical ankle instability (MAI) and the effect of lateral ankle ligament repair on muscle reaction time are unclear. The purpose of this study was to identify the deficit in muscle reaction time, and to evaluate the role of lateral ligament repair in improving muscle reaction time in MAI patients. Sixteen MAI patients diagnosed with lateral ankle ligament tears by ultrasonography and magnetic resonance imaging underwent arthroscopic debridement and open lateral ankle ligament repair with a modified Broström procedure. One day before the operation, reaction times of the tibialis anterior and peroneus longus muscles were recorded following sudden inversion perturbation while walking on a custom walkway, and anterior drawer test (ADT) and American Orthopaedic Foot and Ankle Society (AOFAS) scale score were evaluated. Six months postoperatively, muscle reaction time, ADT and AOFAS scale score were reevaluated, and muscle reaction times in 15 healthy controls were also recorded. Preoperatively, the affected ankles in the MAI group had significantly delayed tibialis anterior and peroneus longus muscles reaction times compared with controls. Six months after the operation, median AOFAS scale scores were significantly greater than preoperatively, and ADT was negative in the MAI group. However, the affected ankles in the MAI group showed no difference in muscle reaction time compared with preoperative values. MAI patients had prolonged muscle reaction time. The modified Broström procedure produced satisfactory clinical outcomes in MAI patients, but did not shorten reaction times of the tibialis anterior and peroneus longus muscles. © Georg Thieme Verlag KG Stuttgart · New York.

On the relationship between lower extremity muscles activation and peak vertical and posterior ground reaction forces during single leg drop landing.

PubMed

Mahaki, M; Mi'mar, R; Mahaki, B

2015-10-01

Anterior cruciate ligament (ACL) injury continues to be an important medical issue for athletes participating in sports. Vertical and posterior ground reaction forces have received considerable attention for their potential influence on ACL injuries. The purpose of this study was to examine the relationship between electromyographic activity of lower extremity muscles and the peak vertical and posterior ground reaction forces during single leg drop landing. Thirteen physical education male students participated in this correlation study. Electromyographic activities of gluteus medius, biceps femoris, medial gastrocnemius, soleus as well as anterior tibialis muscles along with ground reaction forces were measured. Participants performed single-leg landing from a 0.3 m height on to a force platform. Landing was divided into two phases: 100 ms preceding ground contact and 100 ms proceeding ground contact. Pearson correlation test was used to determine the relationships between these muscles activity and peak vertical and posterior ground reaction forces. The results of the study indicated that the activity of soleus and tibialis anterior in pre-landing phase were positively correlated with peak vertical ground reaction force ([P≤0.04], [P≤0.008], respectively). However, no significant correlation was found between the activities of other muscles in pre-landing phase and peak vertical as well as peak posterior ground reaction forces. Also, no significant correlation was found between the activities of muscles in post-landing phase and peak vertical as well as peak posterior ground reaction forces. Soleus loading shifts the proximal tibia posterior at the knee joint and tibialis anterior prevent hyperporonation of the ankle, a mechanisms of ACL injury. Hence, neuromuscular training promoting preparatory muscle activity in these muscles may reduce the incidence of ACL injuries.

The Fiber Contractility and Cytoskeleton Losses in Space are Less Pronounced in Mongolian Gerbils

NASA Astrophysics Data System (ADS)

Lipets, E. N.; Ponomareva, E. V.; Ogneva, I. V.; Vikhliantsev, I. M.; Karaduleva, E. V.; Kartashkina, N. L.; Kuznetsov, S. L.; Podlubnaia, Z. A.; Shenkman, B. S.

2008-06-01

This work was purposed on the comparison of space flight effects on m. soleus and m. tibialis anterior of Mongolian gerbils. The animals have been flown onboard biosatellite Foton-M3 for 12 days. Contractile properties of single skinned muscle fibers were studied. It was revealed that diameter of m. soleus skinned fibers and maximal isometric tension were decreased by 19.7% and 21.8% respectively. The Ca-sensitivity reduction wasn't significant, that was in accordance with absence of changes of titin and nebulin relative content in soleus and minor manifestations in slow-to-fast fiber ratio (9%, p<0.05). There weren't observed significant changes of the same parameters in m. tibialis anterior. Ultimately the fiber contractility and cytoskeleton losses in space are less pronounced in Mongolian gerbils than in rats.

Acute effects of whole-body vibration on the motor function of patients with stroke: a randomized clinical trial.

PubMed

Silva, Adriana Teresa; Dias, Miqueline Pivoto Faria; Calixto, Ruanito; Carone, Antonio Luis; Martinez, Beatriz Bertolaccini; Silva, Andreia Maria; Honorato, Donizeti Cesar

2014-04-01

The aim of this study was to investigate the acute effects of whole-body vibration on the motor function of patients with stroke. The present investigation was a randomized clinical trial studying 43 individuals with hemiparesis after stroke, with 33 subjects allocated to the intervention group and 10 subjects allocated to the control group. The intervention group was subjected to one session of vibration therapy (frequency of 50 Hz and amplitude of 2 mm) comprising four 1-min series with 1-min rest intervals between series in three body positions: bipedal stances with the knees flexed to 30 degrees and 90 degrees and a unipedal stance on the paretic limb. The analytical tests were as follows: simultaneous electromyography of the affected and unaffected tibialis anterior and rectus femoris muscles bilaterally in voluntary isometric contraction; the Six-Minute Walk Test; the Stair-Climb Test; and the Timed Get-Up-and-Go Test. The data were analyzed by independent and paired t tests and by analysis of covariance. There was no evidence of effects on the group and time interaction relative to variables affected side rectus femoris, unaffected side rectus femoris, affected side tibialis anterior, unaffected side tibialis anterior, and the Stair-Climb Test (P > 0.05). There was evidence of effects on the group interaction relative to variables Six-Minute Walk Test and Timed Get-Up-and-Go Test (P < 0.05). Whole-body vibration contributed little to improve the functional levels of stroke patients.

Differences in Muscle Activity between Natural Forefoot and Rearfoot Strikers during Running

PubMed Central

Yong, Jennifer R.; Silder, Amy; Delp, Scott L.

2014-01-01

Running research has focused on reducing injuries by changing running technique. One proposed method is to change from rearfoot striking (RFS) to forefoot striking (FFS) because FFS is thought to be a more natural running pattern that may reduce loading and injury risk. Muscle activity affects loading and influences running patterns; however, the differences in muscle activity between natural FFS runners and natural RFS runners are unknown. The purpose of this study was to measure muscle activity in natural FFS runners and natural RFS runners. We tested the hypotheses that tibialis anterior activity would be significantly lower while activity of the plantarflexors would be significantly greater in FFS runners, compared to RFS runners, during late swing phase and early stance phase. Gait kinematics, ground reaction forces and electromyographic patterns of ten muscles were collected from twelve natural RFS runners and ten natural FFS runners. The root mean square (RMS) of each muscle’s activity was calculated during terminal swing phase and early stance phase. We found significantly lower RMS activity in the tibialis anterior in FFS runners during terminal swing phase, compared to RFS runners. In contrast, the medial and lateral gastrocnemius showed significantly greater RMS activity in terminal swing phase in FFS runners. No significant differences were found during early stance phase for the tibialis anterior or the plantarflexors. Recognizing the differences in muscle activity between FFS and RFS runners is an important step toward understanding how foot strike patterns may contribute to different types of injury. PMID:25458201

Compensatory strategies during walking in response to excessive muscle co-contraction at the ankle joint.

PubMed

Wang, Ruoli; Gutierrez-Farewik, Elena M

2014-03-01

Excessive co-contraction causes inefficient or abnormal movement in several neuromuscular pathologies. How synergistic muscles spanning the ankle, knee and hip adapt to co-contraction of ankle muscles is not well understood. This study aimed to identify the compensation strategies required to retain normal walking with excessive antagonistic ankle muscle co-contraction. Muscle-actuated simulations of normal walking were performed to quantify compensatory mechanisms of ankle and knee muscles during stance in the presence of normal, medium and high levels of co-contraction of antagonistic pairs gastrocnemius+tibialis anterior and soleus+tibialis anterior. The study showed that if co-contraction increases, the synergistic ankle muscles can compensate; with gastrocmemius+tibialis anterior co-contraction, the soleus will increase its contribution to ankle plantarflexion acceleration. At the knee, however, almost all muscles spanning the knee and hip are involved in compensation. We also found that ankle and knee muscles alone can provide sufficient compensation at the ankle joint, but hip muscles must be involved to generate sufficient knee moment. Our findings imply that subjects with a rather high level of dorsiflexor+plantarflexor co-contraction can still perform normal walking. This also suggests that capacity of other lower limb muscles to compensate is important to retain normal walking in co-contracted persons. The compensatory mechanisms can be useful in clinical interpretation of motion analyses, when secondary muscle co-contraction or other deficits may present simultaneously in subjects with motion disorders. Copyright © 2014 Elsevier B.V. All rights reserved.

Changes in tibialis anterior corticospinal properties after acute prolonged muscle vibration.

PubMed

Farabet, Adrien; Souron, Robin; Millet, Guillaume Y; Lapole, Thomas

2016-06-01

Prolonged local vibration is known to impair muscle performance. While involved mechanisms were previously evidenced at the spinal level, changes at the cortical level were also hypothesized. The aims of the present study were to investigate the effects of 30 min of 100-Hz tibialis anterior muscle vibration on force production capacities and to further identify the respective changes in spinal loop properties, descending voluntary drive and corticospinal properties. Thirteen subjects were tested before and after a vibration condition, and before and after a resting control condition. Maximal voluntary contraction (MVC) in dorsiflexion was measured. Transcranial magnetic stimulation was superimposed during MVCs to assess cortical voluntary activation (VATMS), motor-evoked potential amplitude (MEP) and cortical silent period length (CSP). MEP and CSP were also measured during 50 and 75 % MVC contractions. Spinal excitability was investigated by mean of H-reflex. There were no vibration effects on MVC (p = 0.805), maximal EMG activity (p = 0.653), VATMS (p = 1), and CSP (p = 0.877). Vibration tended to decrease MEP amplitude (p = 0.117). H-reflex amplitude was depressed following vibration (p = 0.008). Dorsiflexion maximal force production capacities were unaffected by 30 min of tibialis anterior muscle vibration, despite spinal loop and corticospinal excitabilities being reduced. These findings suggest that acute prolonged vibration has the potential to modulate corticospinal excitability of lower limb muscles without a concomitant functional consequence.

Age related neuromuscular changes in sEMG of m. Tibialis Anterior using higher order statistics (Gaussianity & linearity test).

PubMed

Siddiqi, Ariba; Arjunan, Sridhar P; Kumar, Dinesh K

2016-08-01

Age-associated changes in the surface electromyogram (sEMG) of Tibialis Anterior (TA) muscle can be attributable to neuromuscular alterations that precede strength loss. We have used our sEMG model of the Tibialis Anterior to interpret the age-related changes and compared with the experimental sEMG. Eighteen young (20-30 years) and 18 older (60-85 years) performed isometric dorsiflexion at 6 different percentage levels of maximum voluntary contractions (MVC), and their sEMG from the TA muscle was recorded. Six different age-related changes in the neuromuscular system were simulated using the sEMG model at the same MVCs as the experiment. The maximal power of the spectrum, Gaussianity and Linearity Test Statistics were computed from the simulated and experimental sEMG. A correlation analysis at α=0.05 was performed between the simulated and experimental age-related change in the sEMG features. The results show the loss in motor units was distinguished by the Gaussianity and Linearity test statistics; while the maximal power of the PSD distinguished between the muscular factors. The simulated condition of 40% loss of motor units with halved the number of fast fibers best correlated with the age-related change observed in the experimental sEMG higher order statistical features. The simulated aging condition found by this study corresponds with the moderate motor unit remodelling and negligible strength loss reported in literature for the cohorts aged 60-70 years.

Good results after Ponseti treatment for neglected congenital clubfoot in Ethiopia. A prospective study of 22 children (32 feet) from 2 to 10 years of age.

PubMed

Ayana, Birhanu; Klungsøyr, Peter J

2014-12-01

Neglected clubfoot deformity is a major cause of disability in low-income countries. Most children with clubfoot have little access to treatment in these countries, and they are often inadequately treated. We evaluated the effectiveness of Ponseti's technique in neglected clubfoot in children in a rural setting in Ethiopia. A prospective study was conducted from June 2007 through July 2010. 22 consecutive children aged 2-10 years (32 feet) with neglected clubfoot were treated by the Ponseti method. The deformity was assessed using the Pirani scoring system. The average follow-up time was 3 years. A plantigrade functional foot was obtained in all patients by Ponseti casting and limited surgical intervention. 2 patients (4 feet) had recurrent deformity. They required re-manipulation and re-tenotomy of the Achilles tendon and 1 other patient required tibialis anterior transfer for dynamic supination deformity of the foot. This study shows that the Ponseti method with some additional surgery can be used successfully as the primary treatment in neglected clubfoot, and that it minimizes the need for extensive corrective surgery.

Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle?

PubMed

Turmo-Garuz, A; Rodas, G; Balius, R; Til, L; Miguel-Perez, M; Pedret, C; Del Buono, A; Maffulli, N

2014-08-01

The purpose of the study is to explain the cause-effect relationship in three patients who reported combined ruptures of the Achilles tendon and the gastrosoleus complex 6 months after they had received corticosteroids injections for the management of retrocalcaneal bursitis. Three cryopreserved cadavers (three men, three left legs) were examined to assess the anatomic connection between the retrocalcaneal bursa and the Achilles tendon (distal and anterior fibers). Blue triptan medium contrast was injected. An unexpected connection between the retrocalcaneal bursa and the anterior fibers of the Achilles tendon was found in all instances. Local corticosteroid injection of the retrocalcaneal bursa may help the symptoms of retrocalcanear bursitis, but pose a risk of Achilles tendon rupture. This risk-benefit has to be taken into account when corticosteroid injections are prescribed to professional and high-level athletes.

Ultrasound-guided steroid tendon sheath injections in juvenile idiopathic arthritis: a 10-year single-center retrospective study.

PubMed

Peters, Shannon E; Laxer, Ronald M; Connolly, Bairbre L; Parra, Dimitri A

2017-04-11

The aims of this study were to: (a) Identify tendon sheaths most commonly treated with steroid injections in a pediatric patient population with Juvenile Idiopathic Arthritis (JIA); (b) Describe technical aspects of the procedure; (c) Characterize sonographic appearance of tenosynovitis in JIA; (d) Assess agreement between clinical request and sites injected. This was a 10 year single-center retrospective study (May 2006-April 2016) of patients with JIA referred by Rheumatology for ultrasound-guided tendon sheath injections. Patient demographics, clinical referral information, sonographic appearance of the tendon sheaths and technical aspects of the procedure were analyzed. There were 308 procedures of 244 patients (75% female, mean age 9.6 years) who underwent a total of 926 tendon sheath injections. Ankle tendons were most commonly injected (84.9%), specifically the tendon sheaths of tibialis posterior (22.3%), peroneus longus (20%) and brevis (19.7%). The majority of treated sites (91.9%) showed peritendinous fluid and sheath thickening on ultrasound. There were 2 minor intra-procedure complications without sequelae. A good agreement between clinical request and sites injected was observed. Ultrasound-guided tendon sheath injections with steroids are used frequently to treat patients with JIA. It is a safe intervention with a high technical success rate. The ankle region, specifically the medial compartment, is the site most commonly injected in this group of patients. The most common sonographic finding is peritendinous fluid and sheath thickening. These findings might assist clinicians and radiologists to characterize and more effectively manage tenosynovitis in patients with JIA.

Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction

NASA Astrophysics Data System (ADS)

Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

2008-09-01

This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

Bone anchors or interference screws? A biomechanical evaluation for autograft ankle stabilization.

PubMed

Jeys, Lee; Korrosis, Sotiris; Stewart, Todd; Harris, Nicholas J

2004-01-01

Autograft stabilization uses free semitendinosus tendon grafts to anatomically reconstruct the anterior talofibular ligament. Study aims were to evaluate the biomechanical properties of Mitek GII anchors compared with the Arthrex Bio-Tenodesis Screw for free tendon reconstruction of the anterior talofibular ligament. There are no differences in load to failure and percentage specimen elongation at failure between the 2 methods. Controlled laboratory study using porcine models. Sixty porcine tendon constructs were failure tested. Re-creating the pull of the anterior talofibular ligament, loads were applied at 70 degrees to the bones. Thirty-six tendons were fixed to porcine tali and tested using a single pull to failure; 10 were secured with anchors and No. 2 Ethibond, 10 with anchors and FiberWire, 10 with screws and Fiberwire, and 6 with partially gripped screws. Cyclic preloading was conducted on 6 tendons fixed by anchors and on 6 tendons fixed by screws before failure testing. Two groups of 6 components fixed to the fibula were also tested. The talus single-pull anchor group produced a mean load of 114 N and elongation of 37% at failure. The talus single-pull screw group produced a mean load of 227 N and elongation of 22% at failure (P <.05). Cyclic preloading at 65% failure load before failure testing produced increases in load and decreases in elongation at failure. Partially gripped screws produced a load of 133 N and elongation of 30% at failure. The fibula model produced significant increases in load to failure for both. The human anterior talofibular ligament has loads of 139 N at failure with instability occurring at 20% elongation. Interference screw fixation produced significantly greater failure strength and less elongation at failure than bone anchors. The improved biomechanics of interference screws suggests that these may be more suited to in vivo reconstruction of the anterior talofibular ligament than are bone anchors.

Effects of microgravity on myogenic factor expressions during postnatal development of rat skeletal muscle

NASA Technical Reports Server (NTRS)

Inobe, Manabu; Inobe, Ikuko; Adams, Gregory R.; Baldwin, Kenneth M.; Takeda, Shin'Ichi

2002-01-01

To clarify the role of gravity in the postnatal development of skeletal muscle, we exposed neonatal rats at 7 days of age to microgravity. After 16 days of spaceflight, tibialis anterior, plantaris, medial gastrocnemius, and soleus muscles were removed from the hindlimb musculature and examined for the expression of MyoD-family transcription factors such as MyoD, myogenin, and MRF4. For this purpose, we established a unique semiquantitative method, based on RT-PCR, using specific primers tagged with infrared fluorescence. The relative expression of MyoD in the tibialis anterior and plantaris muscles and that of myogenin in the plantaris and soleus muscles were significantly reduced (P < 0.001) in the flight animals. In contrast, MRF4 expression was not changed in any muscle. These results suggest that MyoD and myogenin, but not MRF4, are sensitive to gravity-related stimuli in some skeletal muscles during postnatal development.

Predictors for anterior pelvic tilt following surgical correction of flexed knee gait including patellar tendon shortening in children with cerebral palsy.

PubMed

Böhm, Harald; Hösl, Matthias; Döderlein, Leonhard

2017-05-01

Patellar tendon shortening procedure within single event multilevel surgeries was shown to improve crouch gait in Cerebral Palsy (CP) patients. However, one of the drawbacks associated to the correction of flexed knee gait may be increased pelvic anterior tilt with compensatory lumbar lordosis. Which CP patients are at risk for excessive anterior pelvic tilt following correction of flexed knee gait including patellar tendon shortening? 32 patients with CP between 8 and 18 years GMFCS I&II were included. They received patellar tendon shortenings within multilevel surgery. Patients with concomitant knee flexor lengthening were excluded. Gait analysis and clinical testing was performed pre- and 24.1 (SD=1.9) months postoperatively. Patients were subdivided into more/less than 5° increase in anterior pelvic tilt. Preoperative measures indicating m. rectus and m. psoas shortness, knee flexor over-length, hip extensor and abdominal muscle weakness and equinus gait were compared between groups. Stepwise multilinear regression of the response value increase in pelvic tilt during stance phase was performed from parameters that were significantly different between groups. 34% of patients showed more than 5° increased pelvic anterior tilt postoperatively. Best predictors for anterior pelvic tilt from preoperative measures were increased m. rectus tone and reduced hip extension during walking that explained together 39% of the variance in increase of anterior pelvic tilt. Every third patient showed considerable increased pelvic tilt following surgery of flexed knee gait. In particular patients with preoperative higher muscle tone in m. rectus and lower hip extension during walking were at risk and both features need to be addressed in the therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

Magnetic Resonance Imaging Allows the Evaluation of Tissue Damage and Regeneration in a Mouse Model of Critical Limb Ischemia.

PubMed

Zaccagnini, Germana; Palmisano, Anna; Canu, Tamara; Maimone, Biagina; Lo Russo, Francesco M; Ambrogi, Federico; Gaetano, Carlo; De Cobelli, Francesco; Del Maschio, Alessandro; Esposito, Antonio; Martelli, Fabio

2015-01-01

Magnetic resonance imaging (MRI) provides non-invasive, repetitive measures in the same individual, allowing the study of a physio-pathological event over time. In this study, we tested the performance of 7 Tesla multi-parametric MRI to monitor the dynamic changes of mouse skeletal muscle injury and regeneration upon acute ischemia induced by femoral artery dissection. T2-mapping (T2 relaxation time), diffusion-tensor imaging (Fractional Anisotropy) and perfusion by Dynamic Contrast-Enhanced MRI (K-trans) were measured and imaging results were correlated with histological morphometric analysis in both Gastrocnemius and Tibialis anterior muscles. We found that tissue damage positively correlated with T2-relaxation time, while myofiber regeneration and capillary density positively correlated with Fractional Anisotropy. Interestingly, K-trans positively correlated with capillary density. Accordingly, repeated MRI measurements between day 1 and day 28 after surgery in ischemic muscles showed that: 1) T2-relaxation time rapidly increased upon ischemia and then gradually declined, returning almost to basal level in the last phases of the regeneration process; 2) Fractional Anisotropy dropped upon ischemic damage induction and then recovered along with muscle regeneration and neoangiogenesis; 3) K-trans reached a minimum upon ischemia, then progressively recovered. Overall, Gastrocnemius and Tibialis anterior muscles displayed similar patterns of MRI parameters dynamic, with more marked responses and less variability in Tibialis anterior. We conclude that MRI provides quantitative information about both tissue damage after ischemia and the subsequent vascular and muscle regeneration, accounting for the differences between subjects and, within the same individual, between different muscles.

Differences in muscle activity between natural forefoot and rearfoot strikers during running.

PubMed

Yong, Jennifer R; Silder, Amy; Delp, Scott L

2014-11-28

Running research has focused on reducing injuries by changing running technique. One proposed method is to change from rearfoot striking (RFS) to forefoot striking (FFS) because FFS is thought to be a more natural running pattern that may reduce loading and injury risk. Muscle activity affects loading and influences running patterns; however, the differences in muscle activity between natural FFS runners and natural RFS runners are unknown. The purpose of this study was to measure muscle activity in natural FFS runners and natural RFS runners. We tested the hypotheses that tibialis anterior activity would be significantly lower while activity of the plantarflexors would be significantly greater in FFS runners, compared to RFS runners, during late swing phase and early stance phase. Gait kinematics, ground reaction forces and electromyographic patterns of ten muscles were collected from twelve natural RFS runners and ten natural FFS runners. The root mean square (RMS) of each muscle׳s activity was calculated during terminal swing phase and early stance phase. We found significantly lower RMS activity in the tibialis anterior in FFS runners during terminal swing phase, compared to RFS runners. In contrast, the medial and lateral gastrocnemius showed significantly greater RMS activity in terminal swing phase in FFS runners. No significant differences were found during early stance phase for the tibialis anterior or the plantarflexors. Recognizing the differences in muscle activity between FFS and RFS runners is an important step toward understanding how foot strike patterns may contribute to different types of injury. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pairing Voluntary Movement and Muscle-Located Electrical Stimulation Increases Cortical Excitability

PubMed Central

Jochumsen, Mads; Niazi, Imran K.; Signal, Nada; Nedergaard, Rasmus W.; Holt, Kelly; Haavik, Heidi; Taylor, Denise

2016-01-01

Learning new motor skills has been correlated with increased cortical excitability. In this study, different location of electrical stimulation (ES), nerve, or muscle, was paired with voluntary movement to investigate if ES paired with voluntary movement (a) would increase the excitability of cortical projections to tibialis anterior and (b) if stimulation location mattered. Cortical excitability changes were quantified using motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation (TMS) at varying intensities during four conditions. Twelve healthy subjects performed 50 dorsiflexions at the ankle during nerve or muscle ES at motor threshold (MTh). ES alone was delivered 50 times and the movement was performed 50 times. A significant increase in the excitability from pre- to post-intervention (P = 0.0061) and pre- to 30 min post-intervention (P = 0.017) measurements was observed when voluntary movement was paired with muscle ES located at tibialis anterior. An increase of 50 ± 57 and 28 ± 54% in the maximum MEPs was obtained for voluntary movement paired with muscle-located and nerve-located ES, respectively. The maximum MEPs for voluntary movement alone and muscle-located ES alone were −5 ± 28 and 2 ± 42%, respectively. Pairing voluntary movement with muscle-located ES increases excitability of corticospinal projections of tibialis anterior in healthy participants. This finding suggests that active participation during muscle-located ES protocols increases cortical excitability to a greater extent than stimulation alone. The next stage of this research is to investigate the effect in people with stroke. The results may have implications for motor recovery in patients with motor impairments following neurological injury. PMID:27733823

Experimental Evidence of the Tonic Vibration Reflex during Whole-Body Vibration of the Loaded and Unloaded Leg

PubMed Central

Zaidell, Lisa N.; Mileva, Katya N.; Sumners, David P.; Bowtell, Joanna L.

2013-01-01

Increased muscle activation during whole-body vibration (WBV) is mainly ascribed to a complex spinal and supraspinal neurophysiological mechanism termed the tonic vibration reflex (TVR). However, TVR has not been experimentally demonstrated during low-frequency WBV, therefore this investigation aimed to determine the expression of TVR during WBV.  Whilst seated, eight healthy males were exposed to either vertical WBV applied to the leg via the plantar-surface of the foot, or Achilles tendon vibration (ATV) at 25Hz and 50Hzfor 70s. Ankle plantar-flexion force, tri-axial accelerations at the shank and vibration source, and surface EMG activity of m. soleus (SOL) and m. tibialis anterior (TA) were recorded from the unloaded and passively loaded leg to simulate body mass supported during standing.  Plantar flexion force was similarly augmented by WBV and ATV and increased over time in a load- and frequency dependent fashion. SOL and TA EMG amplitudes increased over time in all conditions independently of vibration mode. 50Hz WBV and ATV resulted in greater muscle activation than 25Hz in SOL when the shank was loaded and in TA when the shank was unloaded despite the greater transmission of vertical acceleration from source to shank with 25Hz and WBV, especially during loading. Low-amplitude WBV of the unloaded and passively loaded leg produced slow tonic muscle contraction and plantar-flexion force increase of similar magnitudes to those induced by Achilles tendon vibration at the same frequencies. This study provides the first experimental evidence supporting the TVR as a plausible mechanism underlying the neuromuscular response to whole-body vibration. PMID:24386466

Tendon and ligament injuries: the genetic component

PubMed Central

September, Alison V; Schwellnus, Martin P; Collins, Malcolm

2007-01-01

Tendons and ligaments within the upper and lower limbs are some of the more common sites of musculoskeletal injuries during physical activity. Several extrinsic and intrinsic factors have been shown to be associated with these injuries. More recently, studies have suggested that there is also, at least in part, a genetic component to the Achilles tendon, rotator cuff and anterior cruciate ligament injuries. However, specific genes have not been suggested to be associated with rotator cuff or anterior cruciate ligament injuries. Sequence variants of the tenascin C (TNC) gene, on the other hand, have been shown to be associated with Achilles tendinopathies and Achilles tendon ruptures, whereas a variant of the collagen V α 1 (COL5A1) gene has also been shown to be associated with Achilles tendinopathies. Both genes encode for important structural components of tendons and ligaments. The COL5A1 gene encodes for a component of type V collagen, which has an important role in regulating collagen fibre assembly and fibre diameters. The TNC gene, on the other hand, encodes for TNC, which regulates the tissue's response to mechanical load. To date, only variants in two genes have been shown to be associated with Achilles tendon injuries. In addition, although specific genes have not been identified, investigators have suggested that there is also a genetic component to both rotator cuff and anterior cruciate ligament injuries. In future, specific genotypes associated with increased risk of injury to specific tendons and ligaments can prevent these injuries by identifying individuals at higher risk. PMID:17261551

Neuromuscular Alterations After Ankle Sprains: An Animal Model to Establish Causal Links After Injury.

PubMed

Lepley, Lindsey K; McKeon, Patrick O; Fitzpatrick, Shane G; Beckemeyer, Catherine L; Uhl, Timothy L; Butterfield, Timothy A

2016-10-01

The mechanisms that contribute to the development of chronic ankle instability are not understood. Investigators have developed a hypothetical model in which neuromuscular alterations that stem from damaged ankle ligaments are thought to affect periarticular and proximal muscle activity. However, the retrospective nature of these studies does not allow a causal link to be established. To assess temporal alterations in the activity of 2 periarticular muscles of the rat ankle and 2 proximal muscles of the rat hind limb after an ankle sprain. Controlled laboratory study. Laboratory. Five healthy adult male Long Evans rats (age = 16 weeks, mass = 400.0 ± 13.5 g). Indwelling fine-wire electromyography (EMG) electrodes were implanted surgically into the biceps femoris, medial gastrocnemius, vastus lateralis, and tibialis anterior muscles of the rats. We recorded baseline EMG measurements while the rats walked on a motor-driven treadmill and then induced a closed lateral ankle sprain by overextending the lateral ankle ligaments. After ankle sprain, the rats were placed on the treadmill every 24 hours for 7 days, and we recorded postsprain EMG data. Onset time of muscle activity, phase duration, sample entropy, and minimal detectable change (MDC) were assessed and compared with baseline using 2-tailed dependent t tests. Compared with baseline, delayed onset time of muscle activity was exhibited in the biceps femoris (baseline = -16.7 ± 54.0 milliseconds [ms]) on day 0 (5.2 ± 64.1 ms; t 4 = -4.655, P = .043) and tibialis anterior (baseline = 307.0 ± 64.2 ms) muscles on day 3 (362.5 ± 55.9 ms; t 4 = -5.427, P = .03) and day 6 (357.3 ± 39.6 ms; t 4 = -3.802, P = .02). Longer phase durations were observed for the vastus lateralis (baseline = 321.9 ± 92.6 ms) on day 3 (401.3 ± 101.2 ms; t 3 = -4.001, P = .03), day 4 (404.1 ± 93.0 ms; t 3 = -3.320, P = .048), and day 5 (364.6 ± 105.2 ms; t 3 = -3.963, P = .03) and for the tibialis anterior (baseline = 103.9 ± 16.4 ms) on day 4 (154.9 ± 7.8 ms; t 3 = -4.331, P = .050) and day 6 (141.9 ± 16.2 ms; t 3 = -3.441, P = .03). After sprain, greater sample entropy was found for the vastus lateralis (baseline = 0.7 ± 0.3) on day 6 (0.9 ± 0.4; t 4 = -3.481, P = .03) and day 7 (0.9 ± 0.3; t 4 = -2.637, P = .050) and for the tibialis anterior (baseline = 0.6 ± 0.4) on day 4 (0.9 ± 0.5; t 4 = -3.224, P = .03). The MDC analysis revealed increased sample entropy values for the vastus lateralis and tibialis anterior. Manually inducing an ankle sprain in a rat by overextending the lateral ankle ligaments altered the complexity of muscle-activation patterns, and the alterations exceeded the MDC of the baseline data.

Effects of tibialis anterior vibration on postural control when exposed to support surface translations.

PubMed

Temple, David R; Lee, Beom-Chan; Layne, Charles S

2016-03-01

The sensory re-weighting theory suggests unreliable inputs may be down-weighted to favor more reliable sensory information and thus maintain proper postural control. This study investigated the effects of tibialis anterior (TA) vibration on center of pressure (COP) motion in healthy individuals exposed to support surface translations to further explore the concept of sensory re-weighting. Twenty healthy young adults stood with eyes closed and arms across their chest while exposed to randomized blocks of five trials. Each trial lasted 8 s, with TA vibration either on or off. After 2 s, a sudden backward or forward translation occurred. Anterior-posterior (A/P) COP data were evaluated during the preparatory (first 2 s), perturbation (next 3 s), and recovery (last 3 s) phases to assess the effect of vibration on perturbation response features. The knowledge of an impending perturbation resulted in reduced anterior COP motion with TA vibration in the preparatory phase relative to the magnitude of anterior motion typically observed during TA vibration. During the perturbation phase, vibration did not influence COP motion. However, during the recovery phase vibration induced greater anterior COP motion than during trials without vibration. The fact that TA vibration produced differing effects on COP motion depending upon the phase of the perturbation response may suggest that the immediate context during which postural control is being regulated affects A/P COP responses to TA vibration. This indicates that proprioceptive information is likely continuously re-weighted according to the context in order to maintain effective postural control.

Analysis of deep tissue hypersensitivity to pressure pain in professional pianists with insidious mechanical neck pain.

PubMed

Linari-Melfi, Marcela; Cantarero-Villanueva, Irene; Fernández-Lao, Carolina; Fernández-de-Las-Peñas, César; Guisado-Barrilao, Rafael; Arroyo-Morales, Manuel

2011-11-24

The aim of this study was to investigate whether pressure pain hyperalgesia is a feature of professional pianists suffering from neck pain as their main playing-related musculoskeletal disorder. Twenty-three active expert pianists, 6 males and 17 females (age: 36 ± 12 years) with insidious neck pain and 23 pianists, 9 males and 14 females (age: 38 ± 10 years) without neck pain the previous year were recruited. A numerical pain rate scale, Neck Disability Index, hand size and pressure pain thresholds (PPT) were assessed bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, the second metacarpal and the tibialis anterior muscle in a blinded design. The results showed that PPT levels were significantly decreased bilaterally over the second metacarpal and tibialis anterior muscles (P < 0.05), but not over C5-C6 zygapophyseal joint and deltoid muscle (P > 0.10), in pianists with neck pain as compared to healthy pianists. Pianists with neck pain had a smaller (P < 0.05) hand size (mean: 181.8 ± 11.8) as compared to pianists without neck pain (mean: 188. 6 ± 13.1). PPT over the tibialis anterior muscles was negatively correlated with the intensity of neck pain. Our findings revealed pressure pain hypersensitivity over distant non-symptomatic distant points but not over the symptomatic areas in pianists suffering from neck pain. In addition, pianists with neck pain also had smaller hand size than those without neck pain. Future studies are needed to further determine the relevance of these findings in the clinical course of neck pain as playing-related musculoskeletal disorder in professional pianists.

Muscle Reaction Time During a Simulated Lateral Ankle Sprain After Wet-Ice Application or Cold-Water Immersion.

PubMed

Thain, Peter K; Bleakley, Christopher M; Mitchell, Andrew C S

2015-07-01

Cryotherapy is used widely in sport and exercise medicine to manage acute injuries and facilitate rehabilitation. The analgesic effects of cryotherapy are well established; however, a potential caveat is that cooling tissue negatively affects neuromuscular control through delayed muscle reaction time. This topic is important to investigate because athletes often return to exercise, rehabilitation, or competitive activity immediately or shortly after cryotherapy. To compare the effects of wet-ice application, cold-water immersion, and an untreated control condition on peroneus longus and tibialis anterior muscle reaction time during a simulated lateral ankle sprain. Randomized controlled clinical trial. University of Hertfordshire human performance laboratory. A total of 54 physically active individuals (age = 20.1 ± 1.5 years, height = 1.7 ± 0.07 m, mass = 66.7 ± 5.4 kg) who had no injury or history of ankle sprain. Wet-ice application, cold-water immersion, or an untreated control condition applied to the ankle for 10 minutes. Muscle reaction time and muscle amplitude of the peroneus longus and tibialis anterior in response to a simulated lateral ankle sprain were calculated. The ankle-sprain simulation incorporated a combined inversion and plantar-flexion movement. We observed no change in muscle reaction time or muscle amplitude after cryotherapy for either the peroneus longus or tibialis anterior (P > .05). Ten minutes of joint cooling did not adversely affect muscle reaction time or muscle amplitude in response to a simulated lateral ankle sprain. These findings suggested that athletes can safely return to sporting activity immediately after icing. Further evidence showed that ice can be applied before ankle rehabilitation without adversely affecting dynamic neuromuscular control. Investigation in patients with acute ankle sprains is warranted to assess the clinical applicability of these interventions.

Comparison of calf muscle architecture between Asian children with spastic cerebral palsy and typically developing peers.

PubMed

Chen, Ying; He, Lu; Xu, Kaishou; Li, Jinling; Guan, Buyun; Tang, Hongmei

2018-01-01

To compare the muscle thickness, fascicle length, and pennation angle of the gastrocnemius, soleus, and tibialis anterior between Asian children with spastic cerebral palsy (CP) and typically developing (TD) peers. This cross-sectional study involved a total of 72 children with hemiplegic CP (n = 24), and diplegic CP (n = 24) and their TD peers (n = 24). Muscle architecture was measured at rest using ultrasound. Clinical measures included gross motor function and a modified Ashworth scale. The thicknesses of the tibialis anterior and medial gastrocnemius muscles were smaller in the affected calf of children with CP (p<0.05) than in those of their TD peers. Additionally, the lengths of the lateral gastrocnemius and soleus fascicle were shorter (p<0.05) in children with diplegic CP than in their TD peers. The fascicle length was shorter in the affected calf of children with CP (p<0.05) than in the calves of their TD peers or the unaffected calf of children with hemiplegic CP. However, the length of the lateral gastrocnemius fascicle was similar between the two legs of children with hemiplegic CP. The pennation angles of the medial gastrocnemius and soleus muscles were larger (p<0.05) in the affected calf in children with hemiplegic CP than in the calves of their TD peers. The fascicle length of the lateral gastrocnemius and the thickness of the soleus muscle were positively correlated with gross motor function scores in children with CP (p<0.05). Muscle thickness and fascicle length were lower in the affected tibialis anterior, gastrocnemius, and soleus in children with spastic CP. These changes may limit the ability to stand and walk, and indicate a need to strengthen the affected muscle.

Electromyographic analysis of standing posture and demi-plié in ballet and modern dancers.

PubMed

Trepman, E; Gellman, R E; Solomon, R; Murthy, K R; Micheli, L J; De Luca, C J

1994-06-01

Surface electromyography was used to analyze lower extremity muscle activity during standing posture and demi-plié in first position with lower extremities turned out, in five ballet and seven modern female professional dancers. In standing posture, increased electromyographic (EMG) activity above baseline was detected most frequently at the medial gastrocnemius (54% standing repetitions) and tibialis anterior (29%) electrodes (all dancers); in ballet dancers, increased EMG activity during standing was significantly less frequent at the medial gastrocnemius, but more frequent at the tibialis anterior, than in modern dancers. In demi-plié, the tibialis anterior had a discrete peak of EMG activity at midcycle in all dancers (97% demi-pliés). All dancers also had midcycle EMG activity in both vastus lateralis and medialis (100% demi-pliés). At the end of rising phase of demi-plié, ballet dancers had greater EMG activity than at midcycle in vastus lateralis (100% demi-pliés) and medialis (92%); in modern dancers, end-rising phase voltage was lower than at midcycle for vastus lateralis (71% demi-pliés) and medialis (83%). Genu recurvatum > or = 10 degrees was observed at the beginning and end of demi-plié in all ballet dancers, but not in modern dancers. There was marked variation of EMG activity during demi-plié in the lateral gastrocnemius, medial gastrocnemius, gluteus maximus, hamstrings, and adductors. The results support the hypothesis that ballet and modern dancers have different patterns of muscle use in standing posture and demi-plié, which in part may be a result of differences in genu recurvatum and turnout between the two groups.

Analysis of deep tissue hypersensitivity to pressure pain in professional pianists with insidious mechanical neck pain

PubMed Central

2011-01-01

Background The aim of this study was to investigate whether pressure pain hyperalgesia is a feature of professional pianists suffering from neck pain as their main playing-related musculoskeletal disorder. Methods Twenty-three active expert pianists, 6 males and 17 females (age: 36 ± 12 years) with insidious neck pain and 23 pianists, 9 males and 14 females (age: 38 ± 10 years) without neck pain the previous year were recruited. A numerical pain rate scale, Neck Disability Index, hand size and pressure pain thresholds (PPT) were assessed bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, the second metacarpal and the tibialis anterior muscle in a blinded design. Results The results showed that PPT levels were significantly decreased bilaterally over the second metacarpal and tibialis anterior muscles (P < 0.05), but not over C5-C6 zygapophyseal joint and deltoid muscle (P > 0.10), in pianists with neck pain as compared to healthy pianists. Pianists with neck pain had a smaller (P < 0.05) hand size (mean: 181.8 ± 11.8) as compared to pianists without neck pain (mean: 188. 6 ± 13.1). PPT over the tibialis anterior muscles was negatively correlated with the intensity of neck pain. Conclusions Our findings revealed pressure pain hypersensitivity over distant non-symptomatic distant points but not over the symptomatic areas in pianists suffering from neck pain. In addition, pianists with neck pain also had smaller hand size than those without neck pain. Future studies are needed to further determine the relevance of these findings in the clinical course of neck pain as playing-related musculoskeletal disorder in professional pianists. PMID:22111912

Comparison of calf muscle architecture between Asian children with spastic cerebral palsy and typically developing peers

PubMed Central

Li, Jinling; Guan, Buyun; Tang, Hongmei

2018-01-01

Objective To compare the muscle thickness, fascicle length, and pennation angle of the gastrocnemius, soleus, and tibialis anterior between Asian children with spastic cerebral palsy (CP) and typically developing (TD) peers. Methods This cross-sectional study involved a total of 72 children with hemiplegic CP (n = 24), and diplegic CP (n = 24) and their TD peers (n = 24). Muscle architecture was measured at rest using ultrasound. Clinical measures included gross motor function and a modified Ashworth scale. Results The thicknesses of the tibialis anterior and medial gastrocnemius muscles were smaller in the affected calf of children with CP (p<0.05) than in those of their TD peers. Additionally, the lengths of the lateral gastrocnemius and soleus fascicle were shorter (p<0.05) in children with diplegic CP than in their TD peers. The fascicle length was shorter in the affected calf of children with CP (p<0.05) than in the calves of their TD peers or the unaffected calf of children with hemiplegic CP. However, the length of the lateral gastrocnemius fascicle was similar between the two legs of children with hemiplegic CP. The pennation angles of the medial gastrocnemius and soleus muscles were larger (p<0.05) in the affected calf in children with hemiplegic CP than in the calves of their TD peers. The fascicle length of the lateral gastrocnemius and the thickness of the soleus muscle were positively correlated with gross motor function scores in children with CP (p<0.05). Conclusions Muscle thickness and fascicle length were lower in the affected tibialis anterior, gastrocnemius, and soleus in children with spastic CP. These changes may limit the ability to stand and walk, and indicate a need to strengthen the affected muscle. PMID:29304114

Self-reported Recovery is Associated With Improvement in Localized Hyperalgesia Among Adolescent Females With Patellofemoral Pain: Results From a Cluster Randomized Trial.

PubMed

Rathleff, Michael S; Roos, Ewa M; Olesen, Jens L; Rasmussen, Sten; Arendt-Nielsen, Lars

2016-05-01

Adolescent females with patellofemoral pain (PFP) have localized (around the knee) and distal (tibialis anterior muscle) hyperalgesia assessed by decreased pressure pain thresholds (PPT). This may have implications for treating PFP as both localized and central pain mechanisms may contribute to the manifestations of pain. The objective of this study was to compare the change in localized and distal hyperalgesia among female adolescents with PFP deeming themselves recovered compared with those not recovered 3 months after patient education with or without exercise therapy. This is an ancillary analysis of a cluster randomized controlled trial investigating the effect of patient education with or without exercise therapy on self-reported recovery in 121 adolescents with PFP. PPTs were measured at 4 sites around the knee and on tibialis anterior in a random subsample of 57 female adolescents. Changes in localized and distal hyperalgesia from baseline to follow-up were compared with self-reported recovery. Adolescents were categorized as recovered if they rated themselves as "completely recovered" or "strongly recovered" on a 7-point Likert scale. Thirty-nine adolescents (68%) were available for follow-up at 3 months and 10 adolescents reported being recovered. Recovered adolescents had a 68 kPa (95% CI, 1, 136; P=0.047) larger improvement in PPT around the knee and a 76 kPa (95% CI, -29, 181; P=0.16) nonsignificant improvement in PPT on the tibialis anterior compared with adolescents not recovered. Female adolescents with PFP who rated themselves as recovered had a larger reduction in localized hyperalgesia compared with those not recovered.

Comparison of cross-sectional anatomy and computed tomography of the tarsus in horses.

PubMed

Raes, Els V; Bergman, Eric H J; van der Veen, Henk; Vanderperren, Katrien; Van der Vekens, Elke; Saunders, Jimmy H

2011-09-01

To compare computed tomography (CT) images of equine tarsi with cross-sectional anatomic slices and evaluate the potential of CT for imaging pathological tarsal changes in horses. 6 anatomically normal equine cadaveric hind limbs and 4 tarsi with pathological changes. Precontrast CT was performed on 3 equine tarsi; sagittal and dorsal reconstructions were made. In all limbs, postcontrast CT was performed after intra-articular contrast medium injection of the tarsocrural, centrodistal, and tarsometatarsal joints. Images were matched with corresponding anatomic slices. Four tarsi with pathological changes underwent CT examination. The tibia, talus, calcaneus, and central, fused first and second, third, and fourth tarsal bones were clearly visualized as well as the long digital extensor, superficial digital flexor, lateral digital flexor (with tarsal flexor retinaculum), gastrocnemius, peroneus tertius, and tibialis cranialis tendons and the long plantar ligament. The lateral digital extensor, medial digital flexor, split peroneus tertius, and tibialis cranialis tendons and collateral ligaments could be located but not always clearly identified. Some small tarsal ligaments were identifiable, including plantar, medial, interosseus, and lateral talocalcaneal ligaments; interosseus talocentral, centrodistal, and tarsometatarsal ligaments; proximal and distal plantar ligaments; and talometatarsal ligament. Parts of the articular cartilage could be assessed on postcontrast images. Lesions were detected in the 4 tarsi with pathological changes. CT of the tarsus is recommended when radiography and ultrasonography are inconclusive and during preoperative planning for treatment of complex fractures. Images from this study can serve as a CT reference, and CT of pathological changes was useful.

Randomized Controlled Trial Comparing Orthosis Augmented by Either Stretching or Stretching and Strengthening for Stage II Tibialis Posterior Tendon Dysfunction.

PubMed

Houck, Jeff; Neville, Christopher; Tome, Josh; Flemister, Adolph

2015-09-01

The value of strengthening and stretching exercises combined with orthosis treatment in a home-based program has not been evaluated. The purpose of this study was to compare the effects of augmenting orthosis treatment with either stretching or a combination of stretching and strengthening in participants with stage II tibialis posterior tendon dysfunction (TPTD). Participants included 39 patients with stage II TPTD who were recruited from a medical center and then randomly assigned to a strengthening or stretching treatment group. Excluding 3 dropouts, there were 19 participants in the strengthening group and 17 in the stretching group. The stretching treatment consisted of a prefabricated orthosis used in conjunction with stretching exercises. The strengthening treatment consisted of a prefabricated orthosis used in conjunction with the stretching and strengthening exercises. The main outcome measures were self-report (ie, Foot Function Index and Short Musculoskeletal Function Assessment) and isometric deep posterior compartment strength. Two-way analysis of variance was used to test for differences between groups at 6 and 12 weeks after starting the exercise programs. Both groups significantly improved in pain and function over the 12-week trial period. The self-report measures showed minimal differences between the treatment groups. There were no differences in isometric deep posterior compartment strength. A moderate-intensity, home-based exercise program was minimally effective in augmenting orthosis wear alone in participants with stage II TPTD. Level I, prospective randomized study. © The Author(s) 2015.

The effect of platelet-derived growth factors on knee stability after anterior cruciate ligament reconstruction: a prospective randomized clinical study.

PubMed

Vogrin, Matjaz; Rupreht, Mitja; Crnjac, Anton; Dinevski, Dejan; Krajnc, Zmago; Recnik, Gregor

2010-05-01

Arthroscopic reconstruction is a standard surgical procedure in cases of symptomatic knee instability due to rupture of the anterior cruciate ligament. Bone-tendon-bone and hamstring tendon grafts are both in use for anterior cruciate ligament reconstruction. There are no significant differences between the two types of graft in relation to function scores, but there is a difference in anteroposterior stability when measured on the KT-2000 arthrometer: knee joints after reconstruction with bone-tendon-bone autografts are more stable than those reconstructed with hamstring tendon autografts. To improve knee stability after anterior cruciate ligament reconstruction with a hamstring graft and use of platelet-derived growth factors. Platelet-leukocyte gel was produced from platelet-leukocyte-rich plasma prepared from a unit of whole blood in an autologous platelet separator. The gel was applied locally, after hamstring graft placement. Fifty patients were included in the study: 25 in the platelet gel group, 25 in a control group. We evaluated anteroposterior knee stability with the KT-2000 arthrometer before surgery and at 3 and 6 months after surgery. Patients treated with the gel demonstrated significantly better anteroposterior knee stability than patients in the control group. The calculated improvements in knee stability at 6 months were 1.3 +/- 1.8 mm in the control group and 3.1 +/- 2.5 mm in the platelet gel group (P = 0.011). Platelet-leukocyte gel, applied locally, can improve knee stability in surgery for reconstruction of the anterior cruciate ligament.

Supraspinal control of automatic postural responses in people with multiple sclerosis.

PubMed

Peterson, D S; Gera, G; Horak, F B; Fling, B W

2016-06-01

The neural underpinnings of delayed automatic postural responses in people with multiple sclerosis (PwMS) are unclear. We assessed whether white matter pathways of two supraspinal regions (the cortical proprioceptive Broadman's Area-3; and the balance/locomotor-related pedunculopontine nucleus) were related to delayed postural muscle response latencies in response to external perturbations. 19 PwMS (48.8±11.4years; EDSS=3.5 (range: 2-4)) and 12 healthy adults (51.7±12.2years) underwent 20 discrete, backward translations of a support surface. Onset latency of agonist (medial-gastrocnemius) and antagonist (tibialis anterior) muscles were assessed. Diffusion tensor imaging assessed white-matter integrity (i.e. radial diffusivity) of cortical proprioceptive and balance/locomotor-related tracts. Latency of the tibialis anterior, but not medial gastrocnemius was larger in PwMS than control subjects (p=0.012 and 0.071, respectively). Radial diffusivity of balance/locomotor tracts was higher (worse) in PwMS than control subjects (p=0.004), and was significantly correlated with tibialis (p=0.002), but not gastrocnemius (p=0.06) onset latency. Diffusivity of cortical proprioceptive tracts was not correlated with muscle onset. Lesions in supraspinal structures including the pedunculopontine nucleus balance/locomotor network may contribute to delayed onset of postural muscle activity in PwMS, contributing to balance deficits in PwMS. Published by Elsevier B.V.

[Anterior dislocation of the popliteus tendon].

PubMed

Martinez Molina, Oscar

2009-01-01

Review the most relevant aspects of the posterolateral corner anatomy of the knee, based on the analysis of papers that throughout the years have made important contributions to the knowledge of these structures. Last et al rejected the idea that the popliteal tendon is an isolated structure, suggesting rather that its variants are closely linked to other anatomical structures. The studies by Tria et al contributed the features of the tendon as it attaches to the lateral condyle, just to mention a couple of examples. This is the case of a 48 year-old female patient with a knee injury caused by an external rotation mechanism. Clinical features included pain, a protruding sensation in the lateral aspect of the knee, and voluntary pseudoblocking resulting from external rotation maneuvers. Knee arthroscopy was performed and dislocation of the popliteal tendon anterior to the lateral condyle was diagnosed, besides a longitudinal tear. The tendon was repositioned, radiofrequency was applied to both the tendon and the popliteal hiatus, and the former was kept in place with a plaster cast worn for 6 weeks. Even though the isolated tear or avulsion of the tendon has already been reported, the dislocation or instability of the popliteal tendon as it relates to the lateral femoral condyle has apparently not been approached yet. As we did in this case, other authors have also confirmed the diagnosis arthroscopically, Naver in 1985, Rose in 1988, and Burstein in 1990.

CK-2127107 amplifies skeletal muscle response to nerve activation in humans.

PubMed

Andrews, Jinsy A; Miller, Timothy M; Vijayakumar, Vipin; Stoltz, Randall; James, Joyce K; Meng, Lisa; Wolff, Andrew A; Malik, Fady I

2018-05-01

Three studies evaluated safety, tolerability, pharmacokinetics, and pharmacodynamics of CK-2127107 (CK-107), a next-generation fast skeletal muscle troponin activator (FSTA), in healthy participants. We tested the hypothesis that CK-107 would amplify the force-frequency response of muscle in humans. To assess the force-frequency response, participants received single doses of CK-107 and placebo in a randomized, double-blind, 4-period, crossover study. The force-frequency response of foot dorsiflexion following stimulation of the deep fibular nerve to activate the tibialis anterior muscle was assessed. CK-107 significantly increased tibialis anterior muscle response with increasing dose and plasma concentration in a frequency-dependent manner; the largest increase in peak force was ∼60% at 10 Hz. CK-107 appears more potent and produced larger increases in force than tirasemtiv-a first-generation FSTA-in a similar pharmacodynamic study, thereby supporting its development for improvement of muscle function of patients. Muscle Nerve 57: 729-734, 2018. © 2017 The Authors. Muscle & Nerve published by Wiley Periodicals, Inc.

Interosseous nerve transfers for tibialis anterior muscle paralysis (foot drop): a human cadaver-based feasibility study.

PubMed

Pirela-Cruz, Miguel A; Hansen, Uel; Terreros, Daniel A; Rossum, Alfred; West, Priscilla

2009-03-01

This study explored the anatomical feasibility of using an interosseous nerve transfer (routed between the tibia and fibula) to restore motor function to the tibialis anterior (TA) muscle, following injury to the common peroneal nerve (resulting in a foot drop). The specific nerve branches evaluated as possible donor nerves included the nerves to the medial gastrocnemius, the lateral gastrocnemius, and the soleus muscles. All nerve transfers were accomplished using a direct interosseous route and a direct repair (one medial gastrocnemius transfer did require interpositional grafting). The distance from the repair site to the TA muscle was shortest for the transfer using the nerve branch to the soleus. Histologically, the nerve branch to the soleus was most similar to the branch to the TA for both axonal count and cross-sectional area. A two-incision surgical approach using a fibular window (mobilizing a fibular segment after double osteotomy) and interosseous routing of the transfer is proposed.

Event related desynchronization-modulated functional electrical stimulation system for stroke rehabilitation: a feasibility study.

PubMed

Takahashi, Mitsuru; Takeda, Kotaro; Otaka, Yohei; Osu, Rieko; Hanakawa, Takashi; Gouko, Manabu; Ito, Koji

2012-08-16

We developed an electroencephalogram-based brain computer interface system to modulate functional electrical stimulation (FES) to the affected tibialis anterior muscle in a stroke patient. The intensity of FES current increased in a stepwise manner when the event-related desynchronization (ERD) reflecting motor intent was continuously detected from the primary cortical motor area. We tested the feasibility of the ERD-modulated FES system in comparison with FES without ERD modulation. The stroke patient who presented with severe hemiparesis attempted to perform dorsiflexion of the paralyzed ankle during which FES was applied either with or without ERD modulation. After 20 minutes of training, the range of movement at the ankle joint and the electromyography amplitude of the affected tibialis anterior muscle were significantly increased following the ERD-modulated FES compared with the FES alone. The proposed rehabilitation technique using ERD-modulated FES for stroke patients was feasible. The system holds potentials to improve the limb function and to benefit stroke patients.

Effects of a multichannel dynamic functional electrical stimulation system on hemiplegic gait and muscle forces

PubMed Central

Qian, Jing-guang; Rong, Ke; Qian, Zhenyun; Wen, Chen; Zhang, Songning

2015-01-01

[Purpose] The purpose of the study was to design and implement a multichannel dynamic functional electrical stimulation system and investigate acute effects of functional electrical stimulation of the tibialis anterior and rectus femoris on ankle and knee sagittal-plane kinematics and related muscle forces of hemiplegic gait. [Subjects and Methods] A multichannel dynamic electrical stimulation system was developed with 8-channel low frequency current generators. Eight male hemiplegic patients were trained for 4 weeks with electric stimulation of the tibia anterior and rectus femoris muscles during walking, which was coupled with active contraction. Kinematic data were collected, and muscle forces of the tibialis anterior and rectus femoris of the affected limbs were analyzed using a musculoskelatal modeling approach before and after training. A paired sample t-test was used to detect the differences between before and after training. [Results] The step length of the affected limb significantly increased after the stimulation was applied. The maximum dorsiflexion angle and maximum knee flexion angle of the affected limb were both increased significantly during stimulation. The maximum muscle forces of both the tibia anterior and rectus femoris increased significantly during stimulation compared with before functional electrical stimulation was applied. [Conclusion] This study established a functional electrical stimulation strategy based on hemiplegic gait analysis and musculoskeletal modeling. The multichannel functional electrical stimulation system successfully corrected foot drop and altered circumduction hemiplegic gait pattern. PMID:26696734

The role of the bicipital groove in tendopathy of the long biceps tendon.

PubMed

Pfahler, M; Branner, S; Refior, H J

1999-01-01

Long biceps tendon disease is often underrated but plays an important role in anterior shoulder pain. We studied prospectively the anatomy of the bicipital groove and its relationship to clinical symptoms. Sixty-seven consecutive patients were investigated by mutual ultrasonography and radiographs of the intertubercular groove. All images were scrutinized for biceps tendon status (ultrasonography) and groove anatomy (radiography). Thirty-seven patients (21 male, 16 female, average age 48 years) had chronic anterior shoulder pain, and 30 patients (16 male, 14 female, average age 46 years) served as a control group. In 28 shoulders we found sonographic signs of tendovaginitis, and in 14 we found degenerative changes. The mean age of patients with pathologic conditions of the long biceps tendon was 40 years, significantly lower than that of the complete study group. The x-ray films revealed a great variation in the medial and total opening angle of the groove, whereas width, depth, and humeral head diameter showed sex-related differences. Radiologic signs of groove degeneration correlated in 43.6% with biceps tendon disease on the sonogram. Our study revealed statistically significant correlations between groove anatomy and long biceps tendon disease, which should be considered more while shoulder problems are evaluated.

Prediction of Postoperative Clinical Recovery of Drop Foot Attributable to Lumbar Degenerative Diseases, via a Bayesian Network.

PubMed

Takenaka, Shota; Aono, Hiroyuki

2017-03-01

Drop foot resulting from degenerative lumbar diseases can impair activities of daily living. Therefore, predictors of recovery of this symptom have been investigated using univariate or/and multivariate analyses. However, the conclusions have been somewhat controversial. Bayesian network models, which are graphic and intuitive to the clinician, may facilitate understanding of the prognosis of drop foot resulting from degenerative lumbar diseases. (1) To show a layered correlation among predictors of recovery from drop foot resulting from degenerative lumbar diseases; and (2) to develop support tools for clinical decisions to treat drop foot resulting from lumbar degenerative diseases. Between 1993 and 2013, we treated 141 patients with decompressive lumbar spine surgery who presented with drop foot attributable to degenerative diseases. Of those, 102 (72%) were included in this retrospective study because they had drop foot of recent development and had no diseases develop that affect evaluation of drop foot after surgery. Specifically, 28 (20%) patients could not be analyzed because their records were not available at a minimum of 2 years followup after surgery and 11 (8%) were lost owing to postoperative conditions that affect the muscle strength evaluation. Eight candidate variables were sex, age, herniated soft disc, duration of the neurologic injury (duration), preoperative tibialis anterior muscle strength (pretibialis anterior), leg pain, cauda equina syndrome, and number of involved levels. Manual muscle testing was used to assess the tibialis anterior muscle strength. Drop foot was defined as a tibialis anterior muscle strength score of less than 3 of 5 (5 = movement against gravity and full resistance, 4 = movement against gravity and moderate resistance, 3 = movement against gravity through full ROM, 3- = movement against gravity through partial ROM, 2 = movement with gravity eliminated through full ROM, 1 = slight contraction but no movement, and 0 = no contraction). The two outcomes of interest were postoperative tibialis anterior muscle strength (posttibialis anterior) of 3 or greater and posttibialis anterior strength of 4 or greater at 2 years after surgery. We developed two separate Bayesian network models with outcomes of interest for posttibialis anterior strength of 3 or greater and posttibialis anterior strength of 4 or greater. The two outcomes correspond to "good" and "excellent" results based on previous reports, respectively. Direct predictors are defined as variables that have the tail of the arrow connecting the outcome of interest, whereas indirect predictors are defined as variables that have the tail of the arrow connecting either direct predictors or other indirect predictors that have the tail of the arrow connecting direct predictors. Sevenfold cross validation and receiver-operating characteristic (ROC) curve analyses were performed to evaluate the accuracy and robustness of the Bayesian network models. Both of our Bayesian network models showed that weaker muscle power before surgery (pretibialis anterior ≤ 1) and longer duration of neurologic injury before treatment (> 30 days) were associated with a decreased likelihood of return of function by 2 years. The models for posttibialis anterior muscle strength of 3 or greater and posttibialis anterior muscle strength of 4 or greater were the same in terms of the graphs, showing that the two direct predictors were pretibialis anterior muscle strength (score ≤ 1 or ≥ 2) and duration (≤ 30 days or > 30 days). Age, herniated soft disc, and leg pain were identified as indirect predictors. We developed a decision-support tool in which the clinician can enter pretibialis anterior muscle strength and duration, and from this obtain the probability estimates of posttibialis anterior muscle strength. The probability estimates of posttibialis anterior muscle strength of 3 or greater and posttibialis anterior muscle strength of 4 or greater were 94% and 85%, respectively, in the most-favorable conditions (pretibialis anterior ≥ 2; duration ≤ 30 days) and 18% and 14%, respectively, in the least-favorable conditions (pretibialis anterior ≤ 1; duration > 30 days). On the sevenfold cross validation, the area under the ROC curve yielded means of 0.78 (95% CI, 0.68-0.87) and 0.74 (95% CI, 0.64-0.84) for posttibialis anterior muscle strength of 3 or greater and posttibialis anterior muscle strength of 4 or greater, respectively. The results of this study suggest that the clinician can understand intuitively the layered correlation among predictors by Bayesian network models. Based on the models, the decision-support tool successfully provided the probability estimates of posttibialis anterior muscle strength to treat drop foot attributable to lumbar degenerative diseases. These models were shown to be robust on the internal validation but should be externally validated in other populations. Level III, therapeutic study.

[Clinical application of peroneal muscles tendon transposition in repair of Achilles tendon rupture].

PubMed

Jin, Rihao; Jin, Yu; Fang, Xiulin

2006-07-01

To discuss applied anatomy, biomechanics and surgical procedures of long peroneal muscles tendon transposition in repair of occlusive achilles tendon rupture. The blood supply and the morphology of long peroneal muscles tendon were observed in the lower extremity of 50 sides adult specimens and the mechanical tests which stretch load on the tendon were carried out. The methods were designed on the basis of the anatomical characteristics and morphology. Ten patients suffering occlusive Achilles tendon rupture were treated by using long peroneal muscles tendon transposition from March 2001 to July 2004. Among 10 patients, there were 7 males and 3 females, aging 32 to 54 years including 6 cases of jump injury, 2 cases of bruise, 1 case of step vacancy and 1 case of spontaneity injury. The interval between injury and surgery was 6 hours to 7 days in 7 fresh rupture and 21 days to 3 months in 3 old rupture. All cases belonged to occlusive Achilles tendon rupture (8 cases of complete rupture and 2 cases of incomplete rupture). The origin of long peroneal muscles was proximal tibia and fibular head, the end of them was base of first metatarsal bones and medial cuboid. The length of tendon was 13.5 +/- 2.5 cm. The width of origin tendon was 0.9 +/- 0.2 cm and the thickness was 0.3 +/- 0.1 cm; the width on apex of lateral malleolus was 0.7 +/- 0.1 cm and the thickness was 0.4 +/- 0.1 cm, the width on head of cuboid was 0.7 +/- 0.1 cm and the thickness was 0.3 +/- 0.1 cm. The long peroneal muscles tendon had abundant blood supply. The results of mechanical test showed that the biggest load was 2,292.4 +/- 617.3 N on tendon calcaneus, 1,020.4 +/- 175.4 N on long peroneal muscles tendon, 752.0 +/- 165.4 N on peroneus brevis tendon and 938.2 +/- 216.7 N on tibialis posterior tendon. Ten cases of occlusive Achilles tendon rupture achieved healing by first intention and were followed up 18-24 months. No Achilles tendon re-rupture, necrosis of skin or other complications occurred. According to Amerind-holm criterion for curative results, the results were excellent in 7 cases and good in 3 cases and the excellent and good rate was 100%. The long peroneal muscles tendon transposition is a perfect and simple way to repair occlusive Achilles tendon rupture.

Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results.

PubMed

Lu, Hongbin; Chen, Can; Xie, Shanshan; Tang, Yifu; Qu, Jin

2018-05-21

Most studies concerning to tendon healing and incorporation into bone are mainly based on animal studies due to the invasive nature of the biopsy procedure. The evidence considering tendon graft healing to bone in humans is limited in several case series or case reports, and therefore, it is difficult to understand the healing process. A computerized search using relevant search terms was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies that investigated tendon graft healing to bone by histologic examination after anterior cruciate ligament (ACL) reconstruction with hamstring. Ten studies were determined to be eligible for this systematic review. Thirty-seven cases were extracted from the included studies. Most studies showed that a fibrovascular interface would form at the tendon-bone interface at the early stage and a fibrous indirect interface with Sharpey-like fibers would be expected at the later stage. Cartilage-like tissue at tendon graft-bone interface was reported in three studies. Tendon graft failed to integrate with the surrounding bone in 10 of the 37 cases. Unexpectedly, suspensory type of fixation was used for the above failure cases. An indirect type of insertion with Sharpey-like fibers at tendon-bone interface could be expected after ACL reconstruction with hamstring. Regional cartilage-like tissue may form at tendon-bone interface occasionally. The underlying tendon-to-bone healing process is far from understood in the human hamstring ACL reconstruction. Further human studies are highly needed to understand tendon graft healing in bone tunnel after hamstring ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A 45-year-old man presenting with anterior compartment syndrome three weeks following conservative treatment of an Achilles tendon rupture.

PubMed

van Niekerk, Michael; Jawad, Farrah; Huntley, James S; McCowan, Stuart

2011-05-01

Compartment syndrome complicating a ruptured Achilles tendon has previously been reported in a surgically treated patient. However--to our knowledge--this is the first report of compartment syndrome following conservative treatment. A 45-year-old man ruptured his Achilles tendon and elected to have treatment in an equinus cast. Three weeks later, he developed compartment syndrome and despite fasciotomy, required surgical debridement of his anterior compartment. Delay in both diagnosis and subsequent fasciotomy resulted in a poor outcome. Any suspicion of compartment syndrome mandates early compartmental pressure monitoring. The exact aetiology is uncertain but we speculate that the equinus position of his ankle combined with weight-bearing, was a major contributing factor.

Biomechanical evaluation of various suture configurations in side-to-side tenorrhaphy.

PubMed

Wagner, Emilio; Ortiz, Cristian; Wagner, Pablo; Guzman, Rodrigo; Ahumada, Ximena; Maffulli, Nicola

2014-02-05

Side-to-side tenorrhaphy is increasingly used, but its mechanical performance has not been studied. Two porcine flexor digitorum tendon segments of equal length (8 cm) and thickness (1 cm) were placed side by side. Eight tenorrhaphies (involving sixteen tendons) were performed with each of four suture techniques (running locked, simple eight, vertical mattress, and pulley suture). The resulting constructs underwent cyclic loading on a tensile testing machine, followed by monotonically increasing tensile load if failure during cyclic loading did not occur. Clamps secured the tendons on each side of the repair, and specimens were mounted vertically. Cyclic loading varied between 15 N and 35 N, with a distension rate of 1 mm/sec. Cyclic loading strength was determined by applying a force of 70 N. The cause of failure and tendon distension during loading were recorded. All failures occurred in the monotonic loading phase and resulted from tendon stripping. No suture or knot failure was observed. The mean loads resisted by the configurations ranged from 138 to 398 N. The mean load to failure, maximum load resisted prior to 1 cm of distension, and load resisted at 1 cm of distension were significantly lower for the vertical mattress suture group than for any of the other three groups (p < 0.031). All four groups sustained loads well above the physiologic loads expected to occur in tendons in the foot and ankle (e.g., in tendon transfer for tibialis posterior tendon insufficiency). None of the four side-to-side configurations distended appreciably during the cyclic loading phase. The vertical mattress suture configuration appeared to be weaker than the other configurations. For surgeons who advocate immediate loading or motion of a side-to-side tendon repair, a pulley, running locked, or simple eight suture technique appears to provide a larger safety margin compared with a vertical mattress suture technique.

Factors predicting the feasibility of monitoring lower-limb muscle motor evoked potentials in patients undergoing excision of spinal cord tumors.

PubMed

Rajshekhar, Vedantam; Velayutham, Parthiban; Joseph, Mathew; Babu, K Srinivasa

2011-06-01

This prospective study on intraoperative muscle motor evoked potentials (MMEPs) from lower-limb muscles in patients undergoing surgery for spinal cord tumors was performed to: 1) determine preoperative clinical features that could predict successful recording of lower-limb MMEPs; 2) determine the muscle in the lower limb from which MMEPs could be most consistently obtained; 3) assess the need to monitor more than 1 muscle per limb; and 4) determine the effect of a successful baseline MMEP recording on early postoperative motor outcome. Of 115 consecutive patients undergoing surgery for spinal cord tumors, 110 were included in this study (44 intramedullary and 66 intradural extramedullary tumors). Muscle MEPs were generated using transcranial electrical stimulation under controlled anesthesia and were recorded from the tibialis anterior, quadriceps, soleus, and external anal sphincter muscles bilaterally. The effect of age (≤ 20 or > 20 years old), location of the tumor (intramedullary or extramedullary), segmental location of the tumor (cervical, thoracic, or lumbar), duration of symptoms (≤ 12 or > 12 months), preoperative functional grade (Nurick Grades 0-3 or 4-5), and muscle power (Medical Research Council Grades 0/5-3/5 or 4/5-5/5) on the success rate of obtaining MMEPs was studied using multiple regression analysis. The effect of the ability to monitor MMEPs on motor outcome at discharge from the hospital was also analyzed. The overall success rate for obtaining baseline lower-limb MMEPs was 68.2% (75 of 110 patients). Eighty-nine percent of patients with Nurick Grades 0-3 had successful MMEP recordings. Muscle MEPs could not be obtained in any patient in whom muscle power was 2/5 or less, but were obtained from 91.4% of patients with muscle power of 4/5 or more. Analysis showed that only preoperative Nurick grade (p ≤ 0.0001) and muscle power (p < 0.0001) were significant predictors of the likelihood of obtaining MMEPs. Responses were most consistently obtained from the tibialis anterior muscle (68%), but in the other 32% MMEPs could not be recorded from the tibialis anterior but could be recorded from another muscle. The ability to monitor MMEPs was associated with better motor outcome at discharge from the hospital (p = 0.052). The likelihood of obtaining lower-limb MMEPs is significantly greater in patients with better functional grades and higher motor power. Muscle MEPs are most consistently obtained from the tibialis anterior muscle but other muscles should also be monitored to optimize the chances of obtaining MMEP responses from the lower limbs.

Quadriceps Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Systematic Review.

PubMed

Hurley, Eoghan T; Calvo-Gurry, Manuel; Withers, Dan; Farrington, Shane K; Moran, Ray; Moran, Cathal J

2018-05-01

To systematically review the current evidence to ascertain whether quadriceps tendon autograft (QT) is a viable option in anterior cruciate ligament reconstruction. A literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Cohort studies comparing QT with bone-patellar tendon-bone autograft (BPTB) or hamstring tendon autograft (HT) were included. Clinical outcomes were compared, with all statistical analyses performed using IBM SPSS Statistics for Windows, version 22.0, with P < .05 being considered statistically significant. We identified 15 clinical trials with 1,910 patients. In all included studies, QT resulted in lower rates of anterior knee pain than BPTB. There was no difference in the rate of graft rupture between QT and BPTB or HT in any of the studies reporting this. One study found that QT resulted in greater knee stability than BPTB, and another study found increased stability compared with HT. One study found that QT resulted in improved functional outcomes compared with BPTB, and another found improved outcomes compared with HT, but one study found worse outcomes compared with BPTB. Current literature suggests QT is a viable option in anterior cruciate ligament reconstruction, with published literature showing comparable knee stability, functional outcomes, donor-site morbidity, and rerupture rates compared with BPTB and HT. Level III, systematic review of Level I, II, and III studies. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Experimental study of tendon graft fixation in anterior cruciate ligament reconstruction with cortical press-fit bolt in rabbits].

PubMed

Qi, Wei; Li, Chun-bao; Wang, Jun-liang; Zhu, Juan-li; Liu, Yu-jie

2013-05-21

To explore the histological outcomes of tendon-bone healing in anterior cruciate ligament (ACL) reconstruction with cortical press-fit bolt (CPB). Twenty-four healthy female or male New Zealand White rabbits (2-3 months old) underwent bilateral ACL reconstruction with extensor digitorum longus tendon. A random method was used to decide one knee would receive the routine ACL reconstruction (control group) and another cortical press-fit bolt fixation (experimental group). After general anesthesia, extensor digitorum longus tendon was harvested and ACL reconstruction performed. All animals were sacrificed at 4, 8 and 12 weeks postoperation. Radiological and histological examinations were made at each timepoint. The specimens were stained with different methods to observe the pathological changes of tendon graft, bone tunnel and cortical press-fit bolt. More revascularization and massive new bone were found in tendon-bone junction of experimental group at 4, 8 and 12 weeks postoperation. The circum-graft new vessel proportion of the experimental and control groups were 0.48 ± 0.12 and 0.26 ± 0.05 respectively (P < 0.05). In the experimental group, more cartilage cells were present in tendon-bone junction at 12 weeks and the circum-graft new bone areas in two groups were 0.41 ± 0.11 and 0.21 ± 0.10 mm(2) respectively (P < 0.05). Cortical press-fit blot may improve tendon-bone healing after ACL reconstruction in rabbits. The application prospects of this procedure are promising.

Neuromuscular Alterations After Ankle Sprains: An Animal Model to Establish Causal Links After Injury

PubMed Central

Lepley, Lindsey K.; McKeon, Patrick O.; Fitzpatrick, Shane G.; Beckemeyer, Catherine L.; Uhl, Timothy L.; Butterfield, Timothy A.

2016-01-01

Context: The mechanisms that contribute to the development of chronic ankle instability are not understood. Investigators have developed a hypothetical model in which neuromuscular alterations that stem from damaged ankle ligaments are thought to affect periarticular and proximal muscle activity. However, the retrospective nature of these studies does not allow a causal link to be established. Objective: To assess temporal alterations in the activity of 2 periarticular muscles of the rat ankle and 2 proximal muscles of the rat hind limb after an ankle sprain. Design: Controlled laboratory study. Setting: Laboratory. Patients or Other Participants: Five healthy adult male Long Evans rats (age = 16 weeks, mass = 400.0 ± 13.5 g). Intervention(s): Indwelling fine-wire electromyography (EMG) electrodes were implanted surgically into the biceps femoris, medial gastrocnemius, vastus lateralis, and tibialis anterior muscles of the rats. We recorded baseline EMG measurements while the rats walked on a motor-driven treadmill and then induced a closed lateral ankle sprain by overextending the lateral ankle ligaments. After ankle sprain, the rats were placed on the treadmill every 24 hours for 7 days, and we recorded postsprain EMG data. Main Outcome Measure(s): Onset time of muscle activity, phase duration, sample entropy, and minimal detectable change (MDC) were assessed and compared with baseline using 2-tailed dependent t tests. Results: Compared with baseline, delayed onset time of muscle activity was exhibited in the biceps femoris (baseline = −16.7 ± 54.0 milliseconds [ms]) on day 0 (5.2 ± 64.1 ms; t4 = −4.655, P = .043) and tibialis anterior (baseline = 307.0 ± 64.2 ms) muscles on day 3 (362.5 ± 55.9 ms; t4 = −5.427, P = .03) and day 6 (357.3 ± 39.6 ms; t4 = −3.802, P = .02). Longer phase durations were observed for the vastus lateralis (baseline = 321.9 ± 92.6 ms) on day 3 (401.3 ± 101.2 ms; t3 = −4.001, P = .03), day 4 (404.1 ± 93.0 ms; t3 = −3.320, P = .048), and day 5 (364.6 ± 105.2 ms; t3 = −3.963, P = .03) and for the tibialis anterior (baseline = 103.9 ± 16.4 ms) on day 4 (154.9 ± 7.8 ms; t3 = −4.331, P = .050) and day 6 (141.9 ± 16.2 ms; t3 = −3.441, P = .03). After sprain, greater sample entropy was found for the vastus lateralis (baseline = 0.7 ± 0.3) on day 6 (0.9 ± 0.4; t4 = −3.481, P = .03) and day 7 (0.9 ± 0.3; t4 = −2.637, P = .050) and for the tibialis anterior (baseline = 0.6 ± 0.4) on day 4 (0.9 ± 0.5; t4 = −3.224, P = .03). The MDC analysis revealed increased sample entropy values for the vastus lateralis and tibialis anterior. Conclusions: Manually inducing an ankle sprain in a rat by overextending the lateral ankle ligaments altered the complexity of muscle-activation patterns, and the alterations exceeded the MDC of the baseline data. PMID:27831747

Greater inadvertent muscle damage in direct anterior approach when compared with the direct superior approach for total hip arthroplasty.

PubMed

Amanatullah, D F; Masini, M A; Roger, D J; Pagnano, M W

2016-08-01

We wished to quantify the extent of soft-tissue damage sustained during minimally invasive total hip arthroplasty through the direct anterior (DA) and direct superior (DS) approaches. In eight cadavers, the DA approach was performed on one side, and the DS approach on the other, a single brand of uncemented hip prosthesis was implanted by two surgeons, considered expert in their surgical approaches. Subsequent reflection of the gluteus maximus allowed the extent of muscle and tendon damage to be measured and the percentage damage to each anatomical structure to be calculated. The DA approach caused substantially greater damage to the gluteus minimus muscle and tendon when compared with the DS approach (t-test, p = 0.049 and 0.003, respectively). The tensor fascia lata and rectus femoris muscles were damaged only in the DA approach. There was no difference in the amount of damage to the gluteus medius muscle and tendon, piriformis tendon, obturator internus tendon, obturator externus tendon or quadratus femoris muscle between approaches. The posterior soft-tissue releases of the DA approach damaged the gluteus minimus muscle and tendon, piriformis tendon and obturator internus tendon. The DS approach caused less soft-tissue damage than the DA approach. However the clinical relevance is unknown. Further clinical outcome studies, radiographic evaluation of component position, gait analyses and serum biomarker levels are necessary to evaluate and corroborate the safety and efficacy of the DS approach. Cite this article: Bone Joint J 2016;98-B1036-42. ©2016 The British Editorial Society of Bone & Joint Surgery.

Half-peroneus-longus-tendon graft augmentation for unqualified hamstring tendon graft of anterior cruciate ligament reconstruction.

PubMed

Liu, Chung-Ting; Lu, Yung-Chang; Huang, Chang-Hung

2015-09-01

In some situations, harvested hamstring tendon grafts are not qualified for anterior cruciate ligament (ACL) reconstruction. This study aimed to present a reinforcing method with additional half peroneus longus tendon (half-PLT) graft augmentation. Eight cases underwent ACL reconstruction with unqualified hamstring tendon grafts (diameter <7 mm) and were salvaged by additional half-PLT graft augmentation. The pivot shift test and KT-1000 tests were performed 3 years after surgery. Functional evaluation of subjective International Knee Documentation Committee (IKDC) and Lysholm scores was also done. In addition, Foot and Ankle Disability Index (FADI) scores were used to evaluate the function of the ankle donor site. The diameter of unqualified four-strand hamstring tendon grafts was 6.2 mm on average (range, 6.0-6.5 mm). The average diameter of hamstring grafts with half-PLT augmentation was 9.6 mm (range, 9.5-10.0 mm). The pivot shift test was negative in all patients. No significant differences between normal and abnormal knees were found by KT-1000. The average IKDC score was 86.0 (range, 83 to 89), and the average Lysholm score was 84.4 (range, 80-90). The average FADI score for the donor sites of half-PLT was 135.8 (range, 134-136). Additional half-PLT can successfully and safely reinforce unqualified hamstring tendon grafts for ACL reconstruction.

Anterior stability of the reverse shoulder arthroplasty depending on implant configuration and rotator cuff condition.

PubMed

Pastor, Marc-Frederic; Kraemer, Manuel; Wellmann, Mathias; Hurschler, Christof; Smith, Tomas

2016-11-01

The aim of this study was to investigate the stabilizing influence of the rotator cuff as well as the importance of glenosphere and onlay configuration on the anterior stability of the reverse total shoulder replacement (RTSR). A reverse total shoulder replacement was implanted into eight human cadaveric shoulders, and biomechanical testing was performed under three conditions: after implantation of the RTSR, after additional dissection of the subscapularis tendon, and after additional dissection of the infraspinatus and teres minor tendon. Testing was performed in 30° of abduction and three rotational positions: 30° internal rotation, neutral rotation, and 30° external rotation. Furthermore, the 38-mm and 42-mm glenospheres were tested in combination with a standard and a high-mobility humeral onlay. A gradually increased force was applied to the glenohumeral joint in anterior direction until the RTSR dislocated. The 42-mm glenosphere showed superior stability compared with the 38-mm glenosphere. The standard humeral onlay required significantly higher anterior dislocation forces than the more shallow high-mobility onlay. External rotation was the most stable position. Furthermore, isolated detachment of the subscapularis and combined dissection of the infraspinatus, teres minor, and subscapularis tendon increased anterior instability. This study showed superior stability with the 42-mm glenosphere and the more conforming standard onlay. External rotation was the most stable position. Detachment of the subscapularis as well as dissection of the complete rotator cuff decreased anterior stability.

Effect of a novel sterilization method on biomechanical properties of soft tissue allografts.

PubMed

Baldini, T; Caperton, K; Hawkins, M; McCarty, E

2016-12-01

Evaluate allograft tissue commonly used in soft tissue reconstruction to determine whether stiffness and strength were significantly altered after grafts were treated with different sterilization methods. Unprocessed, irradiated, and grafts treated with supercritical CO 2 were compared. Thirty-eight anterior or posterior tibialis tendons were obtained from a tissue bank (Allograft Innovations, Gainesville, FL). Group I was unprocessed, group II was sterilized with gamma irradiation (20-28 kGy), and group III was sterilized with supercritical CO 2 . The grafts were pretensioned to 89 N for 300 s. Specimens were then loaded from 50 to 300 N at 0.5 Hz for 250 cycles before being loaded to failure at 50 mm/min. Dependent variables were compared between sterilization groups with one-way ANOVA (P < 0.05) and equivalence trial. There was no significant difference in load to failure or failure stress among groups I, II, and III. Group III resulted in 27-36 % lower stiffness than group I and II. This difference was significant at 1, 10, 50, 100, and 250 cycles. There was no significant difference in stiffness between group I and group II. The two sterilization methods tested in this study do not affect allograft strength. The supercritical CO 2 sterilization method resulted in significantly lower stiffness than unprocessed and irradiated allografts. However, the stiffness and strength of all groups tested were greater than that of published values of the native intact anterior cruciate ligament (ACL). This study provides previously unpublished mechanical test data on a new sterilization technique that will assist surgeons to decide which allograft to use in ACL reconstruction surgery. III.

Do peak torque angles of muscles change following anterior cruciate ligament reconstruction using hamstring or patellar tendon graft?

PubMed

Yosmaoğlu, Hayri Baran; Baltacı, Gül; Sönmezer, Emel; Özer, Hamza; Doğan, Deha

2017-12-01

This study aims to compare the effects of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring or patellar tendon graft on the peak torque angle. The study included 132 patients (103 males, 29 females; mean age 29±9 year) who were performed ACL reconstruction with autogenous hamstring or patellar tendon graft. The peak torque angles in the quadriceps and hamstring muscles were recorded using an isokinetic dynamometer. Angle of peak knee flexion torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the hamstring tendon group. Angle of peak knee extension torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the patellar tendon group. There were no statistically significant differences in the flexion and extension peak torque angles between the operated and nonoperated knees at 60°/second in both groups. The angle of peak torque at relatively high angular velocities is affected after ACL reconstruction in patients with hamstring or patellar tendon grafts. The graft donor site directly influences this parameter. This finding may be important for clinicians in terms of preventing re-injury.

Tension degradation of anterior cruciate ligament grafts with dynamic flexion-extension loading: a biomechanical model in porcine knees.

PubMed

Dargel, Jens; Koebke, Jürgen; Brüggemann, Gert-Peter; Pennig, Dietmar; Schmidt-Wiethoff, Rüdiger

2009-10-01

This study investigates the influence of various femoral anterior cruciate ligament graft fixation methods on the amount of tension degradation and the initial fixation strength after cyclic flexion-extension loading in a porcine knee model. One hundred twenty porcine digital extensor tendons, used as 4-stranded free tendon grafts, were fixated within porcine femoral bone tunnels by use of extracortical button, cross-pin, or interference screw fixation. One hundred twenty porcine patellar tendon-bone grafts were fixated by use of cross-pin, interference screw, or press-fit fixation. Each femur-graft complex was submitted to cyclic flexion-extension loading for 1,000 cycles throughout different loading ranges, and the total loss of tension was determined. After cyclic testing, the grafts were loaded to failure, and the data were compared with a pullout series without cyclic loading. Tension degradation after 1,000 cycles of flexion-extension loading averaged 62.6% +/- 10.0% in free tendon grafts and 48.9% +/- 13.35% in patellar tendon-bone grafts. There was no influence of the loading range on the total amount of tension degradation. The total amount of tension degradation was the highest with interference screw fixation of free tendon and patellar tendon-bone grafts. Despite excessive loss of tension, the initial fixation strength of the femur-graft complex was not reduced. The method of femoral graft fixation significantly influenced tension degradation during dynamic flexion-extension loading. Femoral graft fixation methods that secure the graft close to the tunnel entrance and that displace the graft substance from the center of the bone tunnel show the largest amount of tension degradation during cyclic flexion-extension loading. The graft substance, not the fixation site, was the weakest link of the graft complex within this investigation. We believe that the graft fixation method should be considered when aiming to improve the precision of femoral graft placement in anterior cruciate ligament reconstruction.

Acquired midfoot deformity and function in individuals with diabetes and peripheral neuropathy.

PubMed

Hastings, Mary K; Mueller, Michael J; Woodburn, James; Strube, Michael J; Commean, Paul; Johnson, Jeffrey E; Cheuy, Victor; Sinacore, David R

2016-02-01

Diabetes mellitus related medial column foot deformity is a major contributor to ulceration and amputation. However, little is known about the relationship between medial column alignment and function and the integrity of the soft tissues that support and move the medial column. The purposes of this study were to determine the predictors of medial column alignment and function in people with diabetes and peripheral neuropathy. 23 participants with diabetes and neuropathy had radiographs, heel rise kinematics, magnetic resonance imaging and isokinetic muscle testing to measure: 1) medial column alignment (Meary's angle--the angle between the 1st metatarsal longitudinal axis and the talar head and neck), 2) medial column function (forefoot relative to hindfoot plantarflexion during heel rise), 3) intrinsic foot muscle and fat volume, ratio of posterior tibialis to flexor digitorum tendon volume, 4) plantar fascia function (Meary's angle change from toes flat to extended) and 5) plantarflexor peak torque. Predictors of medial column alignment and function were determined using simultaneous entry multiple regression. Posterior tibialis to flexor digitorum tendon volume ratio and intrinsic foot muscle volume were significant predictors of medial column alignment (P<.05), accounting for 44% of the variance. Intrinsic foot fat volume and plantarflexor peak torque were significant predictors of medial column function (P<.05), accounting for 37% of the variance. Deterioration of medial column supporting structures predicted alignment and function. Prospective research is required to monitor alignment, structure, and function over time to inform early intervention strategies to prevent deformity, ulceration, and amputation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patellar tendon re-rupture on the opposite end of the previous site of surgical repair

PubMed Central

KOH, Bryan Thean Howe; SAYAMPANATHAN, Andrew A; LEE, Keng Thiam

2017-01-01

We describe a rare case of a patellar tendon “re-rupture” at the opposite end of a previous proximal tendon repair. A 32-year-old male with a history of surgically repaired right proximal patellar tendon rupture presented with an acute non-traumatic right knee pain and instability during sports. Magnetic resonance imaging confirmed a complete rupture of his distal patellar tendon at the tibial tuberosity. The patellar tendon was repaired using two 5.5 mm BioCorkscrews (Arthrex) inserted into the tibial tuberosity; the tendon was stitched with the No. 2 fiberwires using Krackow technique. As the patellar tendon was degenerative, the repair was augmented with a semitendinosus tendon harvested using an open tendon stripper, leaving the distal attachment intact. At 2.6 years followup he had mild anterior knee pain, range of motion 0-130° and was able to squat. MRI scan done at followup revealed good healing of repaired patellar tendon. PMID:28566788

Similar Outcomes After Osteochondral Allograft Transplantation in Anterior Cruciate Ligament-Intact and -Reconstructed Knees: A Comparative Matched-Group Analysis With Minimum 2-Year Follow-Up.

PubMed

Wang, Dean; Eliasberg, Claire D; Wang, Tim; Fader, Ryan R; Coxe, Francesca R; Pais, Mollyann D; Williams, Riley J

2017-12-01

To compare failure rates and clinical outcomes of osteochondral allograft transplantation (OCA) in anterior cruciate ligament (ACL)-intact versus ACL-reconstructed knees at midterm follow-up. After a priori power analysis, a prospective registry of patients treated with OCA for focal chondral lesions ≥2 cm 2 in size with minimum 2-year follow-up was used to match ACL-reconstructed knees with ACL-intact knees by age, sex, and primary chondral defect location. Exclusion criteria included meniscus transplantation, realignment osteotomy, or other ligamentous injury. Complications, reoperations, and patient responses to validated outcome measures were reviewed. Failure was defined by any procedure involving allograft removal/revision or conversion to arthroplasty. Kaplan-Meier analysis and multivariate Cox regression were performed to evaluate the association of ACL reconstruction (ACLR) with failure. A total of 50 ACL-intact and 25 ACL-reconstructed (18 prior, 7 concomitant) OCA patients were analyzed. The mean age was 36.2 years (range, 14-62 years). Mean follow-up was 3.9 years (range, 2-14 years). Patient demographics and chondral lesion characteristics were similar between groups. ACL-reconstructed patients averaged 2.2 ± 1.9 prior surgeries on the ipsilateral knee compared with 1.4 ± 1.4 surgeries for ACL-intact patients (P = .014). Grafts used for the last ACLR included bone-patellar tendon-bone autograft, hamstring autograft, Achilles tendon allograft, and tibialis allograft (data available for only 11 of 25 patients). At final follow-up, 22% of ACL-intact and 32% of ACL-reconstructed patients had undergone reoperation. OCA survivorship was 90% and 96% at 2 years and 79% and 85% at 5 years in ACL-intact and ACL-reconstructed patients, respectively (P = .774). ACLR was not independently associated with failure. Both groups demonstrated clinically significant improvements in the Short Form-36 pain and physical functioning, International Knee Documentation Committee subjective, and Knee Outcome Survey-Activities of Daily Living scores at final follow-up (P < .001), with no significant differences in preoperative, postoperative, and change scores between groups. OCA in the setting of prior or concomitant ACLR does not portend higher failure rates or compromise clinical outcomes. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Calcific retropharyngeal tendinitis. [Radiological findings

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karasick, D.; Karasick, S.

1981-12-01

Calcific retropharyngeal tendinitis is an imflammation of the longus colli muscle tendon which is located on the anterior surface of the verterbral column extending from the atlas to the third thoracic vertebra. The acute inflammatory condition is selflimiting with symptoms consisting of a gradually increasing neck pain often associated with throat pain and difficulty swallowing. The pain is aggravated by head and neck movement. Clinically the condition can be confused with retropharyngeal absecess, meningitis, infectious spondylitis, and post-traumatic muscle spasm. The radiographic features of this condition consist of pre-vertebral soft tissue swelling from C1 to C4 and amorphous calcific densitymore » in the longus colli tendon anterior to the body of C2 and inferior to the anterior arch of C1.« less

Knee isokinetic performance following anterior cruciate ligament reconstruction: patellar tendon versus hamstrings graft.

PubMed

Machado, Felipe; Debieux, Pedro; Kaleka, Camila Cohen; Astur, Diego; Peccin, Maria Stella; Cohen, Moisés

2018-02-01

To compare knee isokinetic performance six months after reconstruction of the anterior cruciate ligament using grafts from either the patellar tendon or the hamstrings among patients who underwent the same rehabilitation protocol. Thirty-four patients were evaluated (17 with grafts from the patellar tendon and 17 with grafts from the hamstrings). Operated and non-operated knees were compared with regards to the variables of peak torque, work and the hamstring/quadriceps relationship at velocities of 60º/s and 180º/s and power of 180º/s after six months of surgery. The patients with ACL reconstruction using the patellar tendon (BPTB) showed quadriceps deficits for all variables, but the flexor musculature was balanced. In the hamstring group, both the extensors and the flexors showed deficits for the variables analyzed, except for hamstring power at 180º/s. Patients in the patellar tendon group had a greater quadriceps deficit compared with those in the hamstrings group. Patients in the hamstrings group had a greater muscular deficit in the flexor mechanism compared with the contralateral knee. An unbalanced H/Q ratio was observed regardless of graft type, but this was more evident in the BPTB group.

[Normal anatomy and related pathological changes of shoulder on MRI].

PubMed

Zhu, Q; Katsuya, N

2000-04-01

To describe the normal anatomy and common abnormal changes of rotator cuff impingement and tears and recurrent anterior instability of shoulder joint in MRI pictures. MRI was compared in 285 patients with shoulder diseases and 20 patients with symptomatic shoulder diseases. On oblique coronal image, the supraspinatus presented moderate signal intensity and low signal intensity in its tendon-muscle conjunction ranging from the humeral head to the greater tuberosity. The MRI manifestations of impingement lesion of the rotator cuff were as follows: high signal intensity of tendons, changes of their shapes, retraction of tendon-muscle conjunction, and muscle atrophy with high signal intensity. On T1-weighted axial image, the anterior and posterior glenohumeral labrum, the long head biceps tendon were displayed in low signal intensity. The anterior labrum manifested a sharp triangle contour and the posterior labrum a round one. The whole four muscles of the rotator cuff manifested on oblique sagital image. However, it was of less value in detecting the abnormalities of the rotator cuff and the glenohumeral labrum on sagittal imaging. The sensitivity in demonstrating rotator cuff complete tear was 95% for MRI and 91% for arthrography; the specificity was 88% for MRI and 100% for arthrography. The sensitivity and specificity of MRI were 96% and 75% for detecting glenoid labrum abnormalities, and 78% and 88% for detecting labrum tear in anterior recurrent dislocation of the shoulder. Magnetic resonance imaging with its excellent contrast resolution in multiple anatomic planes allows noninvasive visualization of bone and soft tissues in the rotator cuff and labrum.

Locomotion in Stroke Subjects: Interactions between Unaffected and Affected Sides

ERIC Educational Resources Information Center

Kloter, Evelyne; Wirz, Markus; Dietz, Volker

2011-01-01

The aim of this study was to evaluate the sensorimotor interactions between unaffected and affected sides of post-stroke subjects during locomotion. In healthy subjects, stimulation of the tibial nerve during the mid-stance phase is followed by electromyography responses not only in the ipsilateral tibialis anterior, but also in the proximal arm…

Intramuscular Pressure Measurement During Locomotion in Humans

NASA Technical Reports Server (NTRS)

Ballard, Ricard E.

1996-01-01

To assess the usefulness of intramuscular pressure (IMP) measurement for studying muscle function during gait, IMP was recorded in the soleus and tibialis anterior muscles of ten volunteers during, treadmill walking, and running using transducer-tipped catheters. Soleus IMP exhibited single peaks during late-stance phase of walking (181 +/- 69 mmHg, mean +/- S.E.) and running (269 +/- 95 mmHg). Tibialis anterior IMP showed a biphasic response, with the largest peak (90 +/- 15 mmHg during walking and 151 +/- 25 mmHg during running) occurring shortly after heel strike. IMP magnitude increased with gait speed in both muscles. Linear regression of soleus IMP against ankle joint torque obtained by a dynamometer in two subjects produced linear relationships (r = 0.97). Application of these relationships to IMP data yielded estimated peak soleus moment contributions of 0.95-165 Nm/Kg during walking, and 1.43-2.70 Nm/Kg during running. IMP results from local muscle tissue deformations caused by muscle force development and thus, provides a direct, practical index of muscle function during locomotion in humans.

Leg intramuscular pressures during locomotion in humans

NASA Technical Reports Server (NTRS)

Ballard, R. E.; Watenpaugh, D. E.; Breit, G. A.; Murthy, G.; Holley, D. C.; Hargens, A. R.

1998-01-01

To assess the usefulness of intramuscular pressure (IMP) measurement for studying muscle function during gait, IMP was recorded in the soleus and tibialis anterior muscles of 10 volunteers during treadmill walking and running by using transducer-tipped catheters. Soleus IMP exhibited single peaks during late-stance phase of walking [181 +/- 69 (SE) mmHg] and running (269 +/- 95 mmHg). Tibialis anterior IMP showed a biphasic response, with the largest peak (90 +/- 15 mmHg during walking and 151 +/- 25 mmHg during running) occurring shortly after heel strike. IMP magnitude increased with gait speed in both muscles. Linear regression of soleus IMP against ankle joint torque obtained by a dynamometer produced linear relationships (n = 2, r = 0.97 for both). Application of these relationships to IMP data yielded estimated peak soleus moment contributions of 0.95-1.65 N . m/kg during walking, and 1.43-2.70 N . m/kg during running. Phasic elevations of IMP during exercise are probably generated by local muscle tissue deformations due to muscle force development. Thus profiles of IMP provide a direct, reproducible index of muscle function during locomotion in humans.

The effectiveness of a single session of Whole-Body Vibration in improving the balance and the strength in type 2 diabetic patients with mild to moderate degree of peripheral neuropathy: a pilot study.

PubMed

Kordi Yoosefinejad, Amin; Shadmehr, Azadeh; Olyaei, Ghloamreza; Talebian, Saeed; Bagheri, Hossein

2014-01-01

Peripheral neuropathy is a common complication of diabetes mellitus. Muscle strength and the balance deficits are seen in these patients. Whole-Body Vibration (WBV) is a time-efficient method which may be beneficial for them. The immediate effects of WBV on muscle strength and balance have not been studied yet. The aim of this study was to investigate the effects of one session of WBV on muscle strength and the balance of diabetic patients. Ten diabetic patients with peripheral neuropathy took part in this study. Outcome measurements were total strength, strength of tibialis anterior and quadriceps femoris muscles and the balance parameters including Unilateral Stance Test and Timed Up and Go Test. Tibialis anterior muscle strength and Timed Up and GO Test parameters showed significant differences post-exercise in comparison to baseline. A session of WBV had positive effects on muscle strength and the balance in patients with type-2 diabetes associated with neuropathy. Copyright © 2013 Elsevier Ltd. All rights reserved.

Age-Associated Changes in the Spectral and Statistical Parameters of Surface Electromyogram of Tibialis Anterior.

PubMed

Siddiqi, Ariba; Arjunan, Sridhar Poosapadi; Kumar, Dinesh Kant

2016-01-01

Age-related neuromuscular change of Tibialis Anterior (TA) is a leading cause of muscle strength decline among the elderly. This study has established the baseline for age-associated changes in sEMG of TA at different levels of voluntary contraction. We have investigated the use of Gaussianity and maximal power of the power spectral density (PSD) as suitable features to identify age-associated changes in the surface electromyogram (sEMG). Eighteen younger (20-30 years) and 18 older (60-85 years) cohorts completed two trials of isometric dorsiflexion at four different force levels between 10% and 50% of the maximal voluntary contraction. Gaussianity and maximal power of the PSD of sEMG were determined. Results show a significant increase in sEMG's maximal power of the PSD and Gaussianity with increase in force for both cohorts. It was also observed that older cohorts had higher maximal power of the PSD and lower Gaussianity. These age-related differences observed in the PSD and Gaussianity could be due to motor unit remodelling. This can be useful for noninvasive tracking of age-associated neuromuscular changes.

A model for generating Surface EMG signal of m. Tibialis Anterior.

PubMed

Siddiqi, Ariba; Kumar, Dinesh; Arjunan, Sridhar P

2014-01-01

A model that simulates surface electromyogram (sEMG) signal of m. Tibialis Anterior has been developed and tested. This has a firing rate equation that is based on experimental findings. It also has a recruitment threshold that is based on observed statistical distribution. Importantly, it has considered both, slow and fast type which has been distinguished based on their conduction velocity. This model has assumed that the deeper unipennate half of the muscle does not contribute significantly to the potential induced on the surface of the muscle and has approximated the muscle to have parallel structure. The model was validated by comparing the simulated and the experimental sEMG signal recordings. Experiments were conducted on eight subjects who performed isometric dorsiflexion at 10, 20, 30, 50, 75, and 100% maximal voluntary contraction. Normalized root mean square and median frequency of the experimental and simulated EMG signal were computed and the slopes of the linearity with the force were statistically analyzed. The gradients were found to be similar (p>0.05) for both experimental and simulated sEMG signal, validating the proposed model.

Inducement of semitendinosus tendon regeneration to the pes anserinus after its harvest for anterior cruciate ligament reconstruction-A new inducer grafting technique

PubMed Central

2012-01-01

Purpose To investigate the usefulness of the “inducer grafting” technique for regeneration of the semitendinosus (ST) tendon after its harvest for anterior cruciate ligament (ACL) reconstruction. Methods Twenty knees of 20 patients (mean age at the time of surgery, 23.1 years) underwent ACL reconstruction with a double bundle autograft using the ST tendon (7 patients) and the ST + the gracilis (G) tendons (13 patients). “Inducer grafting” technique After harvesting the ST tendon, a passing pin with a loop thread is inserted along with the tendon stripper. The passing pin is pulled out from the medial thigh and the loop thread retained. As an inducer graft, the ST tendon branch is used. After the ACL graft has been secured, the inducer graft is sutured to the pes anserinus and the proximal end passed through by pulling the thread out. Then the inducer graft is placed within the tendon canal. The mean follow-up period was 15 months. The presence and morphology of the regenerated ST tendon were examined by MRI. And the isometric hamstring strength was examined at 45°, 90° and 120° of knee flexion. Results One month after the operation in all the patients, MRI demonstrated a low-intensity structure at the anatomical location of the ST, at the level of the superior pole of the patella and the joint line, apparently representing the regenerated ST tendon. Four months after the operation, the distal portion of the regenerated ST tendon had reached the pes anserinus in all patients. Twelve months after the operation, the regenerated ST tendon was hypertrophic in 19 of the 20 patients (95%). The isometric knee flexion torque of the ACL-reconstructed limb was significantly lower at 90° and 120° compared with the contralateral limb. Conclusion These results suggest that the “inducer grafting” technique is able to improve the regeneration rate of the harvested ST tendon and promote hypertrophy of the regenerated ST tendon, extending all the way to the pes anserinus. However, this technique couldn’t improve the deficits in knee flexion torque after ACL reconstruction. PMID:22607724

N-acetylcysteine inhibits muscle fatigue in humans.

PubMed Central

Reid, M B; Stokić, D S; Koch, S M; Khawli, F A; Leis, A A

1994-01-01

N-acetylcysteine (NAC) is a nonspecific antioxidant that selectively inhibits acute fatigue of rodent skeletal muscle stimulated at low (but not high) tetanic frequencies and that decreases contractile function of unfatigued muscle in a dose-dependent manner. The present experiments test the hypothesis that NAC pretreatment can inhibit acute muscular fatigue in humans. Healthy volunteers were studied on two occasions each. Subjects were pretreated with NAC 150 mg/kg or 5% dextrose in water by intravenous infusion. The subject then sat in a chair with surface electrodes positioned over the motor point of tibialis anterior, an ankle dorsiflexor of mixed-fiber composition. The muscle was stimulated to contract electrically (40-55 mA, 0.2-ms pulses) and force production was measured. Function of the unfatigued muscle was assessed by measuring the forces produced during maximal voluntary contractions (MVC) of ankle dorsiflexor muscle groups and during electrical stimulation of tibialis anterior at 1, 10, 20, 40, 80, and 120 Hz (protocol 1). Fatigue was produced using repetitive tetanic stimulations at 10 Hz (protocol 1) or 40 Hz (protocol 2); intermittent stimulations subsequently were used to monitor recovery from fatigue. The contralateral leg then was studied using the same protocol. Pretreatment with NAC did not alter the function of unfatigued muscle; MVC performance and the force-frequency relationship of tibialis anterior were unchanged. During fatiguing contractions stimulated at 10 Hz, NAC increased force output by approximately 15% (P < 0.0001), an effect that was evident after 3 min of repetitive contraction (P < 0.0125) and persisted throughout the 30-min protocol. NAC had no effect on fatigue induced using 40 Hz stimuli or on recovery from fatigue. N-acetylcysteine pretreatment can improve performance of human limb muscle during fatiguing exercise, suggesting that oxidative stress plays a causal role in the fatigue process and identifying antioxidant therapy as a novel intervention that may be useful clinically. PMID:7989604

Muscle Reaction Time During a Simulated Lateral Ankle Sprain After Wet-Ice Application or Cold-Water Immersion

PubMed Central

Thain, Peter K.; Bleakley, Christopher M.; Mitchell, Andrew C. S.

2015-01-01

Context Cryotherapy is used widely in sport and exercise medicine to manage acute injuries and facilitate rehabilitation. The analgesic effects of cryotherapy are well established; however, a potential caveat is that cooling tissue negatively affects neuromuscular control through delayed muscle reaction time. This topic is important to investigate because athletes often return to exercise, rehabilitation, or competitive activity immediately or shortly after cryotherapy. Objective To compare the effects of wet-ice application, cold-water immersion, and an untreated control condition on peroneus longus and tibialis anterior muscle reaction time during a simulated lateral ankle sprain. Design Randomized controlled clinical trial. Setting University of Hertfordshire human performance laboratory. Patients or Other Participants A total of 54 physically active individuals (age = 20.1 ± 1.5 years, height = 1.7 ± 0.07 m, mass = 66.7 ± 5.4 kg) who had no injury or history of ankle sprain. Intervention(s) Wet-ice application, cold-water immersion, or an untreated control condition applied to the ankle for 10 minutes. Main Outcome Measure(s) Muscle reaction time and muscle amplitude of the peroneus longus and tibialis anterior in response to a simulated lateral ankle sprain were calculated. The ankle-sprain simulation incorporated a combined inversion and plantar-flexion movement. Results We observed no change in muscle reaction time or muscle amplitude after cryotherapy for either the peroneus longus or tibialis anterior (P > .05). Conclusions Ten minutes of joint cooling did not adversely affect muscle reaction time or muscle amplitude in response to a simulated lateral ankle sprain. These findings suggested that athletes can safely return to sporting activity immediately after icing. Further evidence showed that ice can be applied before ankle rehabilitation without adversely affecting dynamic neuromuscular control. Investigation in patients with acute ankle sprains is warranted to assess the clinical applicability of these interventions. PMID:26067429

Young, Healthy Subjects Can Reduce the Activity of Calf Muscles When Provided with EMG Biofeedback in Upright Stance

PubMed Central

Vieira, Taian M.; Baudry, Stéphane; Botter, Alberto

2016-01-01

Recent evidence suggests the minimization of muscular effort rather than of the size of bodily sway may be the primary, nervous system goal when regulating the human, standing posture. Different programs have been proposed for balance training; none however has been focused on the activation of postural muscles during standing. In this study we investigated the possibility of minimizing the activation of the calf muscles during standing through biofeedback. By providing subjects with an audio signal that varied in amplitude and frequency with the amplitude of surface electromyograms (EMG) recorded from different regions of the gastrocnemius and soleus muscles, we expected them to be able to minimize the level of muscle activation during standing without increasing the excursion of the center of pressure (CoP). CoP data and surface EMG from gastrocnemii, soleus and tibialis anterior muscles were obtained from 10 healthy participants while standing at ease and while standing with EMG biofeedback. Four sensitivities were used to test subjects' responsiveness to the EMG biofeedback. Compared with standing at ease, the two most sensitive feedback conditions induced a decrease in plantar flexor activity (~15%; P < 0.05) and an increase in tibialis anterior EMG (~10%; P < 0.05). Furthermore, CoP mean position significantly shifted backward (~30 mm). In contrast, the use of less sensitive EMG biofeedback resulted in a significant decrease in EMG activity of ankle plantar flexors with a marginal increase in TA activity compared with standing at ease. These changes were not accompanied by greater CoP displacements or significant changes in mean CoP position. Key results revealed subjects were able to keep standing stability while reducing the activity of gastrocnemius and soleus without loading their tibialis anterior muscle when standing with EMG biofeedback. These results may therefore posit the basis for the development of training protocols aimed at assisting subjects in more efficiently controlling leg muscle activity during standing. PMID:27199773

Incidence of Major Tendon Ruptures and Anterior Cruciate Ligament Tears in US Army Soldiers

DTIC Science & Technology

2007-08-01

the effect of activity, race, age, or gender. The majority of the reports have been case studies or focused on one particular tendon and do not have...forces created by eccentric muscle activation are usually responsible for tendon failure. 1312 White et al The American Journal of Sports Medicine...Activities that maximize eccentric loading, such as repeti- tive jumping and sprinting exercises for the lower extrem- ities (bench press for the pectoralis

An acellular biologic scaffold does not regenerate appreciable de novo muscle tissue in rat models of volumetric muscle loss injury.

PubMed

Aurora, Amit; Roe, Janet L; Corona, Benjamin T; Walters, Thomas J

2015-10-01

Extracellular matrix (ECM) derived scaffolds continue to be investigated for the treatment of volumetric muscle loss (VML) injuries. Clinically, ECM scaffolds have been used for lower extremity VML repair; in particular, MatriStem™, a porcine urinary bladder matrix (UBM), has shown improved functional outcomes and vascularization, but limited myogenesis. However, efficacy of the scaffold for the repair of traumatic muscle injuries has not been examined systematically. In this study, we demonstrate that the porcine UBM scaffold when used to repair a rodent gastrocnemius musculotendinous junction (MTJ) and tibialis anterior (TA) VML injury does not support muscle tissue regeneration. In the MTJ model, the scaffold was completely resorbed without tissue remodeling, suggesting that the scaffold may not be suitable for the clinical repair of muscle-tendon injuries. In the TA VML injury, the scaffold remodeled into a fibrotic tissue and showed functional improvement, but not due to muscle fiber regeneration. The inclusion of physical rehabilitation also did not improve functional response or tissue remodeling. We conclude that the porcine UBM scaffold when used to treat VML injuries may hasten the functional recovery through the mechanism of scaffold mediated functional fibrosis. Thus for appreciable muscle regeneration, repair strategies that incorporate myogenic cells, vasculogenic accelerant and a myoconductive scaffold need to be developed. Published by Elsevier Ltd.

Effect of posterior tibial tendon dysfunction on unipedal standing balance test.

PubMed

Kulig, Kornelia; Lee, Szu-Ping; Reischl, Stephen F; Noceti-DeWit, Lisa

2015-01-01

Foot pain and diminished functional capacity are characteristics of tibialis posterior tendon dysfunction (TPTD). This study tested the hypotheses that women with TPTD would have impaired performance of a unipedal standing balance test (USBT) and that balance performance would be related to the number of single limb heel raises (SLHR). Thirty-nine middle-aged women, 19 with early stage TPTD (stage I and II), were instructed to perform 2 tasks; a USBT and repeated SLHR. Balance success was defined as a 10-second stance. For those who were successful, center of pressure (COP) data in anterior-posterior (AP) and medial-lateral (ML) directions were recorded as a measure of postural sway. SLHR performance was divided into 3 bins (≤2; 3-9 and > 10 repetitions). The between-balance success on performing the SLHR test was analyzed using the Fisher's exact test (2 × 3). Independent t tests were used to compare between-group differences in postural sway. Relationship of postural sway to the number of heel raises was assessed using Spearman's rho. The success rate of the USBT was significantly lower in women with TPTD than the controls (47% vs 85%, P = .041). In addition, women with TPTD who completed the USBT exhibited increased AP COP displacement (14.0 ± 7.4 vs 8.4 ± 1.3 mm, P = .008), and a strong trend of increased ML COP displacement (8.3 ± 4.5 vs 6.1 ± 1.2 mm, P = .050). The success rate of USBT was correlated with the number of SLHR (P = .01). The AP and ML COP displacement were correlated with SLHR (r = -.538 and .495), respectively. Women with TPTD have difficulty in performing the USBT. Performance of the USBT and SLHR are highly correlated and predictive of each other. A unipedal balance test may be used as a proxy TPTD assessment tool to the heel raising test when pain prevents performance. Level III, case control study. © The Author(s) 2014.

Feedforward neural control of toe walking in humans.

PubMed

Lorentzen, Jakob; Willerslev-Olsen, Maria; Hüche Larsen, Helle; Svane, Christian; Forman, Christian; Frisk, Rasmus; Farmer, Simon Francis; Kersting, Uwe; Nielsen, Jens Bo

2018-03-23

Activation of ankle muscles at ground contact during toe walking is unaltered when sensory feedback is blocked or the ground is suddenly dropped. Responses in the soleus muscle to transcranial magnetic stimulation, but not peripheral nerve stimulation, are facilitated at ground contact during toe walking. We argue that toe walking is supported by feedforward control at ground contact. Toe walking requires careful control of the ankle muscles in order to absorb the impact of ground contact and maintain a stable position of the joint. The present study aimed to clarify the peripheral and central neural mechanisms involved. Fifteen healthy adults walked on a treadmill (3.0 km h -1 ). Tibialis anterior (TA) and soleus (Sol) EMG, knee and ankle joint angles, and gastrocnemius-soleus muscle fascicle lengths were recorded. Peripheral and central contributions to the EMG activity were assessed by afferent blockade, H-reflex testing, transcranial magnetic brain stimulation (TMS) and sudden unloading of the planter flexor muscle-tendon complex. Sol EMG activity started prior to ground contact and remained high throughout stance. TA EMG activity, which is normally seen around ground contact during heel strike walking, was absent. Although stretch of the Achilles tendon-muscle complex was observed after ground contact, this was not associated with lengthening of the ankle plantar flexor muscle fascicles. Sol EMG around ground contact was not affected by ischaemic blockade of large-diameter sensory afferents, or the sudden removal of ground support shortly after toe contact. Soleus motor-evoked potentials elicited by TMS were facilitated immediately after ground contact, whereas Sol H-reflexes were not. These findings indicate that at the crucial time of ankle stabilization following ground contact, toe walking is governed by centrally mediated motor drive rather than sensory driven reflex mechanisms. These findings have implications for our understanding of the control of human gait during voluntary toe walking. © 2018 The Authors. The Journal of Physiology © 2018 The Physiological Society.

Dynamic restraint capacity of the hamstring muscles has important functional implications after anterior cruciate ligament injury and anterior cruciate ligament reconstruction.

PubMed

Bryant, Adam L; Creaby, Mark W; Newton, Robert U; Steele, Julie R

2008-12-01

The purpose of this study was to investigate the relation between knee functionality of anterior cruciate ligament deficient (ACLD) and anterior cruciate ligament reconstruction (ACLR) patients and hamstring antagonist torque generated during resisted knee extension. Cross-sectional. Laboratory based. Male ACLD subjects (n=10) (18-35 y) and 27 matched males who had undergone ACLR (14 patella tendon [PT] grafts and 13 combined semitendinosus/gracilis tendon grafts). Not applicable. Knee functionality was rated (0- to 100-point scale) by using the Cincinnati Knee Rating System. Using electromyography data from the semitendinosus (ST) and biceps femoris muscles, we created a mathematical model to estimate the opposing torque generated by the hamstrings during isokinetic knee extension in 10 degrees intervals from 80 degrees to 10 degrees knee flexion. Pearson product-moment correlations revealed that more functional ACLD subjects generated significantly (P<.05) higher hamstring antagonist torque throughout knee extension. In contrast, more functional PT subjects produced significantly lower hamstring antagonist torque at 80 degrees to 70 degrees knee flexion, whereas no significant associations were found between hamstring antagonist torque and knee functionality for the ST/gracilis tendon subjects. An increased hamstring antagonist torque generated by the more functional ACLD subjects, reflective of increased hamstring contractile force, is thought to represent a protective mechanism to compensate for mechanical instability. The restoration of anterior knee stability through ACLR negates the need for augmented hamstring antagonist torque.

Limited fiber type grouping in self-reinnervation cat tibialis anterior muscles.

PubMed

Unguez, G A; Roy, R R; Bodine-Fowler, S; Edgerton, V R

1996-10-01

The percent and distribution patterns of three immunohistochemically identified fiber types within the anterior compartment of the cat tibialis anterior were determined 6 months after denervation and self-reinnervation. After self-reinnervation, mean frequencies of slow (9%) and fast (91%) fibers were similar to those in control (12% and 88%, respectively) muscles. However, a lower proportion of fast-1 (26%) and a higher proportion of fast-2 (65%) fibers were observed in self-reinnervated than control (32% and 56%) muscles. Quantitation of adjacencies between fibers of similar myosin heavy chain (MHC) phenotype, a measure of type grouping, revealed that the frequencies of two slow or two fast-1 fibers being adjacent in self-reinnervated muscles were similar to control. In contrast, the frequency of fast-2/fast-2 fiber adjacencies found in self-reinnervated muscles (45%) was significantly higher than in control muscles (37%). In both groups, the frequency of adjacencies between slow, fast-1, or fast-2 fibers was largely attributable to the number of each fiber type present. These data show that the incidence of grouping within each fiber type present was not altered after 6 months of self-reinnervation. Minimal changes in the spatial distribution of fiber types following self-reinnervation in adults suggests a limited degree of conversion of muscle fibers to a MHC phenotype matching the motoneuron characteristics.

Effect of Forefoot Strike on Lower Extremity Muscle Activity and Knee Joint Angle During Cutting in Female Team Handball Players.

PubMed

Yoshida, Naruto; Kunugi, Shun; Mashimo, Sonoko; Okuma, Yoshihiro; Masunari, Akihiko; Miyazaki, Shogo; Hisajima, Tatsuya; Miyakawa, Shumpei

2015-06-01

The purpose of this study is to examine the effects of different strike forms, during cutting, on knee joint angle and lower limb muscle activity. Surface electromyography was used to measure muscle activity in individuals performing cutting manoeuvres involving either rearfoot strikes (RFS) or forefoot strikes (FFS). Three-dimensional motion analysis was used to calculate changes in knee angles, during cutting, and to determine the relationship between muscle activity and knee joint angle. Force plates were synchronized with electromyography measurements to compare muscle activity immediately before and after foot strike. The valgus angle tends to be smaller during FFS cutting than during RFS cutting. Just prior to ground contact, biceps femoris, semitendinosus, and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was greater during RFS cutting. Immediately after ground contact, biceps femoris and lateral head of the gastrocnemius muscle activities were significantly greater during FFS cutting than during RFS cutting; tibialis anterior muscle activity was significantly lower during FFS cutting. The results of the present study suggest that the hamstrings demonstrate greater activity, immediately after foot strike, during FFS cutting than during RFS cutting. Thus, FFS cutting may involve a lower risk of anterior cruciate ligament injury than does RFS cutting.

Rupture of the subscapularis tendon after shoulder arthroplasty: diagnosis, treatment, and outcome.

PubMed

Miller, Bruce S; Joseph, Thomas A; Noonan, Thomas J; Horan, Marilee P; Hawkins, Richard J

2005-01-01

The purpose of this study was to document the diagnosis, surgical treatment, and functional outcome in patients with subscapularis ruptures after shoulder arthroplasty. Prospective objective and subjective data were collected on 7 patients with symptomatic rupture of the subscapularis tendon after shoulder arthroplasty. Presenting signs and symptoms included pain, weakness in internal rotation, increased external rotation, and anterior instability. All patients were treated with surgical repair of the ruptured tendon. Four required repair augmentation with a transfer of the pectoralis major tendon. After subscapularis repair and pectoralis transfer, 2 patients continued to have anterior instability and required an additional operation to address the instability. At a mean follow-up of 2.3 years (range, 18-55 months), the mean American Shoulder and Elbow Surgeons shoulder score in this study group was 63.2. The mean patient satisfaction rating, on a 10-point scale, was 6.2. Factors associated with post-arthroplasty subscapularis ruptures included subscapularis lengthening techniques used to address internal rotation contracture and previous surgery that violated the subscapularis tendon. Symptomatic subscapularis rupture after shoulder arthroplasty introduces the need for additional surgery and a period of protected or delayed rehabilitation after arthroplasty. Although symptoms were adequately addressed with appropriate surgical treatment, decreased functional outcomes were observed.

Effects of spaceflight on rhesus quadrupedal locomotion after return to 1G

NASA Technical Reports Server (NTRS)

Recktenwald, M. R.; Hodgson, J. A.; Roy, R. R.; Riazanski, S.; McCall, G. E.; Kozlovskaya, I.; Washburn, D. A.; Fanton, J. W.; Edgerton, V. R.; Rumbaugh, D. M. (Principal Investigator)

1999-01-01

Effects of spaceflight on Rhesus quadrupedal locomotion after return to 1G. Locomotor performance, activation patterns of the soleus (Sol), medial gastrocnemius (MG), vastus lateralis (VL), and tibialis anterior (TA) and MG tendon force during quadrupedal stepping were studied in adult Rhesus before and after 14 days of either spaceflight (n = 2) or flight simulation at 1G (n = 3). Flight simulation involved duplication of the spaceflight conditions and experimental protocol in a 1G environment. Postflight, but not postsimulation, electromyographic (EMG) recordings revealed clonus-like activity in all muscles. Compared with preflight, the cycle period and burst durations of the primary extensors (Sol, MG, and VL) tended to decrease postflight. These decreases were associated with shorter steps. The flexor (TA) EMG burst duration postflight was similar to preflight, whereas the burst amplitude was elevated. Consequently, the Sol:TA and MG:TA EMG amplitude ratios were lower following flight, reflecting a "flexor bias." Together, these alterations in mean EMG amplitudes reflect differential adaptations in motor-unit recruitment patterns of flexors and extensors as well as fast and slow motor pools. Shorter cycle period and burst durations persisted throughout the 20-day postflight testing period, whereas mean EMG returned to preflight levels by 17 days postflight. Compared with presimulation, the simulation group showed slight increases in the cycle period and burst durations of all muscles. Mean EMG amplitude decreased in the Sol, increased in the MG and VL, and was unchanged in the TA. Thus adaptations observed postsimulation were different from those observed postflight, indicating that there was a response unique to the microgravity environment, i.e., the modulations in the nervous system controlling locomotion cannot merely be attributed to restriction of movement but appear to be the result of changes in the interpretation of load-related proprioceptive feedback to the nervous system. Peak MG tendon force amplitudes were approximately two times greater post- compared with preflight or presimulation. Adaptations in tendon force and EMG amplitude ratios indicate that the nervous system undergoes a reorganization of the recruitment patterns biased toward an increased recruitment of fast versus slow motor units and flexor versus extensor muscles. Combined, these data indicate that some details of the control of motor pools during locomotion are dependent on the persistence of Earth's gravitational environment.

Location of Rotator Cuff Tear Initiation: A Magnetic Resonance Imaging Study of 191 Shoulders.

PubMed

Jeong, Jeung Yeol; Min, Seul Ki; Park, Keun Min; Park, Yong Bok; Han, Kwang Joon; Yoo, Jae Chul

2018-03-01

Degenerative rotator cuff tears (RCTs) are generally thought to originate at the anterior margin of the supraspinatus tendon. However, a recent ultrasonography study suggested that they might originate more posteriorly than originally thought, perhaps even from the isolated infraspinatus (ISP) tendon, and propagate toward the anterior supraspinatus. Hypothesis/Purpose: It was hypothesized that this finding could be reproduced with magnetic resonance imaging (MRI). The purpose was to determine the most common location of degenerative RCTs by using 3-dimensional multiplanar MRI reconstruction. It was assumed that the location of the partial-thickness tears would identify the area of the initiation of full-thickness tears. Cross-sectional study; Level of evidence, 3. A retrospective analysis was conducted including 245 patients who had RCTs (nearly full- or partial-thickness tears) at the outpatient department between January 2011 and December 2013. RCTs were measured on 3-dimensional multiplanar reconstruction MRI with OsiriX software. The width and distance from the biceps tendon to the anterior margin of the tear were measured on T2-weighted sagittal images. In a spreadsheet, columns of consecutive numbers represented the size of each tear (anteroposterior width) and their locations with respect to the biceps brachii tendon. Data were pooled to graphically represent the width and location of all tears. Frequency histograms of the columns were made to visualize the distribution of tears. The tears were divided into 2 groups based on width (group A, <10 mm; group B, <20 and ≥10 mm) and analyzed for any differences in location related to size. The mean width of all RCTs was 11.9 ± 4.1 mm, and the mean length was 11.1 ± 5.0 mm. Histograms showed the most common location of origin to be 9 to 10 mm posterior to the biceps tendon. The histograms of groups A and B showed similar tear location distributions, indicating that the region approximately 10 mm posterior to the biceps tendon is the most common site of tear initiation. These results demonstrate that degenerative RCTs most commonly originate from approximately 9 to 10 mm posterior to the biceps tendon.

Extrarticular hip impingement.

PubMed

Marin-Peña, Óliver; Sierra-Madrid, Pablo; Lax-Pérez, Raquel; Ferrero-Manzanal, Francisco

2016-05-14

Extrarticular causes of impingement have a current, interesting role in the complaint of groin pain in athletes. Subspine impingement is related to a prominent anterior inferior iliac spine (AIIS) and is actually described as a frequent cause of groin pain. Ischiofemoral impingement is described when the space between the lesser trochanter is decreased. Psoas impingement appears between the psoas tendon and the anterior labrum and anterior acetabular rim.

MRI findings associated with luxatio erecta humeri.

PubMed

Krug, David K; Vinson, Emily N; Helms, Clyde A

2010-01-01

Luxatio erecta humeri is a rare type of inferior glenohumeral dislocation with a unique radiographic appearance; however, the magnetic resonance imaging findings associated with this dislocation have not been described in the radiology literature. The purpose of this study is to identify magnetic resonance imaging findings associated with this uncommon type of glenohumeral dislocation. The magnetic resonance imaging features of four patients with clinical and radiographic evidence of luxatio erecta humeri were reviewed retrospectively by two musculoskeletal-trained radiologists. The reported mechanism of injury in all four patients was falling. The MR imaging examinations were evaluated for the presence of rotator cuff and biceps tendon pathology, glenoid labrum pathology, joint capsule and glenohumeral ligament injury, fractures and bone marrow contusions, articular cartilage injury, and joint effusions. All four patients demonstrated pathology of the glenohumeral joint. Three of the four patients demonstrated rotator cuff tears, including large full thickness tears of the supraspinatus and infraspinatus tendons in two patients, and small full thickness tear of the supraspinatus tendon with partial thickness tear of the infraspinatus tendon in the third patient. In the two patients with large full thickness tears of the supraspinatus and infraspinatus tendons, one patient demonstrated tearing of the subscapularis tendon with dislocation of a partially torn long head of the biceps tendon, and the second patient demonstrated full thickness tearing of the intra-articular biceps tendon. All four patients demonstrated injuries to the glenoid labrum and both anterior and posterior bands of the inferior glenohumeral ligament. Contusions or fractures of the humeral head were seen in two of the patients. Three of the four patients demonstrated cartilage abnormalities including a focal cartilage defect in the anterior inferior glenoid in one patient, and cartilage surface irregularity of the glenoid in the other two patients. Common magnetic resonance imaging findings in patients with a prior luxatio erecta humeri dislocation include rotator cuff tears, injury to the glenoid labrum, and injury to both the anterior and posterior bands of the inferior glenohumeral ligament. These findings are compatible with the mechanism of dislocation in luxatio erecta, and noting these findings on magnetic resonance imaging may suggest that the patient has sustained a prior inferiorly directed glenohumeral dislocation such as luxatio erecta.

Use of Posterior Hamstring Harvest During Anterior Cruciate Ligament Reconstruction in the Pediatric and Adolescent Population.

PubMed

Khanna, Krishn; Janghala, Abhinav; Pandya, Nirav K

2018-06-01

Posterior hamstring harvest has been described in the adult population in a limited fashion, but no study is available describing the use of posterior hamstring harvest in an active pediatric and adolescent cohort. At times, surgeons may be faced with a challenging anterior harvest due to patient anatomic characteristics, particularly the anatomic features and size of the pes tendons. Clinicians need to have multiple harvest approaches at their disposal. Complications with hamstring harvest such as premature graft transection are more problematic in this population due to higher failure rates with allograft tissue. The posterior harvest via its more proximal location may allow for easier tendon identification, visualization of the accessory attachments, and longer preserved tendon length if transection error occurs when the anterior approach is avoided based on surgical technique, patient anatomic characteristics, and surgeon and patient preference. To describe the technique of a posterior hamstring harvest in pediatric and adolescent patients and to analyze complications. Case series; Level of evidence, 4. This study was a retrospective review of a consecutive series of pediatric and adolescent patients who underwent posterior hamstring harvest. During surgery, the patient's leg was abducted and externally rotated to expose the posteromedial aspect of the knee. A 2-cm incision was made overlying the palpable medial hamstring at the popliteal crease. The posterior hamstring tendons were first harvested proximally with an open tendon stripper and distally with a closed stripper. Preoperative, intraoperative, and postoperative findings and complications were analyzed. A total of 214 patients (mean ± SD age, 15.7 ± 4.1 years; range, 8.0-19.8 years) underwent posterior harvest, with a mean ± SD follow-up of 1.83 ± 1.05 years. No complications occurred in our series related to graft harvest-no graft transections, neurovascular injuries, secondary procedures for wound healing or closure, cosmetic concerns, or limitations in return to activity due to the posterior incision. The posterior hamstring harvest is a safe and reliable technique to harvest autograft tendon in pediatric and adolescent anterior cruciate ligament reconstructions. The posterior technique entailed no complications related to harvest. No patients expressed any cosmetic concerns about their incision or had limitations in return to sport due to the posterior harvest.

All-Inside Single-Bundle Reconstruction of the Anterior Cruciate Ligament with the Anterior Half of the Peroneus Longus Tendon Compared to the Semitendinosus Tendon: A Two-Year Follow-Up Study.

PubMed

Bi, Mingguang; Zhao, Chen; Zhang, Shuijun; Yao, Bin; Hong, Zheping; Bi, Qing

2018-02-08

The anterior half of the peroneus longus tendon (AHPLT) has been reported to be acceptable for ligament reconstruction with respect to strength and safety. However, there is little information regarding the clinical outcomes after using the AHPLT compared with other autograft tendons. A prospective randomized controlled study was performed to compare the results of 62 cases of all-inside anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using the AHPLT and 62 cases using semitendinosus graft with an average of 30.0 ± 3.6 months' follow-up. Tunnel placements of enrolled cases were measured on three-dimensional (3D) computed tomography (CT) and X-ray imaging. Knee stability was assessed using the anterior drawer test, pivot shift test, and KT-1000. The International Knee Documentation Committee (IKDC) 2000 subjective score was used to evaluate functional outcomes. The American Orthopedic Foot and Ankle Score (AOFAS) and the assessment of eversion muscle strength were performed to evaluate the function of the ankle donor site. Tunnel positions, which were confirmed with 3D CT, were in the anatomical positions. At the final follow-up, there were no significant differences between the semitendinosus group and the AHPLT group in the IKDC score (90.4 ± 7.1 vs. 89.3. ± 8.4), KT 1000 measurements (1.71 ± 0.57 vs. 1.85 ± 0.77), pivot shift test, and Visual Analogue Scale (VAS) (0.15 ± 0.36 vs. 0.10 ± 0.30). No obvious ankle site complications were found at 24 months. The average AOFAS score of the AHPLT group was comparable to that of the semitendinosus tendon group (99.1 ± 1.40 vs. 99.5 ± 1.21). There was no significant difference in clinical outcomes or knee stability between the semitendinosus group and the AHPLT group at the 2-year follow-up. An AHPLT autograft may be a good alternative for all-inside ACL reconstruction with respect to its strength, safety, and donor site morbidity. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasound in Total Hip Replacement: Value of Anterior Acetabular Cup Visibility and Contact With the Iliopsoas Tendon.

PubMed

Guillin, Raphaël; Bertaud, Valérie; Garetier, Marc; Fantino, Olivier; Polard, Jean-Louis; Lambotte, Jean-Christophe

2018-06-01

To assess visibility of the acetabular cup in total hip replacement and to determine the value of direct and indirect signs of iliopsoas impingement syndrome with ultrasound. Ultrasound examinations were performed by a single operator in 17 patients with iliopsoas impingement syndrome and 48 control patients. Cup visibility, contact between the cup and psoas tendon, and the presence of indirect signs of iliopsoas impingement syndrome were investigated in all patients. When the acetabular cup was visible, its size and position in relation to the psoas tendon were recorded. Anterior cup visibility (P = .03), contact with the psoas tendon (P < .001), psoas tendinopathy (P = .02), and iliopsoas bursitis (P < .001) were significantly associated with iliopsoas impingement syndrome, the latter reported with specificity of 100%. In the sagittal plane at the level of the psoas tendon, a maximum sagittal length of greater than 5 mm and a posteroanterior cup shift of 3 mm or greater yielded respective sensitivities of 82% and 59% and specificities of 81% and 100%. When iliopsoas impingement syndrome is clinically suspected, the presence of iliopsoas bursitis or a posteroanterior cup shift of greater than 3 mm under the psoas tendon serve to confirm the diagnosis. In the absence of these conditions, a therapeutic test may be necessary because of the incomplete, albeit high, specificity of other signs. © 2017 by the American Institute of Ultrasound in Medicine.

Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial.

PubMed

Kristensen, Pia Kjær; Pfeiffer-Jensen, Mogens; Storm, Jens Ole; Thillemann, Theis Muncholm

2014-02-01

Arthroscopic anterior cruciate ligament (ACL) reconstruction is a painful procedure requiring intensive postoperative pain management. Femoral nerve block is widely used in ACL surgery. However, femoral nerve block does not cover the donor site of the hamstring tendons. Local infiltration analgesia is a simple technique that has proven effective in postoperative pain management after total knee arthroplasty. Further, local infiltration analgesia covers the donor site and is associated with few complications. It was hypothesised that local infiltration analgesia at the donor site and wounds would decrease pain and opioid consumption after ACL reconstruction with hamstring tendon graft. Sixty patients undergoing primary ACL surgery with hamstring tendon graft were randomised to receive either local infiltration analgesia or femoral nerve block. Pain was scored on the numeric rating scale, and use of opioid, range of motion and adverse effects were assessed at the postoperative recovery unit (0 h), 3, 24 and 48 h, postoperatively. There were no significant differences between the groups in pain intensity or total opioid consumption at any of the follow-up points. Further, there were no differences between groups concerning side effects and range of motion. Local infiltration analgesia and femoral nerve block are similar in the management of postoperative pain after ACL reconstruction with hamstring tendon graft. Until randomised studies have investigated femoral nerve block combined with infiltration at the donor site, we recommend local infiltration analgesia in ACL reconstruction with hamstring tendon graft.

Outcomes and complications following graft reconstruction for anterior sternoclavicular joint instability.

PubMed

Willinger, Lukas; Schanda, Jakob; Herbst, Elmar; Imhoff, Andreas B; Martetschläger, Frank

2016-12-01

Publications describing tendon graft reconstruction for anterior sternoclavicular joint (SCJ) instability are rare and usually refer to small patient numbers. The aim of this study was to systematically review the literature regarding outcomes and complications following tendon graft reconstruction techniques for anterior SCJ instability. An online database was systematically searched to identify studies on graft reconstruction for anterior SCJ instability. Reported outcome scores were graded as excellent, good, fair and poor to summarize the study results. All reported complications were recorded. Five articles with a total of 80 patients met the inclusion criteria. Reported outcomes were excellent in 10 %, good in 89 % and fair in 1 %. Recurrent instability was found in 10 % of the patients, and 5 % underwent revision surgery due to persistent impairment of shoulder function related to SCJ instability or osteoarthritis. Surgical stabilization techniques for the SCJ using autologous tendon grafts have shown to be safe and reliable and make better patients' pain situation and shoulder function. However, a certain amount of impairment might persist, which needs to be discussed with patients. Severe complications were rare and revision rates were as low as 5 %. Therefore, graft reconstruction techniques should be considered for patients with chronic anterior SCJ instability after a course of failed conservative treatment. This study is valuable for clinicians in daily clinical practice when dealing with this difficult-to-treat pathology and can help surgeons to better predict the clinical outcomes and complications following SCJ graft reconstruction. It should, however, not lead to underestimation of the potential risks of the procedure. Systematic review, Level IV.

A Comparative Animal Study of Tendon Grafts Healing After Remnant-Preserving Versus Conventional Anterior Cruciate Ligament Reconstruction

PubMed Central

Zhang, Lei; Jiang, Kan; Chai, Hao; Zhou, Mei; Bai, Jingping

2016-01-01

Background The aim of this study was to determine if anterior cruciate ligament (ACL) reconstruction by remnant preservation promotes cell proliferation, vascularization, proprioception recovery, and improved biomechanical properties of the tendon grafts. Material/Methods 75 New Zealand rabbits were randomly assigned into the control group (group A), conventional ACL reconstruction group (group B), ACL reconstruction using remnant preservation and graft through remnant sleeve technique group (group C), and ACL reconstruction using remnant preservation and remnant tensioning technique group (group D). The remnant and healing of tendon grafts in groups C and D were observed at 3, 6, and 12 weeks after surgery, and the mRNA expression levels of VEGF, NT-3 and GAP-43 in ACL (group A) or tendon graft samples (groups B, C, and D) were determined by real-time PCR. Tendon graft cell count, microvessel density (MVD), and proprioceptors were determined by H&E staining, CD34, and S-100 immunohistochemical staining. The biomechanical properties of the tendon graft at week 12 in groups B, C, and D were examined by using a tensile strength test. Results Remnant and tendon grafts were not healed at 3, 6, and 12 weeks after the operation in groups C and D. VEGF, NT-3, and GAP-43 mRNA expressions in groups B, C, and D were higher than those in group A (P<0.05), but no significant difference was observed between groups B, C, and D (P>0.05). Furthermore, tendon graft cell count, MVD, proprioception, and biomechanical properties showed no significant differences (P>0.05) among groups B, C, and D at various time points. Conclusions There was no significant difference in cell proliferation, vascularization, proprioception recovery, or biomechanical properties of the tendon grafts between remnant-preserving and conventional ACL reconstruction methods. PMID:27669454

The Effects of Exercise on the Firing Patterns of Single Motor Units.

ERIC Educational Resources Information Center

Cracraft, Joe D.

In this study, the training effects of static and dynamic exercise programs on the firing patterns of 450 single motor units (SMU) in the human tibialis anterior muscle were investigated. In a six week program, the static group (N=5) participated in daily high intensity, short duration, isometric exercises while the dynamic group (N=5)…

Neuromuscular Activation During Short-Track Speed Skating in Young Athletes.

PubMed

Felser, Sabine; Behrens, Martin; Fischer, Susanne; Baeumler, Mario; Salomon, Ralf; Bruhn, Sven

2016-10-01

To investigate differences in muscle activation of both legs between the straight and the curve and changes in muscle activity during a 1000-m time trial (TT) and their relationship to the change in skating velocity in 9 young short-track speed skaters. The authors recorded skating times and EMG data from different leg muscles during maximum-effort skating trials on the straight and in the curve, as well as during a 1000-m TT. Muscle activation differs between the straight and the curves and between legs; ie, average activities of selected muscles of the right leg were significantly higher during skating through the curves than in the straights. This could not be observed for the left leg. The reduction in speed during the 1000-m TT highly correlates with the decrease in the muscle activity of both the tibialis anterior and the rectus femoris of the right leg. Muscle recruitment is different in relation to lap section (straight vs curve) and leg (right vs left leg). The decreased muscle activity of the tibialis anterior and rectus femoris of the right leg showed the highest relationships with the reduction in skating speed during the 1000-m TT.

Change of muscle architecture following body weight support treadmill training for persons after subacute stroke: evidence from ultrasonography.

PubMed

Liu, Peng; Wang, Yanjun; Hu, Huijing; Mao, Yurong; Huang, Dongfeng; Li, Le

2014-01-01

Although the body weight support treadmill training (BWSTT) in rehabilitation therapy has been appreciated for a long time, the biomechanical effects of this training on muscular system remain unclear. Ultrasonography has been suggested to be a feasible method to measure muscle morphological changes after neurological diseases such as stroke, which may help to enhance the understanding of the mechanism underlying the impaired motor function. This study investigated the muscle architectural changes of tibialis anterior and medial gastrocnemius in patients after subacute stroke by ultrasound. As expected, we found the effect of BWSTT on the muscular system. Specifically, the results showed larger pennation angle and muscle thickness of tibialis anterior and longer fascicle length of medial gastrocnemius after the training. The findings of this study suggest that the early rehabilitation training of BWSTT in subacute stage of stroke provides positive changes of the muscle architecture, leading to the potential improvement of the force generation of the muscle. This may not only help us understand changes of subacute stroke in muscular system but also have clinical implications in the evaluation of rehabilitation training after neurological insults.

A comparative study of the electromyographic activities of lower extremity muscles during level walking and Pedalo riding

PubMed Central

Lee, DongGeon; Kim, YouJeong; Yun, JiHyeon; Jung, MiHye; Lee, GyuChang

2016-01-01

[Purpose] To analyze the electromyographic (EMG) activities of several lower extremity muscles during ground walking and pedaling using the Pedalo Reha-Bar device. [Subjects and Methods] Fifteen healthy adults aged 20–29 year participated in this study. The subjects’ surface EMG signals while walking and Pedalo Reha-Bar riding were recorded. The subjects performed 20 steps on flat ground and 20 cycles on the Pedalo Reha-Bar. During the tasks, EMG signals of the rectus femoris, biceps femoris, tibialis anterior, soleus, and gastrocnemius within a 20-second period were recorded. The mean EMG signals within the 10 seconds from 6 to 15 seconds were used for the data analysis. [Results] There was a significant increase in the bilateral use of the rectus femoris and a significant decrease in the use of the left tibialis anterior and left soleus in pedaling using the Pedalo Reha-Bar device compared to ground walking. [Conclusion] Level walking and the Pedalo Reha-Bar riding utilize different types of muscles activities. These results suggest that Pedalo Reha-Bar riding may be used for neuromuscular activation, especially of the rectus femoris. PMID:27313354

Effects of microgravity and tail suspension on enzymes of individual soleus and tibialis anterior fibers

NASA Technical Reports Server (NTRS)

Chi, Maggie M.-Y.; Choski, Rati; Nemeth, Patti; Krasnov, Igor'; Il'ina-Kakueva, E. I.; Manchester, Jill K.; Lowry, Oliver H.

1992-01-01

Selected enzymes of energy metabolism were measured in random individual fibers of soleus and tibialis anterior (TA) muscles from rats exposed for 2 wk to spaceflight (F) aboard Cosmos 2044 or tail suspension (T) and from synchronous controls. Average size of soleus fibers (dry weight per unit length) was reduced 37 percent in F and T fibers; there was little change in Ta fibers. Enzyme changes were more pronounced in soleus than in TA fibers. Three enzymes characteristic of fast-twitch muscles, pyruvate kinase, glycerol-3-phosphate dehydrogenase, and 1-phosphofructokinase, were elevated in F and T soleus fibers, but changes in phosphofructokinase were not statistically significant. In TA fibers analyzed for hexokinase, malate dehydrogenase, phosphohexoisomerase, and pyruvate kinase, only hexokinase and malate dehydrogenase showed significant changes. Hexokinase incresed 83 percent in one of two T muscles. Enzyme data for TA fibers typed by myosin adenosinetriphosphatase were more informative: phosphofructokinase, phosphorylase, and glycerol-3-phosphate dehydrogenase were increased in type IIn fibers of either F or T muscles or both. Malate dehydrogenase was not changed in fibers of any type in either F or T muscle.

Altered Pain Sensitivity in Elderly Women with Chronic Neck Pain

PubMed Central

Uthaikhup, Sureeporn; Prasert, Romchat; Paungmali, Aatit; Boontha, Kritsana

2015-01-01

Background Age-related changes occur in both the peripheral and central nervous system, yet little is known about the influence of chronic pain on pain sensitivity in older persons. The aim of this study was to investigate pain sensitivity in elders with chronic neck pain compared to healthy elders. Methods Thirty elderly women with chronic neck pain and 30 controls were recruited. Measures of pain sensitivity included pressure pain thresholds, heat/cold pain thresholds and suprathreshold heat pain responses. The pain measures were assessed over the cervical spine and at a remote site, the tibialis anterior muscle. Results Elders with chronic neck pain had lower pressure pain threshold over the articular pillar of C5-C6 and decreased cold pain thresholds over the cervical spine and tibialis anterior muscle when compared with controls (p < 0.05). There were no between group differences in heat pain thresholds and suprathreshold heat pain responses (p > 0.05). Conclusion The presence of pain hypersensitivity in elderly women with chronic neck pain appears to be dependent on types of painful stimuli. This may reflect changes in the peripheral and central nervous system with age. PMID:26039149

Transversal stiffness of fibers and desmin content in leg muscles of rats under gravitational unloading of various durations.

PubMed

Ogneva, I V

2010-12-01

The aim of this research was the analysis of structural changes in various parts of the sarcolemma and contractile apparatus of muscle fibers by measuring their transversal stiffness by atomic force microscopy under gravitational unloading. Soleus, medial gastrocnemius, and tibialis anterior muscles of Wistar rats were the objects of the study. Gravitational unloading was carried out by antiorthostatic suspension of hindlimbs for 1, 3, 7, and 12 days. It was shown that the transversal stiffness of different parts of the contractile apparatus of soleus muscle fibers decreases during gravitational unloading in the relaxed, calcium-activated, and rigor states, the fibers of the medial gastrocnemius show no changes, whereas the transversal stiffness of tibialis anterior muscle increases. Thus the transversal stiffness of the sarcolemma in the relaxed state is reduced in all muscles, which may be due to the direct action of gravity as an external mechanical factor that can influence the tension on a membrane. The change of sarcolemma stiffness in activated fibers, which is due probably to the transfer of tension from the contractile apparatus, correlates with the dynamics of changes in the content of desmin.

[Changes in cell respiration of postural muscle fibers under long-term gravitational unloading after dietary succinate supplementation].

PubMed

Ogneva, I V; Veselova, O M; Larina, I M

2011-01-01

The intensity of cell respiration of the rat m. soleus, m. gastrocnemius c.m. and tibialis anterior fibers during 35-day gravitational unloading, with the addition of succinate in the diet at a dosage rate of 50 mg per 1 kg animal weight has been investigated. The gravitational unloading was modeled by antiorthostatic hindlimb suspension. The intensity of cell respiration was estimated by polarography. It was shown that the rate of oxygen consumption by soleus and gastrocnemius fibers on endogenous and exogenous substrates and with the addition of ADP decreases after the discharge. This may be associated with the transition to the glycolytic energy path due to a decrease in the EMG-activity. At the same time, the respiration rate after the addition of exogenous substrates in soleus fibers did not increase, indicating a disturbance in the function of the NCCR-section of the respiratory chain and more pronounced changes in the structure of muscle fibers. In tibialis anterior fibers, no changes in oxygen consumption velocity were observed. The introduction of succinate to the diet of rats makes it possible to prevent the negative effects of hypokinesia, although it reduces the basal level of intensity of cell respiration.

Age-Associated Changes in the Spectral and Statistical Parameters of Surface Electromyogram of Tibialis Anterior

PubMed Central

2016-01-01

Age-related neuromuscular change of Tibialis Anterior (TA) is a leading cause of muscle strength decline among the elderly. This study has established the baseline for age-associated changes in sEMG of TA at different levels of voluntary contraction. We have investigated the use of Gaussianity and maximal power of the power spectral density (PSD) as suitable features to identify age-associated changes in the surface electromyogram (sEMG). Eighteen younger (20–30 years) and 18 older (60–85 years) cohorts completed two trials of isometric dorsiflexion at four different force levels between 10% and 50% of the maximal voluntary contraction. Gaussianity and maximal power of the PSD of sEMG were determined. Results show a significant increase in sEMG's maximal power of the PSD and Gaussianity with increase in force for both cohorts. It was also observed that older cohorts had higher maximal power of the PSD and lower Gaussianity. These age-related differences observed in the PSD and Gaussianity could be due to motor unit remodelling. This can be useful for noninvasive tracking of age-associated neuromuscular changes. PMID:27610379

Interlimb relation during the double support phase of gait: an electromyographic, mechanical and energy-based analysis.

PubMed

Sousa, Andreia S P; Silva, Augusta; Tavares, João Manuel R S

2013-03-01

The purpose of this study is to analyse the interlimb relation and the influence of mechanical energy on metabolic energy expenditure during gait. In total, 22 subjects were monitored as to electromyographic activity, ground reaction forces and VO2 consumption (metabolic power) during gait. The results demonstrate a moderate negative correlation between the activity of tibialis anterior, biceps femoris and vastus medialis of the trailing limb during the transition between mid-stance and double support and that of the leading limb during double support for the same muscles, and between these and gastrocnemius medialis and soleus of the trailing limb during double support. Trailing limb soleus during the transition between mid-stance and double support was positively correlated to leading limb tibialis anterior, vastus medialis and biceps femoris during double support. Also, the trailing limb centre of mass mechanical work was strongly influenced by the leading limbs, although only the mechanical power related to forward progression of both limbs was correlated to metabolic power. These findings demonstrate a consistent interlimb relation in terms of electromyographic activity and centre of mass mechanical work, being the relations occurred in the plane of forward progression the more important to gait energy expenditure.

An Acute Bout of Barefoot Running Alters Lower-limb Muscle Activation for Minimalist Shoe Users.

PubMed

Snow, N J; Basset, F A; Byrne, J

2016-05-01

Despite the abundance of barefoot running-related research, there have been no electromyography studies evaluating the effects of this mode of exercise on habitual users of minimalist footwear. The present study investigated differences in muscle activation during acute bouts of barefoot and shod running, in minimalist shoe users. 8 male participants ran on a motorized treadmill for 10 min under both conditions, at 70% maximal aerobic speed. Electromyographic data were sampled from the biceps femoris, gluteus maximus, gastrocnemius medialis, tibialis anterior, and vastus lateralis during both swing and stance. Root-mean-square analysis of electromyographic data was conducted to compare muscle activation between conditions. During stance, barefoot running resulted in greater muscle activity in gastrocnemius medialis and gluteus maximus, and lower muscle activity in tibialis anterior. During swing, barefoot running resulted in increased muscle activity in vastus lateralis and gastrocnemius medialus. These results indicate that, for minimalist shoe users, an acute bout of barefoot running results in significantly different lower-limb muscle activity. Increased activation in the above muscles presents a possible mechanism for injury, which should be considered during exercise prescription. © Georg Thieme Verlag KG Stuttgart · New York.

Influence of the initial rupture size and tendon subregion on three-dimensional biomechanical properties of single-row and double-row rotator cuff reconstructions.

PubMed

Lorbach, O; Pape, D; Raber, F; Busch, L C; Kohn, D; Kieb, M

2012-11-01

Influence of the initial rotator cuff tear size and of different subregions of the SSP tendon on the cyclic loading behavior of a modified single-row reconstruction compared to a suture-bridging double-row repair. Artificial tears (25 and 35 mm) were created in the rotator cuff of 24 human cadaver shoulders. The reconstructions were performed as a single-row repair (SR) using a modified suture configuration or a suture-bridge double-row repair (DR). Radiostereometric analysis was used under cyclic loading (50 cycles, 10–180 N, 10–250 N) to calculate cyclic displacement in three different planes (anteroposterior (x), craniocaudal (y) and mediolateral (z) level). Cyclic displacement was recorded, and differences in cyclic displacement of the anterior compared to the posterior subregions of the tendon were calculated. In small-to-medium tears (25 mm) and medium-to-large tears (35 mm), significant lower cyclic displacement was seen for the SR-reconstruction compared to the DR-repair at 180 N (p ≤ 0.0001; p = 0.001) and 250 N (p = 0.001; p = 0.007) in the x-level. These results were confirmed in the y-level at 180 N (p = 0.001; p = 0.0022) and 250 N (p = 0.005; p = 0.0018). Comparison of the initial tear sizes demonstrated significant differences in cyclic displacement for the DR technique in the x-level at 180 N (p = 0.002) and 250 N (p = 0.004). Comparison of the anterior versus the posterior subregion of the tendon revealed significant lower gap formation in the posterior compared to the anterior subregions in the x-level for both tested rotator cuff repairs (p ≤ 0.05). The tested single-row repair using a modified suture configuration achieved superior results in three-dimensional measurements of cyclic displacement compared to the tested double-row suture-bridge repair. The results were dependent on the initial rupture size of the rotator cuff tear. Furthermore, significant differences were found between tendon subregions of the rotator cuff with significantly higher gap formation for the anterior compared to the posterior subregions.

Restoration of shoulder biomechanics according to degree of repair completion in a cadaveric model of massive rotator cuff tear: importance of margin convergence and posterior cuff fixation.

PubMed

Oh, Joo Han; McGarry, Michelle H; Jun, Bong Jae; Gupta, Akash; Chung, Kyung Chil; Hwang, James; Lee, Thay Q

2012-11-01

Complete repair in massive rotator cuff tear may not be possible, allowing for only partial repair. However, the effect of partial repair on glenohumeral biomechanics has not been evaluated. Therefore, the purpose of this study was to compare the rotational range of motion (ROM), glenohumeral kinematics, and gap formation at the repaired tendon edge following massive cuff tear and repair according to the degree of repair completion. Posterior fixation will restore the altered biomechanics of massive rotator cuff tear. Controlled laboratory study. Eight cadaveric shoulders were tested at 0°, 30°, and 60° of abduction in the scapular plane. Muscle loading was applied based on physiological muscle cross-sectional area ratios. Maximum internal (MaxIR) and external rotations (MaxER) were measured. Humeral head apex (HHA) position and gap formation at the repaired tendon edge were measured using a MicroScribe from MaxIR to MaxER in 30° increments. Testing was performed for intact, massive cuff tear, complete repair, and 4 types of partial repair. A repeated-measures analysis of variance was used to determine significant differences. Massive tear significantly increased ROM and shifted HHA superiorly in MaxIR at all abduction angles (P < .05). The complete repair restored ROM to intact (P < .05), while all partial repairs did not. Abnormal HHA elevation due to massive tear was restored by all repairs (P < .05). Release of the anterior single row alone and release of the marginal convergence significantly increased gap formation at the anterior tendon edge (P < .05). This study emphasizes the importance of anterior fixation in massive cuff tear to restore rotational range of motion and decrease gap formation at the repaired tendon edge and of posterior fixation to restore abnormal glenohumeral kinematics due to massive cuff tear. If complete repair of massive cuff tear is not possible, posterior cuff (infraspinatus) repair is necessary to restore abnormal glenohumeral kinematics, and margin convergence anteriorly is recommended to decrease gap formation of the repaired tendon edge, which may provide a better biomechanical environment for healing.

Acceleration of tendon-bone healing of anterior cruciate ligament graft using intermittent negative pressure in rabbits.

PubMed

Sun, Zhengming; Wang, Xiaoqing; Ling, Ming; Wang, Wei; Chang, Yanhai; Yang, Guang; Dong, Xianghui; Wu, Shixun; Wu, Xueyuan; Yang, Bo; Chen, Ming

2017-04-18

The purpose of this study was to test effects of negative pressure on tendon-bone healing after reconstruction of anterior cruciate ligament (ACL) in rabbits. Hind legs of 24 New Zealand White rabbits were randomly selected as negative pressure group and the contralateral hind legs as control. Reconstruction of the ACL was done. Joints of the negative pressure side were placed with drainage tubes connecting the micro-negative pressure aspirator. Control side was placed with ordinary drainage tubes. Drainage tubes on both sides were removed at the same time 5 days after operation. After 6 weeks, joint fluid was drawn to detect the expression levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α); at the same time, femur-ligament-tibia complex was obtained to determine tendon graft tension and to observe the histomorphology, blood vessels of the tendon-bone interface, and expression of vascular endothelial growth factor (VEGF). The maximum load breakage of tendon graft was significantly greater in the negative pressure group than in the control group (P < 0.05). Histological studies of the tendon-bone interface found that there was more new bone formation containing chondroid cells and aligned connective tissue in the negative pressure group than in the control group. Expression of VEGF was higher in the negative pressure group than in the control group (P < 0.01). Content of IL-1β and TNF-α in synovial fluid is lower in the negative pressure group than in the control group (P < 0.01). Intermittent negative pressure plays an active role in tendon-bone healing and creeping substitution of ACL reconstruction in the rabbits.

Using pre-operative MRI to predict intraoperative hamstring graft size for anterior cruciate ligament reconstruction.

PubMed

Leiter, Jeff; Elkurbo, Mohamed; McRae, Sheila; Chiu, James; Froese, Warren; MacDonald, Peter

2017-01-01

Large variation in tendon size between individuals makes hamstring graft diameter for anterior cruciate ligament (ACL) reconstruction unpredictable. Inadequate graft diameter may necessitate an alternative source of tissue requiring pre-operative planning. The purpose of this study was to determine whether magnetic resonance image (MRI) measurements and clinical anthropometric data are predictive of hamstring tendon graft diameter. Data from 109 patients having ACL reconstruction with semitendinosus-gracilis (STGT) autograft were retrospectively evaluated. Cross-sectional area (CSA) of the gracilis tendon (GT) and semitendinosus tendon (ST) were determined from pre-operative MRI scans. Variables included pre-operative height, weight, body mass index (BMI), age and gender; and intra-operative graft diameter. Correlations between anthropometric variables, hamstring tendons CSA and intra-operative graft diameter were calculated. Multiple stepwise regression was performed to assess the predictive value of these variables to graft diameter. Sensitivity and specificity were calculated to evaluate the utility of MRI CSA measurements in accurately identifying inadequate graft diameter (<8 mm). All anthropometric variables were positively correlated with intraoperative graft diameter (p < 0.01). Semitendinosus-gracilis tendon CSA (p < 0.001) and STGT CSA and weight (p < 0.001) were significantly predictive models of graft diameter. Sensitivity and specificity were 79 and 74 %, respectively. The strongest indicators of a four-stranded STGT graft for primary ACL reconstruction were STGT CSA on MRI plus weight. Measurement of graft diameter can be performed pre-operatively via MRI to identify tendons that may be of inadequate size for ACL reconstruction. This can assist with surgical planning to determine the most appropriate graft choice. III.

Cadaver study of anatomic landmark identification for placing ankle arthroscopy portals.

PubMed

Scheibling, B; Koch, G; Clavert, P

2017-05-01

Arthroscopy-assisted surgery is now widely used at the ankle for osteochondral lesions of the talus, anterior and posterior impingement syndromes, talocrural or subtalar fusion, foreign body removal, and ankle instability. Injuries to the vessels and nerves may occur during these procedures. To determine whether ultrasound topographic identification of vulnerable structures decreased the risk of iatrogenic injuries to vessels, nerves, and tendons and influenced the distance separating vulnerable structures from the arthroscope introduced through four different portals. Ultrasonography to identify vulnerable structures before or during arthroscopic surgery on the ankle may be useful. Twenty fresh cadaver ankles from body donations to the anatomy institute in Strasbourg, France, were divided into two equal groups. Preoperative ultrasonography to mark the trajectories of vessels, nerves, and tendons was performed in one group but not in the other. The portals were created using a 4-mm trocar. Each portal was then dissected. The primary evaluation criterion was the presence or absence of injuries to vessels, nerves, and tendons. The secondary evaluation criterion was the distance between these structures and the arthroscope. No tendon injuries occurred with ultrasonography. Without ultrasonography, there were two full-thickness tendon lesions, one to the extensor hallucis longus and the other to the Achilles tendon. Furthermore, with the anterolateral, anteromedial, and posteromedial portals, the distance separating the vessels and nerves from the arthroscope was greater with than without ultrasonography (P=0.041, P=0.005, and P=0.002), respectively; no significant difference was found with the anterior portal. Preoperative ultrasound topographic identification decreases the risk of iatrogenic injury to the vessels, nerves, and tendons during ankle arthroscopy and places these structures at a safer distance from the arthroscope. Our hypothesis was confirmed. IV, cadaver study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Editorial Commentary: All-Inside Anterior Cruciate Ligament Reconstruction Can Afford Satisfactory Clinical Outcome and Functional Stability.

PubMed

Yoshiya, Shinichi

2016-02-01

Anatomic all-inside anterior cruciate ligament reconstruction using the autogenous semitendinosus tendon graft can afford satisfactory outcomes, achieving significant postoperative improvement in all clinical parameters. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

A longitudinal study of skeletal muscle following spinal cord injury and locomotor training.

PubMed

Liu, M; Bose, P; Walter, G A; Thompson, F J; Vandenborne, K

2008-07-01

Experimental rat model of spinal cord contusion injury (contusion SCI). The objectives of this study were (1) to characterize the longitudinal changes in rat lower hindlimb muscle morphology following contusion SCI by using magnetic resonance imaging and (2) to determine the therapeutic potential of two types of locomotor training, treadmill and cycling. University research setting. After moderate midthoracic contusion SCI, Sprague-Dawley rats were assigned to either treadmill training, cycle training or an untrained group. Lower hindlimb muscle size was examined prior to SCI and at 1-, 2-, 4-, 8-, and 12-week post injury. Following contusion SCI, we observed significant atrophy in all rat hindlimb muscles with the posterior muscles (triceps surae and flexor digitorum) showing greater atrophy than the anterior muscles (tibialis anterior and extensor digitorum). The greatest amount of atrophy was measured at 2-week post injury (range from 11 to 26%), and spontaneous recovery in muscle size was observed by 4 weeks post-SCI. Both cycling and treadmill training halted the atrophic process and accelerated the rate of recovery. The therapeutic influence of both training interventions was observed within 1 week of training and no significant difference was noted between the two interventions, except in the tibialis anterior muscle. Finally, a positive correlation was found between locomotor functional scores and hindlimb muscle size following SCI. Both treadmill and cycle training diminish the extent of atrophy and facilitate muscle plasticity after contusion SCI.

Disease and Nonbattle Injuries Sustained by a U.S. Army Brigade Combat Team During Operation Iraqi Freedom

DTIC Science & Technology

2010-07-01

1 0 0 44 7 Tendon 3 0 4 0 1 0 1 0 9 0 Sprain 16 0 18 0 1 0 0 0 35 0 Strain 2 0 1 0 1 0 0 0 4 0 Ligament 1 0 2 1 1 0 0 0 4 1 Rupture 0 1 2 1 0 0 0 1 2...Basamania CJ: Incidence of major tendon ruptures and anterior cruciate ligament tears in US army soldiers. Am J Sports Med 2007; 35(8): 1308-14. 32...1,000 combat-years were as follows: ankle sprain 15.3, anterior cruciate ligament rupture 3.3 and shoulder dislocation 1.2. Conclusions

Anatomic ACL reconstruction: does the platelet-rich plasma accelerate tendon healing?

PubMed

Silva, Alcindo; Sampaio, Ricardo

2009-06-01

Recently, the use of hamstring tendons in anterior cruciate ligament repair has been increasing. However, tendon-to-bone healing occurs slowly, which can be a problem to an early return to sport activities. The use of growth factors from platelets seems to improve tissue healing. We enrolled 40 patients in a prospective study that were submitted to an anatomic reconstruction of the anterior cruciate ligament. Patients were sequentially enrolled into four groups: group A without platelet-rich plasma (PRP); group B with PRP in femoral tunnels at the end of surgery; group C with PRP in femoral tunnels at the end of surgery and intra-articular at 2- and 4 weeks after surgery; group D with PRP activated with thrombin in the femoral tunnels. All patients underwent magnetic resonance imaging of the knee 3 months after surgery to evaluate the signal intensity of the fibrous interzone (FIZ) in the femoral tunnels. We did not find any difference among the groups when comparing the signal intensity of the FIZ on magnetic resonance imaging.

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

Surgical treatment for partial rupture of the distal biceps tendon using palmaris longus tendon graft: A case report.

PubMed

Ozasa, Yasuhiro; Wada, Takuro; Iba, Kousuke; Yamashita, Toshihiko

2018-03-08

We report a case of a partial rupture of the distal biceps tendon that was surgically treated using a palmaris longus tendon graft. A 58-year-old man complained of increasing pain with resisted elbow flexion and supination in the antecubital fossa. Magnetic resonance imaging revealed the irregularity of a distal attachment of the biceps brachii and peripheral signal changes. We diagnosed a partial rupture of the distal biceps tendon. Because conservative treatment failed, surgical treatment was performed through a single anterior approach. The insertion of the tendon was partially ruptured at the radial tuberosity. After the involved site was debrided, the palmaris longus tendon was grafted with suture anchors to reinforce the remaining tendon. Postoperative immobilization was not performed, and all moves were freed after 3 weeks. At the 6-year postoperative follow-up, the patient no longer experienced pain and returned to his original job without any limitations. Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

[Application of silk-based tissue engineering scaffold for tendon / ligament regeneration].

PubMed

Hu, Yejun; Le, Huihui; Jin, Zhangchu; Chen, Xiao; Yin, Zi; Shen, Weiliang; Ouyang, Hongwei

2016-03-01

Tendon/ligament injury is one of the most common impairments in sports medicine. The traditional treatments of damaged tissue repair are unsatisfactory, especially for athletes, due to lack of donor and immune rejection. The strategy of tissue engineering may break through these limitations, and bring new hopes to tendon/ligament repair, even regeneration. Silk is a kind of natural biomaterials, which has good biocompatibility, wide range of mechanical properties and tunable physical structures; so it could be applied as tendon/ligament tissue engineering scaffolds. The silk-based scaffold has robust mechanical properties; combined with other biological ingredients, it could increase the surface area, promote more cell adhesion and improve the biocompatibility. The potential clinical application of silk-based scaffold has been confirmed by in vivo studies on tendon/ligament repairing, such as anterior cruciate ligament, medial collateral ligament, achilles tendon and rotator cuff. To develop novel biomechanically stable and host integrated tissue engineered tendon/ligament needs more further micro and macro studies, combined with product development and clinical application, which will give new hope to patients with tendon/ligament injury.

Concordance of the location of the innervation zone of the tibialis anterior muscle using voluntary and imposed contractions by electrostimulation.

PubMed

Guzmán-Venegas, R A; Bralic, M P; Cordero, J J; Cavada, G; Araneda, O F

2016-04-01

The innervation zone (IZ) corresponds to the location of the neuromuscular junctions. Its location can be determined by using arranged surface linear electrode arrays. Typically, voluntary muscle contractions (VC) are used in this method. However, it also may be necessary to locate the IZ under clinical conditions such as spasticity, in which this type of contraction is difficult to perform. Therefore, contractions imposed by electrostimulation (ES) can be an alternative. There is little background comparing the locations of IZ obtained by two different types of contractions. Evaluate the concordance between using voluntary and imposed contractions from electrostimulation in order to determine the location of the innervation zone of the tibialis anterior muscle in healthy volunteers. The tibialis anterior (TA) muscle of sixteen volunteers (men: 8; women: 8; age: 22.1±1.4years, weight: 61.6±7.5kg, height: 167.1±7.5cm) were evaluated using a linear electrode array. The IZ of the TA muscle was located using two types of muscle contractions, voluntary (10% MVC) and imposed contractions by ES. The concordance between both conditions was evaluated using the Bland-Altman method and the concordance correlation coefficient (CCC). The analyses were applied to the absolute and relative positions to the length of an anatomical landmark frame. CCC for absolute position was 0.98 (p<0.0001, 95% CI [0.98-1.00], and CCC for relative positions also was 0.98 (p<0.0001, 95% CI [0.97-1.00]). The Bland-Altman analysis for absolute data showed an average difference of -0.63mm (SD: 4.1). Whereas, for adjusted data, the average difference was -0.20% (SD: 1.2). The power of the results, based on absolute data, was 98%, whereas for relative data, 82%. In healthy volunteers, there was a substantially concordance between the location of the IZ of the TA muscle derived from using contractions imposed by ES and the location derived from using VC. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pregnancy-induced adaptations in the intrinsic structure of rat pelvic floor muscles.

PubMed

Alperin, Marianna; Lawley, Danielle M; Esparza, Mary C; Lieber, Richard L

2015-08-01

Maternal birth trauma to the pelvic floor muscles (PFMs) is a major risk factor for pelvic floor disorders. Modeling and imaging studies suggest that demands placed on PFMs during childbirth exceed their physiologic limits; however many parous women do not sustain PFM injury. Here we determine whether pregnancy induces adaptations in PFM architecture, the strongest predictor of muscle function, and/or intramuscular extracellular matrix (ECM), responsible for load bearing. To establish if parallel changes occur in muscles outside of the PFM, we also examined a hind limb muscle. Coccygeus, iliocaudalis, pubocaudalis, and tibialis anterior of 3-month-old Sprague-Dawley virgin, mid-pregnant, and late-pregnant; 6-month-old virgin; and 4- and 12-week postpartum rats (N = 10/group) were fixed in situ and harvested. Major architectural parameters determining muscle's excursion and force-generating capacity were quantified, namely, normalized fiber length (Lfn), physiologic cross-sectional area, and sarcomere length. Hydroxyproline content was used as a surrogate for intramuscular ECM quantity. Analyses were performed by 2-way analysis of variance with Tukey post hoc testing at a significance level of .05. Pregnancy induced a significant increase in Lfn in all PFMs by the end of gestation relative to virgin controls. Fibers were elongated by 37% in coccygeus (P < .0001), and by 21% in iliocaudalis and pubocaudalis (P < .0001). Importantly, no Lfn change was observed in the tibialis anterior. Physiologic cross-sectional area and sarcomere length were not affected by pregnancy. By 12 weeks' postpartum, Lfn of all PFMs returned to the prepregnancy values. Relative to virgin controls, ECM increased by 140% in coccygeus, 52% in iliocaudalis, and 75% in pubocaudalis in late-pregnant group, but remained unchanged across time in the tibialis anterior. Postpartum, ECM collagen content returned to prepregnancy levels in iliocaudalis and pubocaudalis, but continued to be significantly elevated in coccygeus (P < .0001). This study demonstrates that pregnancy induces unique adaptations in the structure of the PFMs, which adjust their architectural design by adding sarcomeres in series to increase fiber length as well as mounting a substantial synthesis of collagen in intramuscular ECM. Published by Elsevier Inc.

Revision anterior cruciate ligament reconstruction by double-bundle technique using multi-strand semitendinosus tendon.

PubMed

Muneta, Takeshi; Hara, Kenji; Ju, Young-Jin; Mochizuki, Tomoyuki; Morito, Toshiyuki; Yagishita, Kazuyoshi; Sekiya, Ichiro

2010-06-01

The purpose of the study was to compare the outcome of revision anterior cruciate ligament (ACL) reconstruction by the double-bundle (DB) technique using multi-strand semitendinosus tendon with that of primary reconstruction by use of the same technique. The study included 21 patients who underwent revision ACL reconstruction (mean follow-up, 40 months) with the semitendinosus tendon DB technique between 1995 and 2006 and 86 unilateral primary DB ACL reconstructions (mean follow-up, 33 months) between 2000 and 2004. The outcome of both groups was compared based on differences between operated and unoperated limbs and modified International Knee Documentation Committee grades. Both the overall and sports-related subjective scores were evaluated between the 2 groups. The KT measurements (MEDmetric, San Diego, CA) averaged 1.7 mm (SD, 1.8 mm) in the revision group and 1.5 mm (SD, 1.6 mm) in the primary group. There was no significant difference in KT measurements between the 2 groups. The Lachman test was negative in 83% of revision cases and 87% of primary cases; the anterior drawer test was negative in 83% and 91%, respectively, and the pivot-shift test was negative in 78% and 90%, respectively. There was a tendency for a positive pivot-shift test in the revision group being higher. The Lysholm score and subjective recovery score were significantly lower in the revision group. The semitendinosus tendon DB revision procedure provided range of motion and anterior stability comparable to those after primary DB surgery and a comparable return to athletic activities. However, the patients tended to have positive pivot-shift test results. The revision cases were also inferior in terms of the general evaluation of recovery of knee condition. The outcome scores were lower overall in the revision group. Level IV, therapeutic case series. Copyright (c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2015-01-01

Quadriceps tendon injuries are rare. There is a limited number of studies in the literature, reporting partial quadriceps tendon ruptures. We did not find any study reporting an isolated vastus intermedius tendon injury in the literature. A 22 years old professional rugby player with the complaints of pain in the right lower limb, decreased range of motion in right knee and a mass in the mid-anterior of the right thigh applied following an overloading on his hyperflexed knee during a rugby match. T2 sequence magnetic resonance images revealed discontinuity in the vastus intermedius tendon and intramuscular hematoma. The patient has been conservatively treated. Quadriceps tendon ruptures generally occur after the 4th decade in the presence of degenerative changes. Our case is a young professional rugby player. Isolated vastus intermedius tendon rupture is unusual. Conservative treatment is performed as the intermedius tendon is in the deepest layer of the quadriceps muscle. We report the first case of isolated rupture of the vastus intermedius tendon in the literature and we claim that disorder may be succesfully treated with conservative treatment and adequate physiotheraphy. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

A rare knee extensor mechanism injury: Vastus intermedius tendon rupture

PubMed Central

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

2015-01-01

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

Cuboid oedema due to peroneus longus tendinopathy: a report of four cases.

PubMed

O'Donnell, Paul; Saifuddin, Asif

2005-07-01

To highlight focal bone abnormality in the cuboid due to tendinopathy of the adjacent peroneus longus. A retrospective review was carried out of the relevant clinical and imaging features. Two male and two female patients were studied, mean age 51.5 years (range 32-67 years), referred with foot pain and imaging showing an abnormal cuboid thought to represent either tumour or infection. A long history of foot pain was usual with a maximum of 8 years. Radiographs were normal in two cases and showed erosion in two, one of which exhibited periosteal new bone formation affecting the cuboid. Bone scintigraphy was undertaken in two patients, both of whom showed increased uptake of isotope. MRI, performed in all patients, showed oedema in the cuboid adjacent to the peroneus longus tendon. The tendon and/or paratendinous tissues were abnormal in all cases, but no tendon discontinuity was identified. One patient possessed an os peroneum. Unequivocal evidence of bone erosion was seen using MRI in three patients, but with greater clarity in two cases using CT. Additional findings of tenosynovitis of tibialis posterior, oedema in the adjacent medial malleolus and synovitis of multiple joints in the foot were seen in one patient. Imaging diagnosis was made in all cases avoiding bone biopsy, but surgical exploration of the peroneal tendons was performed in two cases and biopsy of ankle synovium in one. Oedema with erosion of the cuboid bone, simulating a bone lesion (cuboid "pseudotumour"), may be caused by adjacent tendinopathy of peroneus longus. It is vital to be aware of this entity to avoid unnecessary biopsy of the cuboid.

Characterising the proximal patellar tendon attachment and its relationship to skeletal maturity in adolescent ballet dancers

PubMed Central

Rudavsky, Aliza; Cook, Jillianne; Magnusson, Stig Peter; Kjaer, Michael; Docking, Sean

2017-01-01

Summary Background It is unknown how and when the proximal attachment of the patellar tendon matures; puberty may be key in ensuring normal tendon formation. The aim of this study was to investigate the features of the proximal patellar tendon attachment at different stages of skeletal maturity, to help gain an understanding of how and when the tendon attachment matures. Methods Sixty adolescent elite ballet students (ages 11–18) and eight mature adults participated. Peak height velocity (PHV) estimated skeletal maturity. Ultrasound tissue characterisation (UTC) scan was taken of the left knee and analysed for stability of echopattern. An image-based grading scale for greyscale ultrasound was developed to describe the tendon appearance. Anterior-posterior thickness was measured at the inferior pole of the patella, 1 and 2 centimetres distally. Outcomes were compared with skeletal maturity. Results Mid-portion patellar tendon thickness increased with skeletal maturity (p=0.001 at 1 cm and p=0.007 at 2 cm). There was more variance in structural appearance (greyscale classification and UTC echopattern) in pre and peri-PHV participants. Tendon attachment one-year post PHV appeared similar to mature tendons. Conclusions Early adolescence was associated with highly variable tendon appearance, whereas the tendon appeared mature after PHV. Adolescence may be a critical time for the formation of normal tendon attachment. Level of evidence IIb individual cohort study. PMID:29264342

COMPARISON OF FUNCTIONAL ACTIVITIES ON STRUCTURAL CHANGES OF THE INFERIOR PATELLAR POLE

PubMed Central

Wallmann, Harvey; Stalcup, Patrick; DiTommaso, Katie

2017-01-01

Background It is well known that eccentric and concentric exercise produce varied amounts of stress on the connective tissues. Diagnostic ultrasound has been used to measure these structural changes by observing fascicle length, angle, and thickness; however, there is a lack of evidence comparing the structural changes as it relates to eccentric, concentric, and stretching protocols. Purpose The purpose of this study was to compare the acute effects of static stretching, eccentric, concentric, and a combination of eccentric/concentric exercises on structural changes of the muscle tendon unit at the inferior patellar pole utilizing the diagnostic ultrasound. Study Design A repeated measures 2 × 4 within factorial study design with repeated measures on both factors was used to determine the differences in patellar tendon thickness within and between groups. Methods Forty-seven healthy subjects were screened for any lower extremity deficits or orthopaedic pathology. Forty-four (N=44) subjects completed all four protocols; the attrition was due to injuries to the lower extremity, occurring unrelated to the study. A baseline measurement of the anterior inferior patellar tendon was performed with the diagnostic ultrasound prior to each participant completing one of the four interventions per week over a four-week period. Interventions completed by each participant included static stretching, concentric, eccentric, and combined concentric and eccentric exercises. Immediately following each intervention, a post-intervention inferior patellar tendon measurement was recorded using the diagnostic ultrasound. Results Significant differences in anterior to posterior tendon thickness of the inferior patellar tendon were observed between pre (4.983 ± 0.041mm) and post (5.198 ± 0.055mm) measurements (p<0.0005) for the main effect of time. However, no differences in tendon thickness were noted comparing each intervention to one another (p=0.351). Conclusion Differences in tendon thickness were noted acutely for pre- to post measurements across all interventions. Further research is needed to determine if differences in tendon thickness exist with a longer duration of exercise over time and with different types of intervention. PMID:29234561

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.

Vaxfectin (registered trademark) Enhances Both Antibody and In Vitro T Cell Responses to Each Component of a 5-gene Plasmodium falciparum Plasmid DNA Vaccine Mixture Administered at Low Doses

DTIC Science & Technology

2010-01-01

received intramus- cular injections in the tibialis anterior muscle pDNA formu lated in PBS or Vaxfectin® using insulin syringes (0.3 ml: Becton Dick... phosphatidylcholine (DSPC) liposomes in Leishmania vaccine stud- ies and report long-term immunity in mice when the adjuvant was added with the

Longer reaction time of the fibularis longus muscle and reduced postural control in basketball players with functional ankle instability: A pilot study.

PubMed

Méndez-Rebolledo, Guillermo; Guzmán-Muñoz, Eduardo; Gatica-Rojas, Valeska; Zbinden-Foncea, Hermann

2015-08-01

Motor control evaluation in subjects with functional ankle instability is questionable when both ankles of the same subject are compared (affected vs non-affected). To compare the postural control and reaction time of ankle muscles among: basketball players with FAI (instability group), basketball players without FAI (non-instability group) and healthy non-basketball-playing participants (control group). Case-control study. Laboratory. Instability (n = 10), non-instability (n = 10), and control groups (n = 11). Centre of pressure variables (area, velocity and sway) were measured with a force platform. Reaction time of ankle muscles was measured via electromyography. A one-way ANOVA demonstrated that there were significant differences between the instability and non-instability groups in the fibularis longus (p < 0.001), fibularis brevis (p = 0.031) and tibialis anterior (p = 0.049) muscles. Repeated-measures ANOVA and post hoc analysis determined significant differences for the area between the instability and non-instability groups (p = 0.001). Basketball players with FAI have reduced postural control and longer reaction time of the fibularis and tibialis anterior muscles. Copyright © 2014 Elsevier Ltd. All rights reserved.

Cold-water immersion alters muscle recruitment and balance of basketball players during vertical jump landing.

PubMed

Macedo, Christiane de Souza Guerino; Vicente, Rafael Chagas; Cesário, Mauricio Donini; Guirro, Rinaldo Roberto de Jesus

2016-01-01

The purpose of this study was to evaluate the effects of cold-water immersion on the electromyographic (EMG) response of the lower limb and balance during unipodal jump landing. The evaluation comprised 40 individuals (20 basketball players and 20 non-athletes). The EMG response in the lateral gastrocnemius, tibialis anterior, fibular longus, rectus femoris, hamstring and gluteus medius; amplitude and mean speed of the centre of pressure, flight time and ground reaction force (GRF) were analysed. All volunteers remained for 20 min with their ankle immersed in cold-water, and were re-evaluated immediately post and after 10, 20 and 30 min of reheating. The Shapiro-Wilk test, Friedman test and Dunn's post test (P < 0.05) were used. The EMG response values decreased for the lateral gastrocnemius, tibialis anterior, fibular longus and rectus femoris of both athletes and non-athletes (P < 0.05). The comparison between the groups showed that the EMG response was lower for the athletes. Lower jump flight time and GRF, greater amplitude and mean speed of centre of pressure were predominant in the athletes. Cold-water immersion decreased the EMG activity of the lower limb, flight time and GRF and increased the amplitude and mean speed of centre of pressure.

Interfacing peripheral nerve with macro-sieve electrodes following spinal cord injury.

PubMed

Birenbaum, Nathan K; MacEwan, Matthew R; Ray, Wilson Z

2017-06-01

Macro-sieve electrodes were implanted in the sciatic nerve of five adult male Lewis rats following spinal cord injury to assess the ability of the macro-sieve electrode to interface regenerated peripheral nerve fibers post-spinal cord injury. Each spinal cord injury was performed via right lateral hemisection of the cord at the T 9-10 site. Five months post-implantation, the ability of the macro-sieve electrode to interface the regenerated nerve was assessed by stimulating through the macro-sieve electrode and recording both electromyography signals and evoked muscle force from distal musculature. Electromyography measurements were recorded from the tibialis anterior and gastrocnemius muscles, while evoked muscle force measurements were recorded from the tibialis anterior, extensor digitorum longus, and gastrocnemius muscles. The macro-sieve electrode and regenerated sciatic nerve were then explanted for histological evaluation. Successful sciatic nerve regeneration across the macro-sieve electrode interface following spinal cord injury was seen in all five animals. Recorded electromyography signals and muscle force recordings obtained through macro-sieve electrode stimulation confirm the ability of the macro-sieve electrode to successfully recruit distal musculature in this injury model. Taken together, these results demonstrate the macro-sieve electrode as a viable interface for peripheral nerve stimulation in the context of spinal cord injury.

Inter-rater reliability of motor unit number estimates and quantitative motor unit analysis in the tibialis anterior muscle.

PubMed

Boe, S G; Dalton, B H; Harwood, B; Doherty, T J; Rice, C L

2009-05-01

To establish the inter-rater reliability of decomposition-based quantitative electromyography (DQEMG) derived motor unit number estimates (MUNEs) and quantitative motor unit (MU) analysis. Using DQEMG, two examiners independently obtained a sample of needle and surface-detected motor unit potentials (MUPs) from the tibialis anterior muscle from 10 subjects. Coupled with a maximal M wave, surface-detected MUPs were used to derive a MUNE for each subject and each examiner. Additionally, size-related parameters of the individual MUs were obtained following quantitative MUP analysis. Test-retest MUNE values were similar with high reliability observed between examiners (ICC=0.87). Additionally, MUNE variability from test-retest as quantified by a 95% confidence interval was relatively low (+/-28 MUs). Lastly, quantitative data pertaining to MU size, complexity and firing rate were similar between examiners. MUNEs and quantitative MU data can be obtained with high reliability by two independent examiners using DQEMG. Establishing the inter-rater reliability of MUNEs and quantitative MU analysis using DQEMG is central to the clinical applicability of the technique. In addition to assessing response to treatments over time, multiple clinicians may be involved in the longitudinal assessment of the MU pool of individuals with disorders of the central or peripheral nervous system.

Effects of the progressive walking-to-running technique on gait kinematics, ultrasound imaging, and motor function in spastic diplegic cerebral palsy - an experimenter-blind case study.

PubMed

Lee, Nam Gi; Jeong, Su Ji; You, Joshua Sung Hyun; Cho, Kang Hee; Lee, Tae Heon

2013-01-01

The purpose of this study was to investigate the effects of the progressive walking-to-running technique (PWRT) in a child with spastic diplegic cerebral palsy (CP). A single case study with pre-/post-test. An 11-year-old male, diagnosed with spastic diplegic CP. The PWRT was provided for 60 minutes a day, 2 times a week for 12 weeks. Gross motor function tests, ultrasound imaging, hand-held dynamometer, and the Vicon motion capture system were used to determine motor function, muscle size and strength, and gait kinematics. Gross motor function was improved after the intervention. The size of right and left rectus femoris and tibialis anterior muscles in their contracted states were enhanced by 1.36, 5.09, 83.74, and 54.37%, respectively. Associated muscle strength was also increased by 58.8, 30.8, 28.0, and 118.2% in both rectus femoris and tibialis anterior muscles. Left stride length, walking speed, maximal flexion-extension angular excursion of the hip joint were enhanced by 95.7, 87.8, and 100.4% after PWRT, respectively. Our novel walking-running training paradigm was effective for restoring gait and running ability in a child with spastic diplegic CP.

Electromyographic analysis of lower limb muscles during the golf swing performed with three different clubs.

PubMed

Marta, Sérgio; Silva, Luís; Vaz, João Rocha; Castro, Maria António; Reinaldo, Gustavo; Pezarat-Correia, Pedro

2016-01-01

The aim of this study was to describe and compare the EMG patterns of select lower limb muscles throughout the golf swing, performed with three different clubs, in non-elite middle-aged players. Fourteen golfers performed eight swings each using, in random order, a pitching wedge, 7-iron and 4-iron. Surface electromyography (EMG) was recorded bilaterally from lower limb muscles: tibialis anterior, peroneus longus, gastrocnemius medialis, gastrocnemius lateralis, biceps femoris, semitendinosus, gluteus maximus, vastus medialis, rectus femoris and vastus lateralis. Three-dimensional high-speed video analysis was used to determine the golf swing phases. Results showed that, in average handicap golfers, the highest muscle activation levels occurred during the Forward Swing Phase, with the right semitendinosus and the right biceps femoris muscles producing the highest mean activation levels relative to maximal electromyography (70-76% and 68-73% EMG(MAX), respectively). Significant differences between the pitching wedge and the 4-iron club were found in the activation level of the left semitendinosus, right tibialis anterior, right peroneus longus, right vastus medialis, right rectus femuris and right gastrocnemius muscles. The lower limb muscles showed, in most cases and phases, higher mean values of activation on electromyography when golfers performed shots with a 4-iron club.

Noninvasive EEG correlates of overground and stair walking.

PubMed

Brantley, Justin A; Luu, Trieu Phat; Ozdemir, Recep; Zhu, Fangshi; Winslow, Anna T; Huang, Helen; Contreras-Vidal, Jose L

2016-08-01

Automated walking intention detection remains a challenge in lower-limb neuroprosthetic systems. Here, we assess the feasibility of extracting motor intent from scalp electroencephalography (EEG). First, we evaluated the corticomuscular coherence between central EEG electrodes (C1, Cz, C2) and muscles of the shank and thigh during walking on level ground and stairs. Second, we trained decoders to predict the linear envelope of the surface electromyogram (EMG). We observed significant EEG-led corticomuscular coupling between electrodes and sEMG (tibialis anterior) in the high delta (3-4 Hz) and low theta (4-5 Hz) frequency bands during level walking, indicating efferent signaling from the cortex to peripheral motor neurons. The coherence was increased between EEG and vastus lateralis and tibialis anterior in the delta band (<; 2 Hz) during stair ascent, indicating a task specific modulation in corticomuscular coupling. However, EMG was the leading signal for biceps femoris and gastrocnemius coherence during stair ascent, possibly representing afferent feedback loops from periphery to the motor cortex. Decoder validation showed that EEG signals contained information about the sEMG patterns during over ground walking, however, the accuracy of the predicted sEMG patterns decreased during the stair condition. Overall, these initial findings support the feasibility of integrating sEMG and EEG into a hybrid decoder for volitional control of lower limb neuroprostheses.

Ultrasound-Guided Percutaneous Tenotomy of Biceps Tendon: Technical Feasibility on Cadavers.

PubMed

Sconfienza, Luca Maria; Mauri, Giovanni; Messina, Carmelo; Aliprandi, Alberto; Secchi, Francesco; Sardanelli, Francesco; Randelli, Pietro Simone

2016-10-01

We tested the technical feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon (LHBT) in cadavers. Both shoulders of two fresh cadavers were scanned anteriorly to evaluate the extra-articular portion of the LHBT. Under ultrasound monitoring, a scalpel was advanced obliquely up to touch the superficial medial side of the LHBT, cutting it until the tendon was not visible anymore. Ultrasound evaluation was repeated after the procedure, and anatomic dissection was performed. The procedure was 100% feasible: four cuts were made to completely sever the tendon; the duration was less than 1 min. Skin incision measured 5 mm in two cases and 6 mm in two cases. Anatomic dissection confirmed complete tendon cut in all cases with proximal and distal tendon stumps very close to each other. Ultrasound-guided percutaneous LHBT tenotomy was 100% technically feasible in cadavers with a quick procedure and minimal cutaneous incision. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Effects of braiding on tensile properties of four-strand human hamstring tendon grafts.

PubMed

Millett, Peter J; Miller, Bruce S; Close, Matthew; Sterett, William I; Walsh, William; Hawkins, Richard J

2003-01-01

Anterior cruciate ligament reconstruction is commonly performed with autogenous hamstring tendon grafts. To ascertain the effects of braiding on ultimate tensile strength and stiffness of hamstring tendon graft. Controlled laboratory study. Sixteen fresh-frozen semitendinosus and gracilis tendons were harvested from eight matched (right and left) human cadaveric specimens. Both sets of hamstring tendons from each matched pair were doubled, creating a four-strand graft. Grafts were then randomized so that one graft from each matched pair was braided and the other remained unbraided. The diameter of each graft construct was recorded. Grafts were tested to failure on a materials testing machine. There were no significant differences in cross-sectional area before or after braiding. Fifteen of 16 tendons failed midsubstance; 1 failed at the lower clamp. Braiding reduced the initial tensile strength and stiffness of human hamstring tendon grafts in this study by 35.0% and 45.8%, respectively. Braiding may place the collagen fibers in a suboptimal orientation for loading that results in a weaker graft. We do not recommend the use of braiding if the strongest, stiffest initial graft is desired.

FKBP12 deficiency reduces strength deficits after eccentric contraction-induced muscle injury

PubMed Central

Corona, Benjamin T.; Rouviere, Clement; Hamilton, Susan L.; Ingalls, Christopher P.

2008-01-01

Strength deficits associated with eccentric contraction-induced muscle injury stem, in part, from excitation-contraction uncoupling. FKBP12 is a 12-kDa binding protein known to bind to the skeletal muscle sarcoplasmic reticulum Ca2+ release channel [ryanodine receptor (RyR1)] and plays an important role in excitation-contraction coupling. To assess the effects of FKBP12 deficiency on muscle injury and recovery, we measured anterior crural muscle (tibialis anterior and extensor digitorum longus muscles) strength in skeletal muscle-specific FKBP12-deficient and wild-type (WT) mice before and after a single bout of 150 eccentric contractions, as well as before and after the performance of six injury bouts. Histological damage of the tibialis anterior muscle was assessed after injury. Body weight and peak isometric and eccentric torques were lower in FKBP12-deficient mice compared with WT mice. There were no differences between FKBP12-deficient and WT mice in preinjury peak isometric and eccentric torques when normalized to body weight, and no differences in the relative decreases in eccentric torque with a single or multiple injury bouts. After a single injury bout, FKBP12-deficient mice had less initial strength deficits and recovered faster (especially females) than WT mice, despite no differences in the degree of histological damage. After multiple injury bouts, FKBP12-deficient mice recovered muscle strength faster than WT mice and exhibited significantly less histological muscle damage than WT mice. In summary, FKBP12 deficiency results in less initial strength deficits and enhanced recovery from single (especially females) and repeated bouts of injury than WT mice. PMID:18511525

Usefulness of oblique axial scan in magnetic resonance imaging evaluation of anterior talofibular ligament in ankle sprain.

PubMed

Kim, Jin-su; Moon, Yong-ju; Choi, Yun Sun; Park, Young Uk; Park, Seung Min; Lee, Kyung Tai

2012-01-01

The purpose of the present study was to clarify the usefulness of the oblique axial scan parallel to the course of the anterior talofibular ligament in magnetic resonance imaging of the anterior talofibular ligament in patients with chronic ankle instability. We evaluated this anterior talofibular ligament view and routine axial magnetic resonance imaging planes of 115 ankles. We diagnosed the grade of the anterior talofibular ligament injury and confirmed full-length views of the anterior talofibular ligament. Associated lesions were also checked. The subjective diagnostic convenience of associated problems was determined. The full-length view of the anterior talofibular ligament was checked in 85 (73.9%) patients in the routine axial view and 112 (97.4%) patients in the anterior talofibular ligament view. The grade of injury increased in the anterior talofibular ligament view in 26 (22.6%) patients compared with the routine axial view. There were 64 associated injuries. The anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and posterior tibialis tendinitis were more easily diagnosed on the routine axial view than on the anterior talofibular ligament view. An additional anterior talofibular ligament view is useful in the evaluation of the anterior talofibular ligament in patients with chronic ankle instability. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Isokinetic evaluation of internal/external tibial rotation strength after the use of hamstring tendons for anterior cruciate ligament reconstruction.

PubMed

Armour, Tanya; Forwell, Lorie; Litchfield, Robert; Kirkley, Alexandra; Amendola, Ned; Fowler, Peter J

2004-01-01

Evaluation of the knee after an anterior cruciate ligament reconstruction with the use of the semitendinosus and gracilis (hamstring) autografts has primarily focused on flexion and extension strength. The semitendinosus and gracilis muscles contribute to internal tibial rotation, and it has been suggested that harvest of these tendons for the purpose of an anterior cruciate ligament reconstruction contributes to internal tibial rotation weakness. Internal tibial rotation strength may be affected by the semitendinosus and gracilis harvest after anterior cruciate ligament reconstruction. Prospective evaluation of internal and external tibial rotation strength. Inclusion criteria for subjects (N = 30): unilateral anterior cruciate ligament reconstruction at least 2 years previously, a stable anterior cruciate ligament (<5-mm side-to-side difference) at time of testing confirmed by surgeon and KT-1000 arthrometer, no history of knee problems after initial knee reconstruction, a normal contralateral knee, and the ability to comply with the testing protocol. In an attempt to minimize unwanted subtalar joint motion, subjects were immobilized using an ankle brace and tested at angular velocities of 60 degrees /s, 120 degrees /s, and 180 degrees /s at a knee flexion angle of 90 degrees . The mean peak torque measurements for internal rotation strength of the operative limb (60 degrees /s, 17.4 +/- 4.5 ft-lb; 120 degrees /s, 13.9 +/- 3.3 ft-lb; 180 degrees /s, 11.6 +/- 3.0 ft-lb) were statistically different compared to the nonoperated limb (60 degrees /s, 20.5 +/- 4.7 ft-lb; 120 degrees /s, 15.9 +/- 3.8 ft-lb; 180 degrees /s, 13.4 +/- 3.8 ft-lb) at 60 degrees /s (P = .012), 120 degrees /s (P = .036), and 180 degrees /s (P = .045). The nonoperative limb demonstrated greater strength at all speeds. The mean torque measurements for external rotation were statistically similar when compared to the nonoperated limb at all angular velocities. We have shown through our study that patients who undergo surgical intervention to repair a torn anterior cruciate ligament with the use of autogenous hamstring tendons demonstrate with weaker internal tibial rotation postoperatively at 2 years when compared to the contralateral limb.

Morphologic Characteristics and Strength of the Hamstring Muscles Remain Altered at 2 Years After Use of a Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction.

PubMed

Konrath, Jason M; Vertullo, Christopher J; Kennedy, Ben A; Bush, Hamish S; Barrett, Rod S; Lloyd, David G

2016-10-01

The hamstring tendon graft used in anterior cruciate ligament (ACL) reconstruction has been shown to lead to changes to the semitendinosus and gracilis musculature. We hypothesized that (1) loss of donor muscle size would significantly correlate with knee muscle strength deficits, (2) loss of donor muscle size would be greater for muscles that do not experience tendon regeneration, and (3) morphological adaptations would also be evident in nondonor knee muscles. Cross-sectional study; Level of evidence, 3. Twenty participants (14 men and 6 women, mean age 29 ± 7 years, mean body mass 82 ± 15 kg) who had undergone an ACL reconstruction with a hamstring tendon graft at least 2 years previously underwent bilateral magnetic resonance imaging and subsequent strength testing. Muscle and tendon volumes, peak cross-sectional areas (CSAs), and lengths were determined for 12 muscles and 6 functional muscle groups of the surgical and contralateral limbs. Peak isokinetic concentric strength was measured in knee flexion/extension and internal/external tibial rotation. Only 35% of the patients showed regeneration of both the semitendinosus and gracilis tendons. The regenerated tendons were longer with larger volume and CSA compared with the contralateral side. Deficits in semitendinosus and gracilis muscle size were greater for muscles in which tendons did not regenerate. In addition, combined hamstring muscles (semitendinosus, semimembranosus, and biceps femoris) and combined medial knee muscles (semitendinosus, semimembranosus, gracilis, vastus medialis, medial gastrocnemius, and sartorius) on the surgical side were reduced in volume by 12% and 10%, respectively. A 7% larger volume was observed in the surgical limb for the biceps femoris muscle and corresponded with a lower internal/external tibial rotation strength ratio. The difference in volume, peak CSA, and length of the semitendinosus and gracilis correlated significantly with the deficit in knee flexion strength, with Pearson correlations of 0.51, 0.57, and 0.61, respectively. The muscle-tendon properties of the semitendinosus and gracilis are substantially altered after harvesting, and these alterations may contribute to knee flexor weakness in the surgical limb. These deficits are more pronounced in knees with tendons that do not regenerate and are only partially offset by compensatory hypertrophy of other hamstring muscles. © 2016 The Author(s).

Hamstring Graft Preparation Using a Modified Rolling Hitch Technique

PubMed Central

Hong, Chih-Kai; Chang, Chih-Hsun; Chiang, Chen-Hao; Jou, I-Ming; Su, Wei-Ren

2014-01-01

Anterior cruciate ligament reconstruction using double-looped hamstring autograft is a common procedure in orthopaedic practice. However, during placement of the running, locking stitches at each end of the harvested tendons, the surgeon may face several potential obstacles, including the risk of damaging the tendon, predisposing the surgeon to needle-stick injury, and extended time consumption. We report a modified rolling hitch technique for hamstring graft preparation that is quick, cost-saving, and needleless as an alternative method. The original rolling hitch technique uses a traditional knot that attaches a rope to an object; the modified rolling hitch technique was created by adding 1 more turn before finishing with a half-hitch, which may prevent suture slippage off the tendon, thus providing sufficient fixation of the suture-tendon construct. PMID:25126495

Radioprotection provides functional mechanics but delays healing of irradiated tendon allografts after ACL reconstruction in sheep.

PubMed

Seto, Aaron U; Culp, Brian M; Gatt, Charles J; Dunn, Michael

2013-12-01

Successful protection of tissue properties against ionizing radiation effects could allow its use for terminal sterilization of musculoskeletal allografts. In this study we functionally evaluate Achilles tendon allografts processed with a previously developed radioprotective treatment based on (1-ethyl-3-(3-dimethylaminopropyl)carbodiimide) crosslinking and free radical scavenging using ascorbate and riboflavin, for ovine anterior cruciate ligament reconstruction. Arthroscopic anterior cruciate ligament (ACL) reconstruction was performed using double looped allografts, while comparing radioprotected irradiated and fresh frozen allografts after 12 and 24 weeks post-implantation, and to control irradiated grafts after 12 weeks. Radioprotection was successful at preserving early subfailure mechanical properties comparable to fresh frozen allografts. Twelve week graft stiffness and anterior-tibial (A-T) translation for radioprotected and fresh frozen allografts were comparable at 30 % of native stiffness, and 4.6 and 5 times native A-T translation, respectively. Fresh frozen allograft possessed the greatest 24 week peak load at 840 N and stiffness at 177 N/mm. Histological evidence suggested a delay in tendon to bone healing for radioprotected allografts, which was reflected in mechanical properties. There was no evidence that radioprotective treatment inhibited intra-articular graft healing. This specific radioprotective method cannot be recommended for ACL reconstruction allografts, and data suggest that future efforts to improve allograft sterilization procedures should focus on modifying or eliminating the pre-crosslinking procedure.

Neurotized lateral gastrocnemius muscle transfer for persistent traumatic peroneal nerve palsy: Surgical technique.

PubMed

Leclère, F M; Badur, N; Mathys, L; Vögelin, E

2015-08-01

Persistent traumatic peroneal nerve palsy, following nerve surgery failure, is usually treated by tendon transfer or more recently by tibial nerve transfer. However, when there is destruction of the tibial anterior muscle, an isolated nerve transfer is not possible. In this article, we present the key steps and surgical tips for the Ninkovic procedure including transposition of the neurotized lateral gastrocnemius muscle with the aim of restoring active voluntary dorsiflexion. The transposition of the lateral head of the gastrocnemius muscle to the tendons of the anterior tibial muscle group, with simultaneous transposition of the intact proximal end of the deep peroneal nerve to the tibial nerve of the gastrocnemius muscle by microsurgical neurorrhaphy is performed in one stage. It includes 10 key steps which are described in this article. Since 1994, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We review the indications and limitations of the technique. Early clinical results after neurotized lateral gastrocnemius muscle transfer appear excellent; however, they still need to be compared with conventional tendon transfer procedures. Clinical studies are likely to be conducted in this area largely due to the frequency of persistant peroneal nerve palsy and the limitations of functional options in cases of longstanding peripheral nerve palsy, anterior tibial muscle atrophy or destruction. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Postural stability is altered by the stimulation of pain but not warm receptors in humans.

PubMed

Blouin, Jean-Sébastien; Corbeil, Philippe; Teasdale, Normand

2003-10-17

It is now recognized that large diameter myelinated afferents provide the primary source of lower limb proprioceptive information for maintaining an upright standing position. Small diameter afferents transmitting noxious stimuli, however, can also influence motor behaviors. Despite the possible influence of pain on motor behaviors, the effects of pain on the postural control system have not been well documented. Two cutaneous heat stimulations (experiment 1: non-noxious 40 degrees C; experiment 2: noxious 45 degrees C) were applied bilaterally on the calves of the subject with two thermal grills to stimulate A delta and C warm receptors and nociceptors in order to examine their effects on postural stability. The non-noxious stimulation induced a gentle sensation of warmth and the noxious stimulation induced a perception of heat pain (visual analogue scores of 0 and 46 mm, respectively). For both experiments, ten healthy young adults were tested with and without heat stimulations of the lower limbs while standing upright on a force platform with eyes open, eyes closed and eyes closed with tendon co-vibration of tibialis anterior and triceps surae muscles. The center of pressure displacements were analyzed to examine how both stimulations affected the regulation of quiet standing and if the effects were exacerbated when vision was removed or ankle proprioception perturbed. The stimulation of the warm receptors (40 degrees C) did not induce any postural deterioration. With pain (45 degrees C), subjects showed a significant increase in standard deviation, range and mean velocity of postural oscillations as well as standard deviation of the center of pressure velocity. The effects of heat pain were exacerbated when subjects had both their eyes closed and ankle tendons vibrated (increased standard deviation of the center of pressure velocity and mean velocity of the center of pressure). A non-noxious stimulation (40 degrees C) of the small diameter afferents is not a sufficiently intense sensory stimulation to alter the control of posture. A painful stimulation (45 degrees C) of the skin thermoreceptors, however, yielded a deterioration of the postural control system. The observed deteriorating effects of the combined stimulation of nociceptors and Ia afferents (when ankle tendons were vibrated) could result from the convergence of these afferents at the spinal level. This could certainly lead to the hypothesis that individuals suffering from lower limb pain present alterations of the postural control mechanisms; especially populations already at risk of falling (for example, frail elderly) or populations suffering from concomitant lower limb pain and sensory deficits (for example, diabetic polyneuropathy).

Muscular force transmission: a unified, dual or multiple system? A review and some explorative experimental results.

PubMed

Huijing, P

1999-10-01

Structures contributing to force transmission in muscle are reviewed combining some historical and relatively recently published experimental data. Also, effects of aponeurotomy and tenotomy are reviewed shortly as well as some new experimental results regarding these interventions that reinforce the concept of myofascial force transmission. The review is also illustrated by some new images of single muscle fibres from Xenopus Laevis indicative of such transmission and some data about locations of insertion of human gluteus maximus muscle. From this review and the new material, emerges a line of thought indicating that mechanical connections between muscle fibres and intramuscular connective tissue play an important role in force transmission. New experimental observations are presented for non-spanning muscle (i.c., rat biceps femoris muscle), regarding the great variety of types of intramuscular connections that exist i n addition to myo-tendinous junctions at the perimuscular ends of muscle fibres. Such connections are classified as (1) tapered end connections, (2) Myo-myonal junctions, (3) myo-epimysial junctions and (3) Myo-endomysial junctions. This line of thought is followed up by consideration of a possible role of connections of intra- and extramuscular connective tissue in force transmission out of the muscle. Experimental results of an explorative nature, regarding the interactions of extensor digitorum longus (EDL), tibialis anterior (TA) and hallucis longus (HAL) muscles within a relatively intact dorsal flexor compartment of the rat hind leg, indicate that: (1) length force properties of EDL are influenced by TA activity in a length dependent fashion. Depending on TA length, force exerted by EDL, kept at constant origin insertion distance, is variable and the effect is influenced by EDL length itself as well; (2) Force is transmitted from muscle to extramuscular connective tissue and vice versa. As a consequence force exerted at proximal and distal tendons of a muscle are not always equal. The difference being transmitted by extramuscular connective tissue and may appear at the tendons of other muscles or may be transmitted via connective tissue directly to bone. It is concluded that the system of force transmission from skeletal muscle should be considered as a multiple system.

Circadian force and EMG activity in hindlimb muscles of rhesus monkeys

NASA Technical Reports Server (NTRS)

Hodgson, J. A.; Wichayanuparp, S.; Recktenwald, M. R.; Roy, R. R.; McCall, G.; Day, M. K.; Washburn, D.; Fanton, J. W.; Kozlovskaya, I.; Edgerton, V. R.;

Clinical outcome of surgical treatment of the symptomatic accessory navicular.

PubMed

Kopp, Franz J; Marcus, Randall E

2004-01-01

When conservative treatment fails to provide relief for a symptomatic accessory navicular, surgical intervention may be necessary. Numerous studies have been published, reporting the results of the traditional Kidner procedure and alternative surgical techniques, all of which produce mostly satisfactory clinical outcomes. The purpose of this study was to report the clinical results, utilizing the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Scale, of surgical management for symptomatic accessory navicular with simple excision and anatomic repair of the tibialis posterior tendon. The authors retrospectively reviewed the results of 13 consecutive patients (14 feet) who underwent surgical treatment for symptomatic accessory navicular. The patients ranged in age from 16 to 64 years (average, 34.1 years; mean, 28.2 years) at the time of surgery. All patients had a type II accessory navicular. The average follow-up of the patients involved in the study was 103.4 months (range, 45-194 months). The AOFAS Midfoot Scale was utilized to determine both preoperative and postoperative clinical status of the 14 feet included in the study. The average preoperative AOFAS score was 48.2 (range, 20-75; mean, 38.8). The average postoperative AOFAS score was 94.5 (range, 83-100; mean, 94.3). At last follow-up, 13 of 14 feet were without any pain, no patients had activity limitations, and only two of 14 feet required shoe insert modification. Postoperatively, no patients had a clinically notable change in their preoperative midfoot longitudinal arch alignment. All of the patients in the study were satisfied with the outcome of their surgery and would undergo the same operation again under similar circumstances. When conservative measures fail to relieve the symptoms of a painful accessory navicular, simple excision of the accessory navicular and anatomic repair of the posterior tibialis tendon is a successful intervention. Overall, the procedure provides reliable pain relief and patient satisfaction. In the current study, the clinical status of each patient improved significantly postoperatively, quantified utilizing the AOFAS Midfoot Scale.

Is quadriceps tendon a better graft choice than patellar tendon? a prospective randomized study.

PubMed

Lund, Bent; Nielsen, Torsten; Faunø, Peter; Christiansen, Svend Erik; Lind, Martin

2014-05-01

The purpose of this randomized controlled study was to compare knee stability, kneeling pain, harvest site pain, sensitivity loss, and subjective clinical outcome after primary anterior cruciate ligament (ACL) reconstruction with either bone-patellar tendon-bone (BPTB) or quadriceps tendon-bone (QTB) autografts in a noninferiority study design. From 2005 to 2009, a total of 51 patients were included in the present study. Inclusion criteria were isolated ACL injuries in adults. Twenty-five patients were randomized to BPTB grafts and 26 to QTB grafts. An independent examiner performed follow-up evaluations 1 and 2 years postoperatively. Anteroposterior knee laxity was measured with a KT-1000 arthrometer (MEDmetric, San Diego, CA). Anterior knee pain was assessed clinically and by knee-walking ability. Knee Injury and Osteoarthritis Outcome Score (KOOS) and subjective International Knee Documentation Committee (IKDC) score were used for patient-evaluated outcome. Anterior knee laxity was equal between the 2 groups with KT-1000 values of 1.1 ± 1.4 mm and 0.8 ± 1.7 mm standard deviation (SD) at follow-up in QTB and BPTB groups, respectively (P = .65), whereas positive pivot shift test results were seen less frequently (14% compared with 38%, respectively; P = .03). Anterior kneeling pain, evaluated by the knee walking ability test, was significantly less in the QTB group, with only 7% of patients grading knee walking as difficult or impossible compared with 34% in the BPTB group. At 1 and 2 years' follow-up, there was no difference between the 2 groups in subjective patient-evaluated outcome. The IKDC score was 75 ± 13 patients and 76 ± 16 SD at 1-year follow-up in QTB and BPTB groups, respectively (P = .78). At 2 years, 12 patients were lost to follow-up, resulting in 18 in the BPTB group and 21 in the QTB group. The use of the QTB graft results in less kneeling pain, graft site pain, and sensitivity loss than seen with BPTB grafts; however, similar anterior knee stability and subjective outcomes are seen. The results of this study show that QTB is a viable option for ACL reconstruction. Level II, randomized controlled clinical trial. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Isokinetic assessment with two years follow-up of anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons].

PubMed

Condouret, J; Cohn, J; Ferret, J-M; Lemonsu, A; Vasconcelos, W; Dejour, D; Potel, J-F

2008-12-01

This retrospective multicentric study was designed to assess the outcome of quadriceps and hamstrings muscles two years after Anterior Cruciate Ligament (ACL) reconstruction and compare muscles recovery depending on the type of graft and individual variables like age, gender, level of sport, but also in terms of discomfort, pain and functional score. The results focused on the subjective and objective IKDC scores, SF36, the existence or not of subjective disorders and their location. The review included isokinetic muscle tests concentric and eccentric extensors/flexors but also internal rotators/external rotators with analysis of mean work and mean power. One hundred and twenty-seven patients were included with an average age 29 years (+/-10). They all had an ACL reconstruction with patellar tendon or hamstring tendon with single or double bundles. In the serie, the average muscles deficit at two years was 10% for the flexors and extensors but with a significant dispersion. Significant differences were not noted in the mean values of all parameters in term of sex or age (over 30 years or not), neither the type of sport, nor of clinical assessment (Class A and B of objective IKDC score), nor the existence of anterior knee pain. There was a relationship between the level of extensor or flexor recovery and the quality of functional results with minimal muscle deficits close to 5% if the IKDC score was over 90 and deficits falling to 15% in the group with IKDC score less than 90. The type of reconstruction (patellar tendon versus hamstrings) had an influence on the muscle deficit. For extensors, the recovery was the same in the two groups, more than 90% at two years and the distribution of these two populations by level of deficit was quite the same. For flexors, residual deficits were significantly higher in the hamstrings group on the three studied parameters whatever the speed and the type of contraction (concentric or eccentric) with an average deficit of 14 to 18%, while, in the patellar tendon group, there was a dominance over the opposite side of 2 to 3% in concentric contraction. The hamstrings deficit appears to be "harvest dependent". For internal rotators, a significantly higher deficit is observed in eccentric contraction for the hamstrings group. The residual hamstrings deficits were related to the number of tendons harvested: -7% when there was no harvest, 7% with one tendon harvested and 17% with two tendons harvested. The relationship between the level of recovery of the quadriceps muscle and hamstrings at two years and the quality of functional results incite, regarding the significantly higher deficit of flexors in ACL reconstructions with hamstrings, to change the rehabilitation programs and especially on early rehabilitation of hamstrings in eccentric mode in the early weeks postoperative considering the harvest site as an equivalent of muscle tear.

Anterior Cruciate Ligament Reconstruction in a Rabbit Model Using Silk-Collagen Scaffold and Comparison with Autograft

PubMed Central

Bi, Fanggang; Shi, Zhongli; Liu, An; Guo, Peng; Yan, Shigui

2015-01-01

The objective of the present study was to perform an in vivo assessment of a novel silk-collagen scaffold for anterior cruciate ligament (ACL) reconstruction. First, a silk-collagen scaffold was fabricated by combining sericin-extracted knitted silk fibroin mesh and type I collagen to mimic the components of the ligament. Scaffolds were electron-beam sterilized and rolled up to replace the ACL in 20 rabbits in the scaffold group, and autologous semitendinosus tendons were used to reconstruct the ACL in the autograft control group. At 4 and 16 weeks after surgery, grafts were retrieved and analyzed for neoligament regeneration and tendon-bone healing. To evaluate neoligament regeneration, H&E and immunohistochemical staining was performed, and to assess tendon-bone healing, micro-CT, biomechanical test, H&E and Russell-Movat pentachrome staining were performed. Cell infiltration increased over time in the scaffold group, and abundant fibroblast-like cells were found in the core of the scaffold graft at 16 weeks postoperatively. Tenascin-C was strongly positive in newly regenerated tissue at 4 and 16 weeks postoperatively in the scaffold group, similar to observations in the autograft group. Compared with the autograft group, tendon-bone healing was better in the scaffold group with trabecular bone growth into the scaffold. The results indicate that the silk-collagen scaffold has considerable potential for clinical application. PMID:25938408

The spiral glenohumeral ligament: an open and arthroscopic anatomy study.

PubMed

Merila, Mati; Heliö, Harri; Busch, Lüder C; Tomusk, Hannes; Poldoja, Elle; Eller, Aalo; Kask, Kristo; Haviko, Tiit; Kolts, Ivo

2008-11-01

The purpose of this study was to visualize arthroscopically and to describe the micro- and macroscopic anatomy of the poorly known ligament of the anterior capsule of the glenohumeral joint: the so-called ligamentum glenohumerale spirale (spiral GHL). Twenty-two fresh shoulder joints were dissected, and the anatomy of the anterior capsular structures (the spiral GHL, the middle glenohumeral ligament [MGHL], and the anterior band as well as the axillary part of the inferior glenohumeral ligament [AIGHL and AxIGHL, respectively]) was investigated. For arthroscopic visualization, 30 prospective arthroscopic clinical cases and 19 retrospective video clips of the patients who had an arthroscopic shoulder procedure with a normal subscapularis tendon, labrum, and anterior joint capsule were evaluated. The spiral GHL and the AxIGHL were present in all 22 shoulder specimens. The AIGHL was not recognizable on the extra-articular side of the joint capsule. The MGHL was absent in 3 shoulder specimens (13.6%). Arthroscopically, the spiral GHL was found in 22 (44.9%), the MGHL in 43 (87.8%), and the AIGHL in 46 (93.9%) of the cases. The spiral GHL arose from the infraglenoid tubercle and the triceps tendon and inserted together with subscapularis tendon onto the lesser tubercle of the humerus. Our results suggest that extra-articular structure of the spiral GHL is consistently recognizable, the upper part of which can be arthroscopically identified. Advanced anatomic knowledge of the spiral GHL helps the clinician better understand the normal anatomy of the shoulder joint and also helps to differentiate it from pathologic findings of the patient. The biomechanical importance of the spiral GHL and its connection with shoulder pathology remains to be determined in further studies.

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

NASA Technical Reports Server (NTRS)

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

1992-01-01

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

Microvascular oxygen partial pressure during hyperbaric oxygen in diabetic rat skeletal muscle.

PubMed

Yamakoshi, Kohei; Yagishita, Kazuyoshi; Tsuchimochi, Hirotsugu; Inagaki, Tadakatsu; Shirai, Mikiyasu; Poole, David C; Kano, Yutaka

2015-12-15

Hyperbaric oxygen (HBO) is a major therapeutic treatment for ischemic ulcerations that perforate skin and underlying muscle in diabetic patients. These lesions do not heal effectively, in part, because of the hypoxic microvascular O2 partial pressures (PmvO2 ) resulting from diabetes-induced cardiovascular dysfunction, which alters the dynamic balance between O2 delivery (Q̇o2) and utilization (V̇o2) rates. We tested the hypothesis that HBO in diabetic muscle would exacerbate the hyperoxic PmvO2 dynamics due, in part, to a reduction or slowing of the cardiovascular, sympathetic nervous, and respiratory system responses to acute HBO exposure. Adult male Wistar rats were divided randomly into diabetic (DIA: streptozotocin ip) and healthy (control) groups. A small animal hyperbaric chamber was pressurized with oxygen (100% O2) to 3.0 atmospheres absolute (ATA) at 0.2 ATA/min. Phosphorescence quenching techniques were used to measure PmvO2 in tibialis anterior muscle of anesthetized rats during HBO. Lumbar sympathetic nerve activity (LSNA), heart rate (HR), and respiratory rate (RR) were measured electrophysiologically. During the normobaric hyperoxia and HBO, DIA tibialis anterior PmvO2 increased faster (mean response time, CONT 78 ± 8, DIA 55 ± 8 s, P < 0.05) than CONT. Subsequently, PmvO2 remained elevated at similar levels in CONT and DIA muscles until normobaric normoxic recovery where the DIA PmvO2 retained its hyperoxic level longer than CONT. Sympathetic nervous system and cardiac and respiratory responses to HBO were slower in DIA vs. CONT. Specifically the mean response times for RR (CONT: 6 ± 1 s, DIA: 29 ± 4 s, P < 0.05), HR (CONT: 16 ± 1 s, DIA: 45 ± 5 s, P < 0.05), and LSNA (CONT: 140 ± 16 s, DIA: 247 ± 34 s, P < 0.05) were greater following HBO onset in DIA than CONT. HBO treatment increases tibialis anterior muscle PmvO2 more rapidly and for a longer duration in DIA than CONT, but not to a greater level. Whereas respiratory, cardiovascular, and LSNA responses to HBO are profoundly slowed in DIA, only the cardiovascular arm (via HR) may contribute to the muscle vascular incompetence and these faster PmvO2 kinetics. Copyright © 2015 the American Physiological Society.

Motor-neuron pool excitability of the lower leg muscles after acute lateral ankle sprain.

PubMed

Klykken, Lindsey W; Pietrosimone, Brian G; Kim, Kyung-Min; Ingersoll, Christopher D; Hertel, Jay

2011-01-01

Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown. To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls. Case-control study. Laboratory. Ten individuals with acute ankle sprains (6 females, 4 males; age= 19.2 ± 3.8 years, height= 169.4 ± 8.5 cm, mass= 66.3 ± 11.6 kg) and 10 healthy individuals(6 females,4 males; age= 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass= 66.3 ± 10.2 kg) participated. The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs. The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (H(max)) and maximal muscle response (M(max)) and was then normalized using the H(max):M(max) ratio. The soleus MNPE in the ankle-sprain group was higher in the injured limb (H(max):M(max) = 0.63; 95% confidence interval [Cl],0.46, 0.80) than the uninjured limb (H(max):M(max) = 0.47; 95%Cl, 0.08, 0.93)(t(6) = 3.62,P =.01).In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (H(max):M(max) =0.06; 95% Cl, 0.01, 0.10) than in the uninjured ankle (H(max):M(max) =0.22; 95%Cl, 0.09, 0.35),but this finding was not different (t(9) =-2.01, P =.07). No differences were detected between injured (0.22; 95% Cl, 0.14, 0.29) and uninjured (0.25; 95%Cl, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t(9) =-0.739, P =.48). We found no side-to-side differences in any muscle among the healthy group. Facilitated MNPE was present in the involved soleus muscle of patients with acute ankle sprains, but no differences were found in the fibularis longus or tibialis anterior muscles.

Three-Dimensional Bio-Printed Scaffold Sleeves With Mesenchymal Stem Cells for Enhancement of Tendon-to-Bone Healing in Anterior Cruciate Ligament Reconstruction Using Soft-Tissue Tendon Graft.

PubMed

Park, Sin Hyung; Choi, Yeong-Jin; Moon, Sang Won; Lee, Byung Hoon; Shim, Jin-Hyung; Cho, Dong-Woo; Wang, Joon Ho

2018-01-01

To investigate the efficacy of the insertion of 3-dimensional (3D) bio-printed scaffold sleeves seeded with mesenchymal stem cells (MSCs) to enhance osteointegration between the tendon and tunnel bone in anterior cruciate ligament (ACL) reconstruction in a rabbit model. Scaffold sleeves were fabricated by 3D bio-printing. Before ACL reconstruction, MSCs were seeded into the scaffold sleeves. ACL reconstruction with hamstring tendon was performed on both legs of 15 adult rabbits (aged 12 weeks). We implanted 15 bone tunnels with scaffold sleeves with MSCs and implanted another 15 bone tunnels with scaffold sleeves without MSCs before passing the graft. The specimens were harvested at 4, 8, and 12 weeks. H&E staining, immunohistochemical staining of type II collagen, and micro-computed tomography of the tunnel cross-sectional area were evaluated. Histologic assessment was conducted with a histologic scoring system. In the histologic assessment, a smooth bone-to-tendon transition through broad fibrocartilage formation was identified in the treatment group, and the interface zone showed abundant type II collagen production on immunohistochemical staining. Bone-tendon healing histologic scores were significantly higher in the treatment group than in the control group at all time points. Micro-computed tomography at 12 weeks showed smaller tibial (control, 9.4 ± 0.9 mm 2 ; treatment, 5.8 ± 2.9 mm 2 ; P = .044) and femoral (control, 9.6 ± 2.9 mm 2 ; treatment, 6.0 ± 1.0 mm 2 ; P = .03) bone-tunnel areas in the treated group than in the control group. The 3D bio-printed scaffold sleeve with MSCs exhibited excellent results in osteointegration enhancement between the tendon and tunnel bone in ACL reconstruction in a rabbit model. If secure biological healing between the tendon graft and tunnel bone can be induced in the early postoperative period, earlier, more successful rehabilitation may be facilitated. Three-dimensional bio-printed scaffold sleeves with MSCs have the potential to accelerate bone-tendon healing in ACL reconstruction. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Multi-slice MRI reveals heterogeneity in disease distribution along the length of muscle in Duchenne muscular dystrophy.

PubMed

Chrzanowski, Stephen M; Baligand, Celine; Willcocks, Rebecca J; Deol, Jasjit; Schmalfuss, Ilona; Lott, Donovan J; Daniels, Michael J; Senesac, Claudia; Walter, Glenn A; Vandenborne, Krista

2017-09-01

Duchenne muscular dystrophy (DMD) causes progressive pathologic changes to muscle secondary to a cascade of inflammation, lipid deposition, and fibrosis. Clinically, this manifests as progressive weakness, functional loss, and premature mortality. Though insult to whole muscle groups is well established, less is known about the relationship between intramuscular pathology and function. Differences of intramuscular heterogeneity across muscle length were assessed using an ordinal MRI grading scale in lower leg muscles of boys with DMD and correlated to patient's functional status. Cross sectional T 1 weighted MRI images with fat suppression were obtained from ambulatory boys with DMD. Six muscles (tibialis anterior, extensor digitorum longus, peroneus, soleus, medial and lateral gastrocnemii) were graded using an ordinal grading scale over 5 slice sections along the lower leg length. The scores from each slice were combined and results were compared to global motor function and age. Statistically greater differences of involvement were observed at the proximal ends of muscle compared to the midbellies. Multi-slice assessment correlated significantly to age and the Vignos functional scale, whereas single-slice assessment correlated to the Vignos functional scale only. Lastly, differential disease involvement of whole muscle groups and intramuscular heterogeneity were observed amongst similar age subjects. A multi-slice ordinal MRI grading scale revealed that muscles are not uniformly affected, with more advanced disease visible near the tendons in a primarily ambulatory population with DMD. A geographically comprehensive evaluation of the heterogeneously affected muscle in boys with DMD may more accurately assess disease involvement.

Simulating the effect of muscle weakness and contracture on neuromuscular control of normal gait in children.

PubMed

Fox, Aaron S; Carty, Christopher P; Modenese, Luca; Barber, Lee A; Lichtwark, Glen A

2018-03-01

Altered neural control of movement and musculoskeletal deficiencies are common in children with spastic cerebral palsy (SCP), with muscle weakness and contracture commonly experienced. Both neural and musculoskeletal deficiencies are likely to contribute to abnormal gait, such as equinus gait (toe-walking), in children with SCP. However, it is not known whether the musculoskeletal deficiencies prevent normal gait or if neural control could be altered to achieve normal gait. This study examined the effect of simulated muscle weakness and contracture of the major plantarflexor/dorsiflexor muscles on the neuromuscular requirements for achieving normal walking gait in children. Initial muscle-driven simulations of walking with normal musculoskeletal properties by typically developing children were undertaken. Additional simulations with altered musculoskeletal properties were then undertaken; with muscle weakness and contracture simulated by reducing the maximum isometric force and tendon slack length, respectively, of selected muscles. Muscle activations and forces required across all simulations were then compared via waveform analysis. Maintenance of normal gait appeared robust to muscle weakness in isolation, with increased activation of weakened muscles the major compensatory strategy. With muscle contracture, reduced activation of the plantarflexors was required across the mid-portion of stance suggesting a greater contribution from passive forces. Increased activation and force during swing was also required from the tibialis anterior to counteract the increased passive forces from the simulated dorsiflexor muscle contracture. Improvements in plantarflexor and dorsiflexor motor function and muscle strength, concomitant with reductions in plantarflexor muscle stiffness may target the deficits associated with SCP that limit normal gait. Copyright © 2018 Elsevier B.V. All rights reserved.

Utility of an allograft tendon for scoliosis correction via the costo-transverse foreman.

PubMed

Sun, Dong; McCarthy, Michael; Dooley, Adam C; Ramakrishnaiah, Raghu H; Shelton, R Shane; McLaren, Sandra G; Skinner, Robert A; Suva, Larry J; McCarthy, Richard E

2017-01-01

Current convex tethering techniques for treatment of scoliosis have centered on anterior convex staples or polypropylene tethers. We hypothesized that an allograft tendon tether inserted via the costo-transverse foramen would correct an established spinal deformity. In the pilot study, six 8-week-old pigs underwent allograft tendon tethering via the costo-transverse foreman or sham to test the strength of the transplanted tendon to retard spine growth. After 4 months, spinal deformity in three planes was induced in all animals with allograft tendons. In the treatment study, the allograft tendon tether was used to treat established scoliosis in 11 8-week-old pigs (spinal deformity > 50°). Once the deformity was observed (4 months) animals were assigned to either no treatment group or allograft tendon tether group and progression assessed by monthly radiographs. At final follow-up, coronal Cobb angle and maximum vertebral axial rotation of the treatment group was significantly smaller than the non-treatment group, whereas sagittal kyphosis of the treatment group was significantly larger than the non-treatment group. In sum, a significant correction was achieved using a unilateral allograft tendon spinal tether, suggesting that an allograft tendon tethering approach may represent a novel fusion-less procedure to correct idiopathic scoliosis. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:183-192, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Losartan Administration Reduces Fibrosis but Hinders Functional Recovery after Volumetric Muscle Loss Injury

DTIC Science & Technology

2014-09-25

therapy. Pre - viously, losartan has been successfully used to reduce fibrosis and improve both muscle regeneration and function in several models of...efficacy of losartan has not yet been tested in a VML injury model. VML injury involves a substantial loss of muscle tissue that does not regenerate by...fibrosis development after VML injury in the rat tibialis anterior (TA) muscle. METHODS Experimental Design Male Lewis rats with VML were provided access

Measuring anisotropic muscle stiffness properties using elastography.

PubMed

Green, M A; Geng, G; Qin, E; Sinkus, R; Gandevia, S C; Bilston, L E

2013-11-01

Physiological and pathological changes to the anisotropic mechanical properties of skeletal muscle are still largely unknown, with only a few studies quantifying changes in vivo. This study used the noninvasive MR elastography (MRE) technique, in combination with diffusion tensor imaging (DTI), to measure shear modulus anisotropy in the human skeletal muscle in the lower leg. Shear modulus measurements parallel and perpendicular to the fibre direction were made in 10 healthy subjects in the medial gastrocnemius, soleus and tibialis anterior muscles. The results showed significant differences in the medial gastrocnemius (μ‖ = 0.86 ± 0.15 kPa; μ⊥ = 0.66 ± 0.19 kPa, P < 0.001), soleus (μ‖ = 0.83 ± 0.22 kPa; μ⊥ = 0.65 ± 0.13 kPa, P < 0.001) and the tibialis anterior (μ‖ = 0.78 ± 0.24 kPa; μ⊥ = 0.66 ± 0.16 kPa, P = 0.03) muscles, where the shear modulus measured in the direction parallel is greater than that measured in the direction perpendicular to the muscle fibres. No significant differences were measured across muscle groups. This study provides the first direct estimates of the anisotropic shear modulus in the triceps surae muscle group, and shows that the technique may be useful for the probing of mechanical anisotropy changes caused by disease, aging and injury. Copyright © 2013 John Wiley & Sons, Ltd.

Comparison in lower leg neuromuscular activity between runners with unilateral mid-portion Achilles tendinopathy and healthy individuals.

PubMed

Baur, Heiner; Müller, Steffen; Hirschmüller, Anja; Cassel, Michael; Weber, Josefine; Mayer, Frank

2011-06-01

Neuromuscular control in functional situations and possible impairments due to Achilles tendinopathy are not well understood. Thirty controls (CO) and 30 runners with Achilles tendinopathy (AT) were tested on a treadmill at 3.33 ms(-1) (12 km h(-1)). Neuromuscular activity of the lower leg (tibialis anterior, peroneal, and gastrocnemius muscle) was measured by surface electromyography. Mean amplitude values (MAV) for the gait cycle phases preactivation, weight acceptance and push-off were calculated and normalised to the mean activity of the entire gait cycle. MAVs of the tibialis anterior did not differ between CO and AT in any gait cycle phase. The activation of the peroneal muscle was lower in AT in weight acceptance (p=0.006), whereas no difference between CO and AT was found in preactivation (p=0.71) and push-off (p=0.83). Also, MAVs of the gastrocnemius muscle did not differ between AT and CO in preactivity (p=0.71) but were reduced in AT during weight acceptance (p=0.001) and push-off (p=0.04). Achilles tendinopathy does not seem to alter pre-programmed neural control but might induce mechanical deficits of the lower extremity during weight bearing (joint stability). This should be addressed in the therapy process of AT. Copyright © 2010 Elsevier Ltd. All rights reserved.

Alteration of gene expression profiles in skeletal muscle of rats exposed to microgravity during a spaceflight

NASA Technical Reports Server (NTRS)

Taylor, Wayne E.; Bhasin, Shalender; Lalani, Rukhsana; Datta, Anuj; Gonzalez-Cadavid, Nestor F.

2002-01-01

To clarify the mechanism of skeletal muscle wasting during spaceflights, we investigated whether intramuscular gene expression profiles are affected, by using DNA microarray methods. Male rats sent on the 17-day NASA STS-90 Neurolab spaceflight were sacrificed 24 hours after return to earth (MG group). Ground control rats were maintained for 17 days in flight-simulated cages (CS group). Spaceflight induced a 19% and 23% loss of tibialis anterior and gastrocnemius muscle mass, respectively, as compared to ground controls. Muscle RNA was analyzed by the Clontech Atlas DNA expression array in four rats, with two MG/ CS pairs for the tibialis anterior, and one pair for the gastrocnemius. Alterations in gene expression were verified for selected genes by reverse-transcription PCR. In both muscles of MG rats, mRNAs for 12 genes were up-regulated by over 2-fold, and 38 were down-regulated compared to controls. There was inhibition of genes for cell proliferation and growth factor cascades, including cell cycle genes and signal transduction proteins, such as p21 Cip1, retinoblastoma (Rb), cyclins G1/S, -E and -D3, MAP kinase 3, MAD3, and ras related protein RAB2. These data indicate that following exposure to microgravity, there is downregulation of genes involved in regulation of muscle satellite cell replication.

Electrical Stimulation of Denervated Rat Skeletal Muscle Retards Capillary and Muscle Loss in Early Stages of Disuse Atrophy

PubMed Central

Nakagawa, Kouki; Hayao, Keishi; Yotani, Kengo; Ogita, Futoshi; Yamamoto, Noriaki; Onishi, Hideaki

2017-01-01

The purpose of the present study is to investigate the effects of low-frequency electrical muscle stimulation (ES) on the decrease in muscle mass, fiber size, capillary supply, and matrix metalloproteinase (MMP) immunoreactivity in the early stages of denervation-induced limb disuse. Direct ES was performed on the tibialis anterior muscle following denervation in seven-week-old male rats. The rats were divided into the following groups: control (CON), denervation (DN), and denervation with direct ES (DN + ES). Direct ES was performed at an intensity of 16 mA and a frequency of 10 Hz for 30 min per day, six days a week, for one week. We performed immunohistochemical staining to determine the expression of dystrophin, CD34, and MMP-2 in transverse sections of TA muscles. The weight, myofiber cross-sectional area (FCSA), and capillary-to-fiber (C/F) ratio of the tibialis anterior (TA) muscle were significantly reduced in the DN group compared to the control and DN + ES groups. The MMP-2 positive area was significantly greater in DN and DN + ES groups compared to the control group. These findings suggest beneficial effects of direct ES in reducing muscle atrophy and capillary regression without increasing MMP-2 immunoreactivity in the early stages of DN-induced muscle disuse in rat hind limbs. PMID:28497057

Morphological and molecular comparisons between tibialis anterior muscle and levator veli palatini muscle: A preliminary study on their augmentation potential.

PubMed

Cheng, Xu; Song, Lei; Lan, Min; Shi, Bing; Li, Jingtao

2018-01-01

Tibialis anterior (TA) muscle and other somite-derived limb muscles remain the prototype in skeletal muscle study. The majority of head muscles, however, develop from branchial arches and maintain a number of heterogeneities in comparison with their limb counterparts. Levator veli palatini (LVP) muscle is a deep-located head muscle responsible for breathing, swallowing and speech, and is central to cleft palate surgery, yet lacks morphological and molecular investigation. In the present study, multiscale in vivo analyses were performed to compare TA and LVP muscle in terms of their myofiber composition, in-situ stem cell population and augmentation potential. TA muscle was identified to be primarily composed of type 2B myofibers while LVP muscle primarily consisted of type 2A and 2X myofibers. In addition, LVP muscle maintained a higher percentage of centrally-nucleated myofibers and a greater population of satellite cells. Notably, TA and LVP muscle responded to exogenous Wnt7a stimulus in different ways. Three weeks after Wnt7a administration, TA muscle exhibited an increase in myofiber number and a decrease in myofiber size, while LVP muscle demonstrated no significant changes in myofiber number or myofiber size. These results suggested that LVP muscle exhibits obvious differences in comparison with TA muscle. Therefore, knowledge acquired from TA muscle studies requires further testing before being applied to LVP muscle.

Bilateral widespread mechanical pain hypersensitivity as sign of central sensitization in patients with cluster headache.

PubMed

Fernández-de-Las-Peñas, César; Ortega-Santiago, Ricardo; Cuadrado, María L; López-de-Silanes, Carlos; Pareja, Juan A

2011-03-01

To investigate bilateral widespread pressure pain hyperalgesia in deep tissues over symptomatic (trigemino-cervical) and nonsymptomatic (distant pain-free) regions in patients with cluster headache (CH). Central sensitization is claimed to play a relevant role in CH. No study has previously searched for widespread pressure hyperalgesia in deep tissues over both symptomatic (trigemino-cervical) and nonsymptomatic (distant pain-free) regions in patients with CH. Sixteen men (mean age: 43 ± 11 years) with CH in a remission phase and 16 matched controls were recruited. Pressure pain thresholds (PPTs) were bilaterally measured over the supra-orbital (V1), infra-orbital (V2), mental (V3), median (C5), radial (C6), and ulnar (C7) nerves, C5-C6 zygapophyseal joint, mastoid process, and tibialis anterior muscle by an assessor blinded to the subjects' condition. The results showed that PPT levels were significantly decreased bilaterally in patients with CH as compared with healthy controls (all sites, P < .001). A greater degree of sensitization over the mastoid process (P < .001) and a lower degree of sensitization over the tibialis anterior muscle (P < .01) was found. Our findings revealed bilateral widespread pressure pain hypersensitivity in patients with CH confirming the presence of central sensitization mechanisms in this headache condition. © 2010 American Headache Society.

Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: evidence of central processing in unilateral neuropathy.

PubMed

Fernández-de-las-Peñas, César; de la Llave-Rincón, Ana Isabel; Fernández-Carnero, Josué; Cuadrado, María Luz; Arendt-Nielsen, Lars; Pareja, Juan A

2009-06-01

The aim of this study was to investigate whether bilateral widespread pressure hypersensitivity exists in patients with unilateral carpal tunnel syndrome. A total of 20 females with carpal tunnel syndrome (aged 22-60 years), and 20 healthy matched females (aged 21-60 years old) were recruited. Pressure pain thresholds were assessed bilaterally over median, ulnar, and radial nerve trunks, the C5-C6 zygapophyseal joint, the carpal tunnel and the tibialis anterior muscle in a blinded design. The results showed that pressure pain threshold levels were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in patients with unilateral carpal tunnel syndrome as compared to healthy controls (all, P < 0.001). Pressure pain threshold was negatively correlated to both hand pain intensity and duration of symptoms (all, P < 0.001). Our findings revealed bilateral widespread pressure hypersensitivity in subjects with carpal tunnel syndrome, which suggest that widespread central sensitization is involved in patients with unilateral carpal tunnel syndrome. The generalized decrease in pressure pain thresholds associated with pain intensity and duration of symptoms supports a role of the peripheral drive to initiate and maintain central sensitization. Nevertheless, both central and peripheral sensitization mechanisms are probably involved at the same time in carpal tunnel syndrome.

Mechanical and physiological analysis of minimalist versus traditionally-shod running.

PubMed

Kahle, Adam; Brown, Gregory A; Shaw, Ina; Shaw, Brandon S

2016-09-01

It has been purported that minimalist running shoes allow runners to be more biomechanically and metabolically economical, but evidence supporting these claims remains equivocal. This study's aim was to measure oxygen consumption (VO2), heart rate (HR), pulmonary ventilation (VE) and electromyography (EMG) of gastrocnemius and tibialis anterior in 12 recreationally-trained, college-aged males during minimalist and shod running. Participants ran at 70% VO2max on a treadmill in both minimalist and traditional shoes for six minutes each while VO2, HR, VE, EMG and steps taken were recorded. Results indicated no significant differences in VO2 (2.39±0.17 vs. 2.43±0.15 L/min), HR (156.59±2.99 vs. 157.13±3.86 bpm), VE (46.97±3.19 vs. 47.00±2.83 L/min), EMG in the tibialis anterior (2.02±0.28 vs. 1.79±0.20 mV), EMG in the gastrocnemius (1.97±0.36 vs. 2.03±0.37 mV) or steps taken (946.08±13.50 vs. 962.42±19.68 steps) between running in traditional and minimalist shoes, respectively. This study shows that there is no mechanical and physiological benefit when running wearing minimalist shoes as opposed to traditional shoes and warrants a cautious approach to transitioning to minimalist shoe use.

Electrical stimulation site influences the spatial distribution of motor units recruited in tibialis anterior.

PubMed

Okuma, Yoshino; Bergquist, Austin J; Hong, Mandy; Chan, K Ming; Collins, David F

2013-11-01

To compare the spatial distribution of motor units recruited in tibialis anterior (TA) when electrical stimulation is applied over the TA muscle belly versus the common peroneal nerve trunk. Electromyography (EMG) was recorded from the surface and from fine wires in superficial and deep regions of TA. Separate M-wave recruitment curves were constructed for muscle belly and nerve trunk stimulation. During muscle belly stimulation, significantly more current was required to generate M-waves that were 5% of the maximal M-wave (M max; M5%max), 50% M max (M 50%max) and 95% M max (M 95%max) at the deep versus the superficial recording site. In contrast, during nerve trunk stimulation, there were no differences in the current required to reach M5%max, M 50%max or M 95%max between deep and superficial recording sites. Surface EMG reflected activity in both superficial and deep muscle regions. Stimulation over the muscle belly recruited motor units from superficial to deep with increasing stimulation amplitude. Stimulation over the nerve trunk recruited superficial and deep motor units equally, regardless of stimulation amplitude. These results support the idea that where electrical stimulation is applied markedly affects how contractions are produced and have implications for the interpretation of surface EMG data. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report.

PubMed

Dacambra, Mark P; Walker, Richard Ea; Hildebrand, Kevin A

2013-08-23

The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a 'pop' on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps tendon ruptures successfully treated with a single-incision endobutton technique, which represents a valid option in managing this difficult problem.

[Tibial press-fit fixation of flexor tendons for reconstruction of the anterior cruciate ligament].

PubMed

Ettinger, M; Liodakis, E; Haasper, C; Hurschler, C; Breitmeier, D; Krettek, C; Jagodzinski, M

2012-09-01

Press-fit fixation of hamstring tendon autografts for anterior cruciate ligament reconstruction is an interesting technique because no hardware is necessary. This study compares the biomechanical properties of press-fit fixations to an interference screw fixation. Twenty-eight human cadaveric knees were used for hamstring tendon explantation. An additional bone block was harvested from the tibia. We used 28 porcine femora for graft fixation. Constructs were cyclically stretched and then loaded until failure. Maximum load to failure, stiffness and elongation during failure testing and cyclic loading were investigated. The maximum load to failure was 970±83 N for the press-fit tape fixation (T), 572±151 N for the bone bridge fixation (TS), 544±109 N for the interference screw fixation (I), 402±77 N for the press-fit suture fixation (S) and 290±74 N for the bone block fixation technique (F). The T fixation had a significantly better maximum load to failure compared to all other techniques (p<0.001). This study demonstrates that a tibial press-fit technique which uses an additional bone block has better maximum load to failure results compared to a simple interference screw fixation.

[Arthroscopic reconstruction of anterior cruciate ligament with press-fit technique].

PubMed

Halder, A M

2010-08-01

Problems related to the use of interference screws for fixation of bone-patellar tendon-bone grafts for anterior cruciate ligament (ACL) replacement have led to increasing interest in press-fit techniques. Most of the described techniques use press-fit fixation on either the femoral or tibial side. Therefore an arthroscopic technique was developed which achieves bone-patellar tendon-bone graft fixation by press-fit on both sides without the need for supplemental fixation material. The first consecutive 40 patients were examined clinically with a KT-1000 arthrometer and radiologically after a mean of 28.7 months (range 20-40 months) postoperatively. The mean difference in side-to-side laxity was 1.3 mm (SD 2.2 mm) and the results according to the International Knee Documentation Committee (IKDC) score were as follows: 7 A, 28 B, 5 C, 0 D. The presented press-fit technique avoids all complications related to the use of interference screws. It achieves primary stable fixation of the bone-patellar tendon-bone graft thereby allowing early functional rehabilitation. However, fixation strength depends on bone quality and the arthroscopic procedure is demanding. The results showed reliable stabilization of the operated knees.

Arthroscopic anterior cruciate ligament reconstruction using the double press- fit technique: an alternative to interference screw fixation.

PubMed

Halder, Andreas M; Ludwig, Silke; Neumann, Wolfram

2002-01-01

Patellar tendon autograft fixation in arthroscopic anterior cruciate ligament reconstruction is commonly accomplished using interference screws. However, improper insertion of the screws may reduce primary stability, injure the posterior femoral cortex, or displace hardware into the joint. Even if placed properly, metallic screws interfere with postoperative magnetic resonance imaging. In case of revision surgery, removing screws may be difficult and leaves bone defects. Retrospective study. An arthroscopic technique was developed that achieves patellar tendon autograft fixation by press-fit without any supplemental internal fixation. Forty patients were examined clinically and by KT-1000 arthrometer 28.7 months (range, 22 to 40 months) postoperatively. The mean difference in side-to-side laxity was 1.3 mm (SD 2.2) and the results according to the IKDC score were as follows: 7 A, 28 B, 5 C, and 0 D. The double press-fit technique we present avoids all complications related to the use of interference screws and creates an ideal environment for osseous integration of the bone-patellar tendon-bone autograft. Concurrently, it achieves a stable fixation of the autograft and allows early functional rehabilitation. However, fixation strength depends on bone quality and the arthroscopic procedure is demanding.

Anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons: clinical research among three rehabilitation procedures.

PubMed

Zhu, Weimin; Wang, Daping; Han, Yun; Zhang, Na; Zeng, Yanjun

2013-12-01

To compare the effects of the three rehabilitation procedures following anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons. An observational and retrospective case-controlled series. The Department of Sports Medicine, Shenzhen Second People Hospital, Shenzhen, PR China. Forty-five patients who were made to undergo ACL reconstructions by using quadrupled semitendinosus and gracilis tendons were divided into three groups: accelerated rehabilitation procedures group, aggressive rehabilitation procedures group, and self-made rehabilitation procedures group. The knee range of motion, thigh perimeter, IKDC score, and bone tunnel diameter in 3D-CT films were evaluated 3 and 6 months and 1 year later. The knee range of motion and thigh perimeter of group A were higher than those of group B and group C at 3, 6, and 12 months. IKDC scores of group C were better than those of groups A and B. The bone tunnel widening with group B was larger than that with groups A and C, and the differences were statistically significant (P < 0.05). Early rehabilitation is beneficial for restoration of knee function after ACL reconstruction. Moderate procedure is better than accelerated procedure.

Healing of donor site in bone-tendon-bone ACL reconstruction accelerated with plasma rich in growth factors: a randomized clinical trial.

PubMed

Seijas, Roberto; Rius, Marta; Ares, Oscar; García-Balletbó, Montserrat; Serra, Iván; Cugat, Ramón

2015-04-01

To determine whether the use of plasma rich in growth factors accelerates healing of the donor site in bone-tendon-bone anterior cruciate ligament (ACL) reconstruction (patellar graft). The use of the patellar graft presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. A double-blind, randomized, clinical trial was performed comparing two groups of patients who underwent ACL reconstruction using patellar tendon graft and comparing the use of plasma rich in growth factors at the donor site after graft harvest in terms of local regeneration by ultrasound assessment. The plasma rich in growth factors group shows earlier donor site regeneration in comparison with the control group (2 months earlier), with significant differences in the first 4 months of the follow-up. The application of plasma rich in growth factors shows accelerated tissue regeneration processes with respect to the control group. This fact, together with the previously published with similar conclusions, can create a knowledge basis in order to set out new recovery guidelines following ACL reconstruction. Therapeutic study, Level I.

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

[The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease].

PubMed

Bakhach, J; Sentucq-Rigal, J; Mouton, P; Boileau, R; Panconi, B; Guimberteau, J-C

2006-02-01

The Omega "Omega" pulley plasty: a new technique for the surgical management of the De Quervain's disease. The De Quervain tenosynovitis is an inadequacy into the first extensor compartment between the osteo-fibrous tunnel and the tendons. This mechanical conflict generates a tenosynovitis of the extensor pollicis brevis and the abductor pollicis longus tendons. This is generally expressed by a tenderness on the radial side of the wrist over the radial styloid process. The medical management consists on corticoids infiltrations of the first extensor compartment, the avoidance of repetitive and stress movements of the first ray with the use of a rest splint. The surgical approach is considered with the recurrence of the painful symptoms. This well-known pathology is reputated to require a simple section of the pulley. Our post-operative complications have been reported in the literature of this classical surgical solution. These complications concern an incomplete release of the extensor pollicis brevis and the abductor pollicis longus tendons particularly when an extensor sub-compartment exists and was overlooked, an irritation of the collateral branches of the sensitive radial nerve or the occurrence of a nevroma after a nerve injury and the most serious complication is a palmar subluxation of the extensor tendons which can occur with the thumb extended and the wrist flexed. In rare cases, this subluxation can be really painful and requires a surgical management with secondary reconstruction of the pulley. This reconstruction necessitates distal pedicle flaps from the dorsal retinaculum or the brachioradialis tendon. To prevent these complications, Codega and Kapandji described techniques of reconstruction of the pulley after its release. More recently, Le Viet reported a procedure using the anterior flap of the pulley; fixed to the dermis it will work as a barrier and maintain the tendons sliding on the radial styloid groove. These techniques require to divide the pulley and to reconstruct it suturing the different flaps. It can generate adherences between the extensor tendons, the overlying skin and the collateral branches of the radial nerve. The authors present a new and original plasty procedure of the first extensor compartment pulley, the "Omega" Omega plasty. It consists to liberate the anterior attachment of the pulley over the anterior lip of the styloïd process respecting its continuity with the periosteum flap. This conservative procedure is very interesting; it permits enough expansion of the tunnel volume decompressing the extensor tendons as a treatment of the De Quervain disease and respecting the anatomy and the continuity of the osteo-fibrous tunnel. This technique is simple, reliable and respects the first ray extensor tendons gliding physiology and biodynamic. In spite of our short clinical experience with only ten cases, all the patients retrieve a normal function of the thumb with complete disappearance of the first ray tenderness and pain without any complications. These preliminary results are encouraging and push us to consider the "Omega" plasty as a first choice for the surgical treatment of the De Quervain tenosynovitis.

ANATOMICAL RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT OF THE KNEE: DOUBLE BAND OR SINGLE BAND?

PubMed

Zanella, Luiz Antonio Zanotelli; Junior, Adair Bervig; Badotti, Augusto Alves; Michelin, Alexandre Froes; Algarve, Rodrigo Ilha; de Quadros Martins, Cesar Antonio

2012-01-01

To evaluate the double-band and single-band techniques for anatomical reconstruction of the anterior cruciate ligament of the knee and demonstrate that the double-band technique not only provides greater anterior stability but also causes less pain and a better subjective patient response. We selected 42 patients who underwent anterior cruciate ligament reconstruction, by means of either the single-band anatomical reconstruction technique, using flexor tendon grafts with two tunnels, or the double-band anatomical reconstruction technique, using four tunnels and grafts from the semitendinosus and gracilis tendons. All fixations were performed using interference screws. There was no variation in the sample. Before the operation, the objective and subjective IKDC scores, Lysholm score and length of time with the injury were evaluated. All these variables were reassessed six months later, and the KT-1000 correlation with the contralateral knee was also evaluated. There was no significant difference between the two groups in subjective evaluations, but the single-band group showed better results in relation to range of motion and objective evaluations including KT-1000 (with statistical significance). Our study demonstrated that there was no difference between the two groups in subjective evaluations, but better results were found using the single-band anatomical technique, in relation to objective evaluations.

ANATOMICAL RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT OF THE KNEE: DOUBLE BAND OR SINGLE BAND?

PubMed Central

Zanella, Luiz Antonio Zanotelli; Junior, Adair Bervig; Badotti, Augusto Alves; Michelin, Alexandre Froes; Algarve, Rodrigo Ilha; de Quadros Martins, Cesar Antonio

2015-01-01

Objective: To evaluate the double-band and single-band techniques for anatomical reconstruction of the anterior cruciate ligament of the knee and demonstrate that the double-band technique not only provides greater anterior stability but also causes less pain and a better subjective patient response. Methods: We selected 42 patients who underwent anterior cruciate ligament reconstruction, by means of either the single-band anatomical reconstruction technique, using flexor tendon grafts with two tunnels, or the double-band anatomical reconstruction technique, using four tunnels and grafts from the semitendinosus and gracilis tendons. All fixations were performed using interference screws. There was no variation in the sample. Before the operation, the objective and subjective IKDC scores, Lysholm score and length of time with the injury were evaluated. All these variables were reassessed six months later, and the KT-1000 correlation with the contralateral knee was also evaluated. Results: There was no significant difference between the two groups in subjective evaluations, but the single-band group showed better results in relation to range of motion and objective evaluations including KT-1000 (with statistical significance). Conclusion: Our study demonstrated that there was no difference between the two groups in subjective evaluations, but better results were found using the single-band anatomical technique, in relation to objective evaluations. PMID:27042621

Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty.

PubMed

Marra, Marco A; Strzelczak, Marta; Heesterbeek, Petra J C; van de Groes, Sebastiaan A W; Janssen, Dennis; Koopman, Bart F J M; Verdonschot, Nico; Wymenga, Ate B

2018-03-20

When downsizing the femoral component to prevent mediolateral overhang, notching of the anterior femoral cortex may occur, which could be solved by flexing the femoral component. In this study, we investigated the effect of flexion of the femoral component on patellar tendon moment arm, patellofemoral forces and kinematics in posterior-referencing CR-TKA. Our hypothesis was that flexion of the femoral component increases the patellar tendon moment arm, reduces the patellofemoral forces and provides stable kinematics. A validated musculoskeletal model of CR-TKA was used. The flexion of the femoral component was increased in four steps (0°, 3°, 6°, 9°) using posterior referencing, and different alignments were analysed in combination with three implant sizes (3, 4, 5). A chair-rising trial was analysed using the model, while simultaneously estimating quadriceps muscle force, patellofemoral contact force, tibiofemoral and patellofemoral kinematics. Compared to the reference case (size 4 and 0° flexion), for every 3° of increase in flexion of the femoral component the patellar tendon moment arm increased by 1% at knee extension. The peak quadriceps muscle force and patellofemoral contact force decreased by 2%, the patella shifted 0.8 mm more anteriorly and the remaining kinematics remained stable, with knee flexion. With the smaller size, the patellar tendon moment arm decreased by 6%, the quadriceps muscle force and patellofemoral contact force increased by 8 and 12%, and the patellar shifted 5 mm more posteriorly. Opposite trends were found with the bigger size. Flexing the femoral component with posterior referencing reduced the patellofemoral contact forces during a simulated chair-rising trial with a patient-specific musculoskeletal model of CR-TKA. There seems to be little risk when flexing and downsizing the femoral component, compared to when using a bigger size and neutral alignment. These findings provide relevant information to surgeons who wish to prevent anterior notching when downsizing the femoral component.

Optimizing Soft Tissue Management and Spacer Design in Segmental Bone Defects

DTIC Science & Technology

2016-12-01

proximal and distal bone segments. 3. Debride 10 grams of tibialis anterior and gastrocnemius muscles. 4. Place an interlocking intramedullary nail ...using a custom spacer to maintain 5-cm defect length. 5. Place a pre-molded 5 cm long x 2 cm diameter PMMA spacer around the nail in the defect. 6...tibia. 3. Open the IM surrounding the PMMA spacer using a “bomb bay door opening”. 4. Remove the spacer without damaging the membrane or nail . 5

Ipsilateral free semitendinosus tendon graft with interference screw fixation for minimally invasive reconstruction of chronic tears of the Achilles tendon.

PubMed

Maffulli, N; Del Buono, A; Loppini, M; Denaro, V

2014-10-01

Minimally invasive ipsilateral semitendinosus reconstruction of large chronic tears aims to be advantageous for the patient in terms of plantar flexion recovery, anthropometric measures, fast return to daily and sport activity, is safe, with low donor site co-morbidities, low risks of wound complications and neurovascular injuries. Tendon gaps greater than 6 cm and in cases of revision surgery (rerupture). Diabetes, vascular diseases, previous anterior cruciate ligament (ACL) reconstruction using ipsilateral semitendinosus tendon graft. The semitendinosus tendon is harvested through an incision in the medial aspect of the popliteal fossa, and the proximal stump is exposed and mobilized through an incision performed 2 cm proximal and medial to the palpable tendon gap. We repeat the same steps distally, approaching the distal stump of the tendon through a 2.5 cm longitudinal incision made 2 cm distal and just anterior to the lateral margin of the distal stump. Through the distal incision, we expose the Kager's space and the postero-superior corner of the osteotomized calcaneum. We drill a bone tunnel into the calcaneum from dorsal to plantar using a cannulated headed reamer. The semitendinosus tendon graft is passed into the proximal stump through a medial-to-lateral small incision, its two ends are moved distally, and finally it is pulled down and shuttled through the bone tunnel. The construct is fixed to the calcaneum using an interference screw. Immobilization in a below the knee plaster cast with the foot in plantar flexion for 2 weeks, weight bearing on the metatarsal heads as tolerated, use elbow crutches, and keep the knee flexed. At 2 weeks, plaster removed, and rehabilitative exercises started, walker cast allowed. Between 2008 and 2010, the procedure was performed on 28 consecutive patients (21 men and 7 women, median age 46 years). At the 2-year follow-up, average ATRS scores significantly improved (p < 0.0001) compared to average preoperative scores with good to excellent outcomes for 26 out of 28 patients (93 %); the maximum calf circumference also improved considerably whereby no clinical or functional relevance compared to the contralateral side observed. Of the 28 patients 16 (57 %) could practice sport at the same preinjury level, whereby 1 patient experienced persistent pain over the distal wound, which ameliorated after desensitization therapy.

A Comparison of the Quasi-static Mechanical and Nonlinear Viscoelastic Properties of the Human Semitendinosus and Gracilis Tendons

PubMed Central

Abramowitch, Steven D.; Zhang, Xiaoyan; Curran, Molly; Kilger, Robert

2010-01-01

Background Over fifty-percent of anterior cruciate ligament reconstructions are performed using semitendinosus and gracilis tendon autografts. Despite their increased use, there remains little quantitative data on their mechanical behavior. Therefore, the objective of this study was to investigate the quasi-static mechanical and nonlinear viscoelastic properties of human semitendinosus and gracilis tendons, as well as the variation of these properties along their length. Methods Specimens were subjected to a series of uniaxial tensile tests: one-hour static stress-relaxation test, 30-cycle cyclic stress-relaxation test and load to failure test. To describe the nonlinear viscoelastic behavior, the quasi-linear viscoelastic theory was utilized to model data from the static stress relaxation experiment. Findings The constants describing the viscoelastic behavior were similar between the proximal and distal halves of the gracilis tendon. The proximal half of the semitendinosus tendon, however, had a greater viscous response than its distal half, which was also significantly higher than the proximal gracilis tendon. In terms of the quasi-static mechanical properties, the properties were similar between the proximal and distal halves of the semitendinosus tendon. However, the distal gracilis tendon showed a significantly higher tangent modulus and ultimate stress compared to its proximal half, which was also significantly higher than the distal semitendinosus tendon. Interpretation The results of this study demonstrate differences between the semitendinosus and gracilis tendons in terms of their quasi-static mechanical and nonlinear viscoelastic properties. These results are important for establishing surgical preconditioning protocols and graft selection. PMID:20092917

Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With a Free Quadriceps Tendon Autograft.

PubMed

Caterev, Sergiu; Nistor, Dan Viorel; Todor, Adrian

2016-10-01

Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction aims to restore the 2 functional bundles of the ACL in an attempt to better reproduce the native biomechanics of the injured knee and promote long-term knee health. However, this concept is not fully accepted and is not performed on a standard basis. In addition, the superiority of this technique over the conventional single-bundle technique has been questioned, especially the long-term clinical results. One of the down sides of the double-bundle reconstruction is the complexity of the procedure, with increased risks, operative time, and costs compared with the single-bundle procedure. Also, the revision procedure, if necessary, is more challenging. We propose a technique that has some advantages over the traditional double-bundle procedure, using a single femoral tunnel, 2 tibial tunnels, and a free quadriceps tendon autograft.

Anatomy of the Adductor Magnus Origin

PubMed Central

Obey, Mitchel R.; Broski, Stephen M.; Spinner, Robert J.; Collins, Mark S.; Krych, Aaron J.

2016-01-01

Background: The adductor magnus (AM) has historically been a potential source of confusion in patients with suspected proximal hamstring avulsion injuries. Purpose: To investigate the anatomic characteristics of the AM, including its osseous origin, anatomic dimensions, and relationship to the proximal hamstring tendons. Study Design: Descriptive laboratory study. Methods: Dissection of the AM origin was performed in 11 (8 cadavers) fresh-frozen hip-to-foot cadaveric hemipelvis specimens. The gross anatomy and architecture of the proximal hamstring and AM tendons were studied. After dissecting the hamstring tendons away from their origin, the dimension, shape, and orientation of the tendon footprints on the ischial tuberosity were determined. Results: The AM was identified in all cadaveric specimens. The mean tendon thickness (anterior to posterior [AP]) was 5.7 ± 2.9 mm. The mean tendon width (medial to lateral [ML]) was 7.1 ± 2.2 mm. The mean tendon length was 13.1 ± 8.7 cm. The mean footprint height (AP dimension) was 12.1 ± 2.9 mm, and mean footprint width (ML dimension) was 17.3 ± 7.1 mm. The mean distance between the AM footprint and the most medial aspect of the conjoint tendon footprint was 8.5 ± 4.2 mm. Tendon measurements demonstrated a considerable degree of both intra- and interspecimen variability. Conclusion: The AM tendon is consistently present just medial to the conjoint tendon at the ischial tuberosity, representing the lateral-most portion of the AM muscle. This study found wide variation in the dimensional characteristics of the AM tendon between specimens. Its shape and location can mimic the appearance of an intact hamstring (conjoint or semimembranosus) tendon intraoperatively or on diagnostic imaging, potentially misleading surgeons and radiologists. Therefore, detailed knowledge of the AM tendon anatomy, footprint anatomy, and its relationship to the hamstring muscle complex is paramount when planning surgical approach and technique. Clinical Relevance: The reported data may aid surgeons in more accurate recognition, diagnosis, and repair of proximal hamstring avulsion injuries. PMID:26798764

Synovial Mesenchymal Stem Cells Promote Meniscus Regeneration Augmented by an Autologous Achilles Tendon Graft in a Rat Partial Meniscus Defect Model

PubMed Central

Ozeki, Nobutake; Muneta, Takeshi; Matsuta, Seiya; Koga, Hideyuki; Nakagawa, Yusuke; Mizuno, Mitsuru; Tsuji, Kunikazu; Mabuchi, Yo; Akazawa, Chihiro; Kobayashi, Eiji; Saito, Tomoyuki; Sekiya, Ichiro

2015-01-01

Although meniscus defects and degeneration are strongly correlated with the later development of osteoarthritis, the promise of regenerative medicine strategies is to prevent and/or delay the disease's progression. Meniscal reconstruction has been shown in animal models with tendon grafting and transplantation of mesenchymal stem cells (MSCs); however, these procedures have not shown the same efficacy in clinical studies. Here, our aim was to investigate the ability of tendon grafts pretreated with exogenous synovial-derived MSCs to prevent cartilage degeneration in a rat partial meniscus defect model. We removed the anterior half of the medial meniscus and grafted autologous Achilles tendons with or without a 10-minute pretreatment of the tendon with synovial MSCs. The meniscus and surrounding cartilage were evaluated at 2, 4, and 8 weeks (n = 5). Tendon grafts increased meniscus size irrespective of synovial MSCs. Histological scores for regenerated menisci were better in the tendon + MSC group than in the other two groups at 4 and 8 weeks. Both macroscopic and histological scores for articular cartilage were significantly better in the tendon + MSC group at 8 weeks. Implanted synovial MSCs survived around the grafted tendon and native meniscus integration site by cell tracking assays with luciferase+, LacZ+, DiI+, and/or GFP+ synovial MSCs and/or GFP+ tendons. Flow cytometric analysis showed that transplanted synovial MSCs retained their MSC properties at 7 days and host synovial tissue also contained cells with MSC characteristics. Synovial MSCs promoted meniscus regeneration augmented by autologous Achilles tendon grafts and prevented cartilage degeneration in rats. Stem Cells 2015;33:1927–1938 PMID:25993981

[Hindfoot valgus. Diagnosis and therapy of flatfoot].

PubMed

Radl, R; Fuhrmann, G; Maafe, M; Krifter, R-M

2012-04-01

The clinical finding of flatfoot is characterized by a flattening of the medial longitudinal arch and valgus deformity of the hindfoot. The differential diagnosis of flatfoot is the physiological, flexible, contracted flatfoot, which occurs as a congenital or acquired deformity. Congenital flatfoot deformity requires early intensive therapy, while a flexible flatfoot in children has a good prognosis and conservative treatment usually leads to a stable and sufficient load-bearing foot. Severe flatfoot in children can be corrected successfully by simple, minimally invasive procedures. In adults with symptomatic flatfoot, which usually occurs due to an insufficiency of the tendon of the tibialis posterior, conservative therapy with insoles, shoe modifications and physiotherapeutic measures can lead to significant improvement, otherwise surgical correction is recommended. Early, stage-appropriate therapy helps to prevent an impending decompensation of the hindfoot.

Tendon healing in a bone tunnel. Part II: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep.

PubMed

Weiler, Andreas; Hoffmann, Reinhard F G; Bail, Hermann J; Rehm, Oliver; Südkamp, Norbert P

2002-02-01

Tendon-to-bone healing of soft-tissue grafts has been described to progress by the development of a fibrous interzone that undergoes a maturation process leading to the development of an indirect type of ligament insertion. Previous studies used extra-articular models or fixation far away from the joint line; thus, no data are available investigating tendon-to-bone healing of a soft-tissue graft fixed anatomically. Therefore, we studied the tendon-to-bone healing of the anatomic soft-tissue graft interference fit fixation in a model of anterior cruciate ligament (ACL) reconstruction in sheep. Animal study. Thirty-five mature sheep underwent ACL reconstruction with an autologous Achilles tendon split graft. Grafts were directly fixed with biodegradable poly-(D,L-lactide) interference screws. Animals were euthanized after 6, 9, 12, 24, and 52 weeks and histologic evaluations were performed. Undecalcified specimens were evaluated under normal and polarized light. Additionally, animals received a polychrome sequential labeling (tetracycline, xylenol orange, and calcein green) to determine bone growth per time under fluorescent light. Intratunnel histologic findings at 6 weeks showed a tendon-bone junction with only a partial fibrous interzone between the graft tissue and the surrounding bone. A mature intratunnel tendon-bone junction with a zone of fibrocartilage was found at 9 to 12 weeks. At the tunnel entrance site a wide regular ligamentous insertion site was seen in all specimens after 24 weeks. This insertion showed regular patterns such as the direct type of insertion of a normal ligament with a dense basophilic transition zone consisting of mineralized cartilage. A fibrous interzone between the graft tissue and the bone tunnel was only partially developed, which is in contrast to all previous studies in which nonanatomic fixation was used. Thus, it is reasonable to assume that the tendon-to-bone healing in the present study may progress partially by direct-contact healing without the development of a fibrous interzone. To our knowledge, this is the first report describing the development of a direct type of ligament insertion after ACL replacement with a soft-tissue graft. This is in contrast to previous studies reporting the development of an indirect type of insertion when using nonanatomic fixation far away from the joint line. Thus, histologic data strongly indicate that anatomic interference fit fixation is beneficial for tendon-to-bone incorporation by leading to the development of a direct type of ligament insertion.

Repair of distal biceps tendon rupture with the Biotenodesis screw.

PubMed

Khan, W; Agarwal, M; Funk, L

2004-04-01

Distal biceps tendon ruptures are uncommon injuries with only around 300 cases reported in the literature. Current management tends to favour anatomical reinsertion of the tendon into the radial tuberosity, especially in young and active individuals. These injuries are commonly repaired using either a single anterior incision with suture anchors or the Boyd-Anderson dual incision technique. We report the use of a bioabsorbable interference screw for the repair of distal biceps tendon rupture using a minimal incision technique. In this technique the avulsed tendon and a bioabsorbable screw are secured in a drill hole on the radial tuberosity using whip stitch and fibre wire sutures according to Biotenodesis system guidelines. The technique described requires minimal volar dissection that is associated with a reduced number of synostosis and posterior interosseous nerve injuries. The bioabsorbable interference screw has all the advantages of being biodegradable and has been shown to have greater pullout strength than suture anchors. It is also a reasonable alternative to titanium screws in terms of primary fixation strength. The strong fixation provided allows early active motion and return to previous activities as seen in our case.

[The mini-open Latarjet procedure for treatment of recurrent anterior instability of the shoulder].

PubMed

Pogorzelski, J; Beitzel, K; Imhoff, A B; Braun, S

2016-12-01

Shoulder stabilization. Symptomatic recurrent anterior shoulder instability combined with glenoid bone loss of approximately 20-35 % of the glenoid surface, engaging Hill-Sachs lesion and/or previously failed arthroscopic Bankart repair. In patients with a high risk of redislocation (contact sports) or irreparable soft tissue injury the Latarjet procedure can be considered as a first-line treatment. Contraindicated if arthroscopic Bankart repair is possible. Irreparable damage of subscapularis tendon. Bony defect >35 % of the glenoid that cannot be filled with coracoid bone block. Arbitrary shoulder dislocation. Young patients with open growth plates (relative contraindication). Mini-open deltopectoral approach of approximately 6 cm. Preparation of the coracoid process and the conjoined tendons. Osteotomy of the coracoid process at its base using a 90° sawblade. Split of the subscapularis tendon. Preparation of the glenoid defect and implantation of 2-3 suture anchors where appropriate. Drilling of two parallel holes through the coracoid process. Fixation of the bone block with cannulated screws at the anterior glenoid rim and refixation of the joint capsula, if necessary with the help of the suture anchors. Wound drainage and closure in layers. Intermittent immobilization in a sling for 6 weeks with limited abduction, flexion and external rotation. Sport-specific training after 3 months, over-head sports after 6 months. Since 2009 64 mini-open Latarjet procedures (61 patients) performed. In all, 9.4 % of patients suffered from persistent instability (dislocations and subluxations); only 1 patient needed revision surgery due to instability.

Short medial approach harvesting of hamstring tendons.

PubMed

Lanternier, H; de Cussac, J B; Collet, T

2016-04-01

Harvesting the hamstring tendons for anterior cruciate ligament reconstruction is not straightforward to perform or to teach: the incision is small, the work-space is narrow and the surgeon's tactile feedback using the stripper is difficult to explain to juniors. The purpose of this short note is to describe a reliable means of harvesting the semitendinosus, gracilis or both. Patient and tourniquet positioning, instrumentation and landmarks are detailed; then the 6 steps (speed-bump 1, speed-bump 2, bubble, hook, expansions, stripper) are explained. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Revision anterior cruciate ligament reconstruction with nonirradiated fresh-frozen patellar tendon allograft.

PubMed

Fox, Jeff A; Pierce, Mark; Bojchuk, John; Hayden, Jennifer; Bush-Joseph, Charles A; Bach, Bernard R

2004-10-01

To evaluate the effectiveness of a revision anterior cruciate ligament reconstruction with nonirradiated patellar tendon allograft used to salvage a failed index patellar tendon autograft procedure. Retrospective case series with minimum 2-year follow-up. Between 1993 and 1999, 39 patients underwent a revision reconstruction. Clinical, radiographic, arthrometric, and functional evaluations were performed. The Tegner, Lysholm, Noyes, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and SF-12 rating scales were used. Statistical analysis was conducted with our Biostatistics Department. Thirty-two of 38 patients (84%) were personally evaluated. The mean patient age was 28 years (range, 16 to 57 years); the mean follow-up was 4.8 years (range, 2.1 to 12.1 years). After revision, there were significant improvements in the Lachman and pivot-shift test results: 87% had a grade 0/1+ Lachman and a 0/1+ pivot-shift. However, 25% had a grade 1+ pivot-shift. Postoperatively, KT-1000 testing revealed that 84% had a maximum manual side-to-side difference of < or =3 mm and 6% had >5 mm. Functional testing revealed a mean 4% difference in side-to-side comparisons for a single-leg hop for distance and time, as well as vertical jump. The mean results of Noyes sports function (72), Lysholm (75), Tegner (6.3), KOOS sports activity scale (67), SF-12 physical component (48), SF-12 mental component (55), and IKDC (71) were obtained. The Noyes sports activity score showed a significant improvement from 55 preoperatively to 70 at follow-up. Subjectively, 87% of patients indicated that they were completely or mostly satisfied with the surgical outcome. One patient required another revision. The 2- to 11-year follow-up showed that the results of revision ACL reconstruction with a nonirradiated patellar tendon allograft were less favorable than those of a primary anterior cruciate ligament reconstruction, with a lower subjective satisfaction level and a higher percentage of patients with grade 1+ or higher pivot-shift results. However, when compared with previously published reports, our results were comparable and underscore that revision anterior cruciate ligament surgery should be approached with tempered enthusiasm and careful preoperative counseling, and considered as a salvage procedure. Level IV.

A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring tendons fixed with a metal round cannulated interference screw in the femur.

PubMed

Kobayashi, Masahiko; Nakagawa, Yasuaki; Suzuki, Takashi; Okudaira, Shuzo; Nakamura, Takashi

2006-10-01

To assess bone tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with the use of hamstring tendons fixed with a round cannulated interference (RCI) screw in the femur. A consecutive series of 30 ACL reconstructions performed with hamstring tendons fixed with an RCI screw in the femur and with staples via Leeds-Keio ligament in the tibia was retrospectively reviewed. The clinical outcome was evaluated through the Lysholm score. Anterior instability was tested by Telos-SE (Telos Japan, Tokyo, Japan) measurement. The location and angle of each femoral and tibial tunnel were measured with the use of plain radiographs, and bone tunnel enlargement greater than 2 mm detected any time 3, 6, 12, and 24 months postoperatively was defined as positive. Each factor (location and angle of the tunnels, sex, affected side, age, Lysholm score, and Telos-SE measurement) was compared between enlarged and nonenlarged groups. Positive enlargement of the bone tunnel (>2.0 mm) was observed in 36.7% (11 of 30) on the femoral side and 33.3% (10 of 30) on the tibial side, and in 6 knees of both sides. Half of patients (15 of 30) had an enlarged tunnel on the femoral or the tibial side until 1 year postoperatively. In most cases, enlargement reached maximum at 6 months postoperatively. Female patients tended to have an enlarged tunnel, especially on the femoral side (P < .05). Tunnel enlargement was not correlated with location and angle of the tunnels. Moreover, no difference was found in Lysholm score and Telos-SE measurement between enlarged and nonenlarged groups, although the nonenlarged group tended to exhibit higher Lysholm score and lesser instability. Bone tunnel enlargement of the femoral or tibial side was observed in half of patients (6 in both sides, 5 only in the femur, and 4 only in the tibia) after ACL reconstruction was performed with a hamstring tendon fixed with an RCI screw. Female patients had a greater chance for enlargement of the femoral tunnel than did males. This enlargement had no significant impact on patient activity and on anterior instability of the knee 1 year after surgery. Level IV, Therapeutic case series.

Fiber transformation and replacement in low-frequency stimulated rabbit fast-twitch muscles.

PubMed

Schuler, M; Pette, D

1996-08-01

The fast-to-slow conversion of rabbit skeletal muscles by chronic low-frequency (10 Hz, 12 h daily) stimulation involves (1) sequential fast-to-slow fiber-type transitions in the order of type IID-->type IIA-->type I, and (2) the replacement of deteriorating fast-twitch glycolytic fibers by new fibers derived from satellite cells and myotubes. These two processes were analyzed in 30- and 60-day stimulated extensor digitorum longus and tibialis anterior muscles. Fast-to-slow transforming fibers were identified by myofibrillar actomyosin histochemistry as type C fibers and immunohistochemically by their reaction with monoclonal antibodies specific to slow and fast myosin heavy chain isoforms. In situ hybridization of mRNA specific to the myosin heavy chain I isoform identified all fibers expressing slow myosin, i.e., type I and C fibers. The fraction of transforming fibers ranged between 35% and 50% in 30-day stimulated muscles. The percentage of type I fibers (20%) was threefold elevated in extensor digitorum longus muscle, but unaltered (3.5%) in tibialis anterior muscle, suggesting that fast-to-slow fiber conversion was more advanced in the former than in the latter. Fiber replacement was indicated by the finding that the fiber populations of both muscles contained 15% myotubes or small fibers with central nuclei. In situ hybridization revealed that myotubes and small regenerating fibers uniformly expressed myosin heavy chain I mRNA. Similarly, high percentages of slow-myosin-expressing myotubes and small fibers were found in 60-day stimulated muscles.

The age related slow and fast contributions to the overall changes in tibialis anterior contractile features disclosed by maximal single twitch scan.

PubMed

Orizio, Claudio; Cogliati, Marta; Bissolotti, Luciano; Diemont, Bertrand; Gobbo, Massimiliano; Celichowski, Jan

2016-01-01

This work aimed to verify if maximal electrically evoked single twitch (STmax) scan discloses the relative functional weight of fast and slow small bundles of fibres (SBF) in determining the contractile features of tibialis anterior (TA) with ageing. SBFs were recruited by TA main motor point stimulation through 60 increasing levels of stimulation (LS): 20 stimuli at 2Hz for each LS. The lowest and highest LS provided the least ST and STmax, respectively. The scanned STmax was decomposed into individual SBF STs. They were identified when twitches from adjacent LS were significantly different and then subtracted from each other. Nine young (Y) and eleven old (O) subjects were investigated. Contraction time (CT) and STarea/STpeak (A/PT) were calculated per each SBF ST. 143 and 155 SBF STs were obtained in Y and O, respectively. Y: CT and A/PT range: 45-105ms and 67-183mNs/mN, respectively. Literature data set TA fast fibres at 34% so, from the arrays of CT and A/PT, 65ms and 100mNs/mN were identified as the upper limit for SBF fast ST classification. O: no SBF ST could be classified as fast. STmax scan reveals age-related changes in the relative contribution of fast and slow SBFs to the overall muscle mechanics. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

M1/70 attenuates blood-borne neutrophil oxidants, activation, and myofiber damage following stretch injury.

PubMed

Brickson, S; Ji, L L; Schell, K; Olabisi, R; St Pierre Schneider, B; Best, T M

2003-09-01

The purpose of this study was to determine the role of the CD11b-dependent respiratory burst in neutrophil oxidant generation and activation, interleukin-8 (IL-8) production, and myofiber damage after muscle stretch injury by using the monoclonal antibody M1/70 to block this pathway. Twelve male New Zealand White rabbits were randomly assigned to a treatment group: M1/70 (n = 6), IgG isotype control (n = 3), or saline control (n = 3). After intravenous injection of the assigned agent under gas anesthesia, a standardized single-stretch injury was created in the right tibialis anterior, whereas the left tibialis anterior underwent a sham surgery. Blood-borne neutrophil oxidant generation and CD11b receptor density and plasma IL-8 levels were measured pre- and 24 h postinjury. Damage was assessed histologically at the hematoma site by counting torn myofibers. M1/70 group demonstrated decreased blood-borne neutrophil oxidant generation (P < 0.05) and CD11b receptor density (P < 0.05), an increase in plasma IL-8 concentration (P < 0.01), and less torn myofibers (P < 0.01) compared with IgG isotype or saline control groups. These data indicate that 1). CD11b-dependent respiratory burst is a major source of oxidants produced by the neutrophil, and that treatment with M1/70 2). attenuates neutrophil activation status, 3). increases plasma IL-8 concentration, and 4). minimizes myofiber damage 24 h postmuscle stretch injury.

Losing touch: age-related changes in plantar skin sensitivity, lower limb cutaneous reflex strength, and postural stability in older adults

PubMed Central

Peters, Ryan M.; McKeown, Monica D.; Carpenter, Mark G.

2016-01-01

Age-related changes in the density, morphology, and physiology of plantar cutaneous receptors negatively impact the quality and quantity of balance-relevant information arising from the foot soles. Plantar perceptual sensitivity declines with age and may predict postural instability; however, alteration in lower limb cutaneous reflex strength may also explain greater instability in older adults and has yet to be investigated. We replicated the age-related decline in sensitivity by assessing monofilament and vibrotactile (30 and 250 Hz) detection thresholds near the first metatarsal head bilaterally in healthy young and older adults. We additionally applied continuous 30- and 250-Hz vibration to drive mechanically evoked reflex responses in the tibialis anterior muscle, measured via surface electromyography. To investigate potential relationships between plantar sensitivity, cutaneous reflex strength, and postural stability, we performed posturography in subjects during quiet standing without vision. Anteroposterior and mediolateral postural stability decreased with age, and increases in postural sway amplitude and frequency were significantly correlated with increases in plantar detection thresholds. With 30-Hz vibration, cutaneous reflexes were observed in 95% of young adults but in only 53% of older adults, and reflex gain, coherence, and cumulant density at 30 Hz were lower in older adults. Reflexes were not observed with 250-Hz vibration, suggesting this high-frequency cutaneous input is filtered out by motoneurons innervating tibialis anterior. Our findings have important implications for assessing the risk of balance impairment in older adults. PMID:27489366

The effects of body weight unloading on kinetics and muscle activity of overweight males during Overground walking.

PubMed

Fischer, Arielle G; Wolf, Alon

2018-02-01

Excess body weight has become a major worldwide health and social epidemic. Training with body weight unloading, is a common method for gait corrections for various neuromuscular impairments. In the present study we assessed the effects of body weight unloading on knee and ankle kinetics and muscle activation of overweight subjects walking overground under various levels of body weight unloading. Ten overweight subjects (25 ≤ BMI < 29.9 kg/m 2 ) walked overground under a control and three (0%, 15%, 30%) body weight unloading experimental conditions. Gait parameters assessed under these conditions included knee and ankle flexion moments and the Electromygraphic activity of the Tibialis Anterior, Lateral Gastrocnemius and Vastus Lateralis. Increasing body weight unloading levels from 0% to 30% was found to significantly reduce the peak knee flexion and ankle plantarflexion moments. Also observed was a significant reduction in muscle activity of the Tibialis Anterior, Lateral Gastrocnemius and Vastus Lateralis under the three body-weight unloading conditions. Our results demonstrate that a reduction of up to 30% overweight subjects' body weight during gait is conducive to a reduction in the knee and ankle flexion moments and in the balancing net quadriceps moment and ankle flexors moment. The newly devised body weight unloading device is therefore an effective method for reducing joint loads allowing overweight people who require controlled weight bearing scenarios to retrain their gait while engaging in sustained walking exercise. Copyright © 2018 Elsevier Ltd. All rights reserved.

Intramuscular pressures beneath elastic and inelastic leggings

NASA Technical Reports Server (NTRS)

Murthy, G.; Ballard, R. E.; Breit, G. A.; Watenpaugh, D. E.; Hargens, A. R.

1994-01-01

Leg compression devices have been used extensively by patients to combat chronic venous insufficiency and by astronauts to counteract orthostatic intolerance following spaceflight. However, the effects of elastic and inelastic leggings on the calf muscle pump have not been compared. The purpose of this study was to compare in normal subjects the effects of elastic and inelastic compression on leg intramuscular pressure (IMP), an objective index of calf muscle pump function. IMP in soleus and tibialis anterior muscles was measured with transducer-tipped catheters. Surface compression between each legging and the skin was recorded with an air bladder. Subjects were studied under three conditions: (1) control (no legging), (2) elastic legging, and (3) inelastic legging. Pressure data were recorded for each condition during recumbency, sitting, standing, walking, and running. Elastic leggings applied significantly greater surface compression during recumbency (20 +/- 1 mm Hg, mean +/- SE) than inelastic leggings (13 +/- 2 mm Hg). During recumbency, elastic leggings produced significantly higher soleus IMP of 25 +/- 1 mm Hg and tibialis anterior IMP of 28 +/- 1 mm Hg compared to 17 +/- 1 mm Hg and 20 +/- 2 mm Hg, respectively, generated by inelastic leggings and 8 +/- 1 mm Hg and 11 +/- 1 mm Hg, respectively, without leggings. During sitting, walking, and running, however, peak IMPs generated in the muscular compartments by elastic and inelastic leggings were similar. Our results suggest that elastic leg compression applied over a long period in the recumbent posture may impede microcirculation and jeopardize tissue viability.(ABSTRACT TRUNCATED AT 250 WORDS).

Effects of treadmill training on functional recovery following peripheral nerve injury in rats

PubMed Central

Boeltz, Tiffany; Ireland, Meredith; Mathis, Kristin; Nicolini, Jennifer; Poplavski, Karen; Rose, Samuel J.; Wilson, Erin

2013-01-01

Exercise, in the form of moderate daily treadmill training following nerve transection and repair leads to enhanced axon regeneration, but its effect on functional recovery is less well known. Female rats were exercised by walking continuously, at a slow speed (10 m/min), for 1 h/day on a level treadmill, beginning 3 days after unilateral transection and surgical repair of the sciatic nerve, and conducted 5 days/wk for 2 wk. In Trained rats, both direct muscle responses to tibial nerve stimulation and H reflexes in soleus reappeared earlier and increased in amplitude more rapidly over time than in Untrained rats. The efficacy of the restored H reflex was greater in Trained rats than in Untrained controls. The reinnervated tibialis anterior and soleus were coactivated during treadmill locomotion in Untrained rats. In Trained animals, the pattern of activation of soleus, but not tibialis anterior, was not significantly different from that found in Intact rats. The overall length of the hindlimb during level and up- and downslope locomotion was conserved after nerve injury in both groups. This conservation was achieved by changes in limb orientation. Limb length was conserved effectively in all rats during downslope walking but only in Trained rats during level and upslope walking. Moderate daily exercise applied immediately after sciatic nerve transection is sufficient to promote axon regeneration, to restore muscle reflexes, and to improve the ability of rats to cope with different biomechanical demands of slope walking. PMID:23468390

Improved angiogenesis and healing in crush syndrome by fibroblast growth factor-2-containing low-molecular-weight heparin (Fragmin)/protamine nanoparticles.

PubMed

Takikawa, Makoto; Nakamura, Shingo; Ishihara, Masayuki; Takabayashi, Yuki; Fujita, Masanori; Hattori, Hidemi; Kushibiki, Toshihiro; Ishihara, Miya

2015-06-15

We produced fibroblast growth factor (FGF)-2-containing low-molecular-weight heparin (Fragmin)/protamine nanoparticles (FGF-2 + F/P NPs). The purpose of this study was to evaluate the effectiveness of the local administration of FGF-2 + F/P NPs on repairing crush syndrome (CS)-injured lesions after compression release using a nonlethal and reproducible CS injury rat model. The hind limbs of the anesthetized rats were compressed for 6 h using 3.6 kg blocks, as previously described. The effects of administering FGF-2 + F/P NPs (group A), F/P NPs alone (group B), FGF-2 alone (group C), and saline (control; group D) were examined. Motor function, surface blood flow in the hind limbs, and the wet/dry weight ratio in the tibialis anterior muscle were examined for 1-28 d after the compression release. Histologic analyses were also performed. At the middle and late stages (3-28 d after the compression release), group A had higher scores in the motor function, improved blood flow, increased number of blood vessels, and faster recovered muscle tissue, compared with the other groups. There was no significant difference in enhanced edema in the tibialis anterior muscle among all groups. The local administration of FGF-2 + F/P NPs to a CS-injured lesion was effective in repairing damaged muscle tissue after compression release. Copyright © 2015 Elsevier Inc. All rights reserved.

Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain.

PubMed

Walton, David M; Macdermid, Joy C; Nielson, Warren; Teasell, Robert W; Chiasson, Marco; Brown, Lauren

2011-09-01

Clinical measurement. To evaluate the intrarater, interrater, and test-retest reliability of an accessible digital algometer, and to determine the minimum detectable change in normal healthy individuals and a clinical population with neck pain. Pressure pain threshold testing may be a valuable assessment and prognostic indicator for people with neck pain. To date, most of this research has been completed using algometers that are too resource intensive for routine clinical use. Novice raters (physiotherapy students or clinical physiotherapists) were trained to perform algometry testing over 2 clinically relevant sites: the angle of the upper trapezius and the belly of the tibialis anterior. A convenience sample of normal healthy individuals and a clinical sample of people with neck pain were tested by 2 different raters (all participants) and on 2 different days (healthy participants only). Intraclass correlation coefficient (ICC), standard error of measurement, and minimum detectable change were calculated. A total of 60 healthy volunteers and 40 people with neck pain were recruited. Intrarater reliability was almost perfect (ICC = 0.94-0.97), interrater reliability was substantial to near perfect (ICC = 0.79-0.90), and test-retest reliability was substantial (ICC = 0.76-0.79). Smaller change was detectable in the trapezius compared to the tibialis anterior. This study provides evidence that novice raters can perform digital algometry with adequate reliability for research and clinical use in people with and without neck pain.

Lumbar segmental nerve blocks with local anesthetics, pain relief, and motor function: a prospective double-blind study between lidocaine and ropivacaine.

PubMed

Wolff, André P; Wilder Smith, Oliver H G; Crul, Ben J P; van de Heijden, Marc P; Groen, Gerbrand J

2004-08-01

Selective segmental nerve blocks with local anesthetics are applied for diagnostic purposes in patients with chronic back pain to determine the segmental level of the pain. We performed this study to establish myotomal motor effects after L4 spinal nerve blocks by lidocaine and ropivacaine and to evaluate the relationship with pain. Therefore, 20 patients, of which 19 finished the complete protocol, with chronic lumbosacral radicular pain without neurological deficits underwent segmental nerve blocks at L4 with both lidocaine and ropivacaine. Pain intensity scores (verbal numeric rating scale; VNRS) and the maximum voluntary muscle force (MVMF; using a dynamometer expressed in newtons) of the tibialis anterior and quadriceps femoris muscles were measured on the painful side and on the control side. The median VNRS decrease was 4.0 (P < 0.00001; Wilcoxon's signed rank test), without significant differences between ropivacaine and lidocaine (Mann-Whitney U-test). A difference in effect on MVMF was found for affected versus control side (P = 0.016; Tukey test). Multiple regression revealed a significant negative correlation for change in VNRS score versus change in median MVMF (Spearman R = -0.48: P = 0.00001). This study demonstrates that in patients with unilateral chronic low back pain radiating to the leg, pain reduction induced by local anesthetic segmental nerve (L4) block is associated with increased quadriceps femoris and tibialis anterior MVMF, without differences for lidocaine and ropivacaine.

Increased pain sensitivity is not associated with electrodiagnostic findings in women with carpal tunnel syndrome.

PubMed

de la Llave-Rincón, Ana Isabel; Fernández-de-las-Peñas, César; Laguarta-Val, Sofia; Alonso-Blanco, Cristina; Martínez-Perez, Almudena; Arendt-Nielsen, Lars; Pareja, Juan A

2011-01-01

To determine the differences in widespread pressure pain and thermal hypersensitivity in women with minimal, moderate, and severe carpal tunnel syndrome (CTS) and healthy controls. A total of 72 women with CTS (19 with minimal, 18 with moderate, and 35 with severe) and 19 healthy age-matched women participated. Pressure pain thresholds were bilaterally assessed over the median, ulnar, and radial nerves, the C5 to C6 zygapophyseal joint, the carpal tunnel, and the tibialis anterior muscle. In addition, warm and cold detection thresholds and heat and cold pain thresholds were bilaterally assessed over the carpal tunnel and the thenar eminence. All outcome parameters were assessed by an assessor blinded to the participant's condition. No significant differences in pain parameters among patients with minimal, moderate, and severe CTS were found. The results showed that PPT were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, C5 to C6 zygapophyseal joint, and the tibialis anterior muscle in patients with minimal, moderate, or severe CTS as compared with healthy controls (all, P<0.001). In addition, patients with CTS also showed lower heat pain threshold and reduced cold pain threshold compared with controls (P<0.001). No significant sensory differences between minimal, moderate, or severe CTS were found. The similar widespread pressure and thermal hypersensitivity in patients with minimal, moderate, or severe CTS and pain intensity suggests that increased pain sensitivity is not related to electrodiagnostic findings.

Tendon healing in a bone tunnel. Part I: Biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep.

PubMed

Weiler, Andreas; Peine, Ricarda; Pashmineh-Azar, Alireza; Abel, Clemens; Südkamp, Norbert P; Hoffmann, Reinhard F G

2002-02-01

Interference fit fixation of soft-tissue grafts has recently raised strong interest because it allows for anatomic graft fixation that may increase knee stability and graft isometry. Although clinical data show promising results, no data exist on how tendon healing progresses using this fixation. The purpose of the present study was to investigate anterior cruciate ligament (ACL) reconstruction biomechanically using direct tendon-to-bone interference fit fixation with biodegradable interference screws in a sheep model. Animal study. Thirty-five mature sheep underwent ACL reconstruction with an autologous Achilles tendon split graft. Grafts were directly fixed with poly-(D,L-lactide) interference screws. Animals were euthanized after 6, 9, 12, 24, and 52 weeks and standard biomechanical evaluations were performed. All grafts at time zero failed by pullout from the bone tunnel, whereas grafts at 6 and 9 weeks failed intraligamentously at the screw insertion site. At 24 and 52 weeks, grafts failed by osteocartilaginous avulsion. At 24 weeks, interference screws were macroscopically degraded. At 6 and 9 weeks tensile stress was only 6.8% and 9.6%, respectively, of the graft tissue at time zero. At 52 weeks, tensile stress of the reconstruction equaled 63.8% and 47.3% of the Achilles tendon graft at time zero and the native ACL, respectively. A complete restitution of anterior-posterior drawer displacement was found at 52 weeks compared with the time-zero reconstruction. It was found that over the whole healing period the graft fixation proved not to be the weak link of the reconstruction and that direct interference fit fixation withstands loads without motion restriction in the present animal model. The weak link during the early healing stage was the graft at its tunnel entrance site, leading to a critical decrease in mechanical properties. This finding indicates that interference fit fixation of a soft-tissue graft may additionally alter the mechanical properties of the graft in the early remodeling stage because of a possible tissue compromise at the screw insertion site. Although mechanical properties of the graft tissue had not returned to normal at 1 year compared with those at time zero, knee stability had returned to normal at that time. There was no graft pullout after 24 weeks, indicating that screw degradation does not compromise graft fixation.

The relationship of lateral anatomic structures to exiting guide pins during femoral tunnel preparation utilizing an accessory medial portal.

PubMed

Farrow, Lutul D; Parker, Richard D

2010-06-01

Anatomic reconstruction of the anterior cruciate ligament through an accessory medial portal has become increasingly popular. The purpose of this study is to describe the relationship of guide pin exit points to the lateral anatomic structures when preparing the anterior cruciate ligament femoral tunnel through an accessory medial portal. We utilized seven fresh frozen cadaveric knees. Utilizing an anteromedial approach, a guide wire was placed into the center of each bundle's footprint. Each guide wire was advanced through the lateral femoral cortex. The guide pins were passed at 90, 110, and 130 degrees of knee flexion. The distances from each guide pin to the closest relevant structures on the lateral side of the knee were measured. At 90 degrees the posterolateral bundle guide pin was closest to the lateral condyle articular cartilage (mean 5.4 +/- 2.2 mm) and gastrocnemius tendon (mean 5.7 +/- 2.1 mm). At 110 degrees the posterolateral bundle pin was closest to the gastrocnemius tendon (mean 4.5 +/- 3.4 mm). At 130 degrees the posterolateral bundle pin was closest to the gastrocnemius tendon (mean 7.2 +/- 5.5 mm) and lateral collateral ligament (mean 6.8 +/- 2.1 mm). At 90 degrees the anteromedial bundle guide pin was closest to the articular cartilage (mean 2.0 +/- 2.0 mm). At 110 degrees the anteromedial bundle pin was closest to the articular cartilage (mean 7.4 +/- 3.5 mm) and gastrocnemius tendon (mean 12.3 +/- 3.1 mm). At 130 degrees the AM bundle pin was closest to the gastrocnemius tendon (mean 8.2 +/- 3.2 mm) and LCL (mean 15.1 +/- 2.9 mm). Neither guide pin (anteromedial or posterolateral bundle) put the peroneal nerve at risk at any knee flexion angle. At low knee flexion angles the anteromedial and posterolateral bundle guide pins closely approximated multiple lateral structures when using an accessory medial arthroscopic portal. Utilizing higher flexion angles increases the margin of error when preparing both femoral tunnels. During preparation of the anterior cruciate ligament femoral tunnel through an accessory anteromedial portal the tunnels should be drilled in at least 110 degrees of knee flexion in order to move guide pin exit points away from important lateral knee structures.

Autologous platelet-rich plasma gel to reduce donor-site morbidity after patellar tendon graft harvesting for anterior cruciate ligament reconstruction: a randomized, controlled clinical study.

PubMed

Cervellin, M; de Girolamo, L; Bait, C; Denti, M; Volpi, P

2012-01-01

Bone-patellar tendon-bone technique (BPTB) for anterior cruciate ligament injuries is associated with a higher risk of donor-site morbidity. To evaluate whether platelet-rich plasma (PRP), due to its anti-inflammatory properties and capacity to stimulate tissue regeneration, was able to reduce the anterior knee pain, the kneeling pain, and donor-site morbidity, as evidenced by evaluation of VISA and VAS scoring scales and MRI analysis of the tendon and bone defect, we performed a clinical randomized controlled study where PRP gel was applied to donor site after ACL reconstruction with BPTB. Forty young athletes with the indication of ACL reconstruction with patellar tendon grafts were randomly assigned to group A (n = 20 patients, control group) or group B (n = 20 patients, PRP group). The autologous PRP gel was applied to both the patellar and tendon bone plug harvest site and stabilized by the peritenon suture. At 12-month follow-up, all patients underwent clinical examination and VAS and VISA questionnaires, respectively, evaluating the average daily pain of the knee and the pain during particular activities involving the knee, were filled. MRI at the same time point was also performed. VISA scores were significantly higher in the patients treated with PRP (84.5 ± 11.8 and 97.8 ± 2.5 for group A and for group B; P = 0.041), whereas no significant difference in postoperative VAS scores between the two groups was observed (1 ± 1.4 and 0.6 ± 0.9 for group A and group B, n.s.). In 85% of PRP group patients, the tibial and patellar bone defect was satisfactorily filled by new bony tissue (>70% of bone gap filled), whereas this percentage was just of 60% in control group patients, but this difference was not statistically significant. The study shows the usefulness of PRP in reducing subjective pain at the donor-site level after ACL reconstruction with BPTB. However, this approach deserves further investigations to confirm PRP efficacy and to elucidate its mechanism of action. Prospective randomized controlled study, Level I.

A novel remaining tendon preserving repair technique leads to improved outcomes in special rotator cuff tear patterns.

PubMed

Jeon, Yoon Sang; Kim, Rag Gyu; Shin, Sang-Jin

2018-05-16

The purpose of this study was to identify the tear pattern that could be anatomically repaired by preserving the remaining tendon on footprint and evaluate clinical outcomes of patients who underwent remaining tendon preserving cuff repair. Of 523 patients with full-thickness rotator cuff tears who underwent arthroscopic repair, 41 (7.8%) patients had repairable rotator cuff tear while preserving the remaining tendon. Among them, 31 patients were followed-up for more than 2 years, including 26 patients with posterior L-shaped tear and 5 patients with transtendinous tear patterns. Clinical outcomes were evaluated using ASES and Constant score, SANE score for patient satisfaction, and VAS for pain. MRI was taken for tendon integrity 6 months postoperatively. Of the 31 patients, 11 (35.5%) had previous injury history before rotator cuff tear, including 7 (26.9%) of the 26 patients with posterior L-shaped tear and 4 (80%) of the 5 patients with transtendinous tear. The average size of preoperative cuff tear was 17.8 ± 6.8 mm in anterior-to-posterior direction and 15.2 ± 5.1 mm in medial-to-lateral direction. ASES and Constant score, SANE score, and VAS for pain were significantly (p < 0.001) improved after remaining tendon preserving rotator cuff repair. Rotator cuff tendons of 22(84.6%) patients with posterior L-shaped tear and 4(80%) patients with transtendinous tear patterns were healed. Patients who underwent rotator cuff repair with preservation of the remaining tendon on the footprint obtained satisfactory functional outcomes. Rotator cuff tears in patients who had posterior L-shaped tear extending between supraspinatus and infraspinatus tendons or transtendinous tear pattern with substantial remaining tendon could be repaired using remaining tendon preserving repair technique. Anatomic reduction of torn cuff tendon without undue tension could be achieved using the remaining tendon preserving repair technique.

Arthroscopic approach and intra-articular anatomy of the dorsal and plantar synovial compartments of the bovine tarsocrural joint.

PubMed

Lardé, Hélène; Nichols, Sylvain; Babkine, Marie; Desrochers, André

2017-01-01

To determine arthroscopic approaches to the dorsal and plantar synovial compartments of the tarsocrural joint in adult cattle, and to describe the arthroscopic intra-articular anatomy from each approach. Ex vivo study. Fresh adult bovine cadavers (n = 7). Two tarsocrural joint were injected with latex to determine arthroscopic portal locations and arthroscopy of the tarsocrural joint of 12 tarsi was performed. The dorsolateral approach was made through the large pouch located between the long digital extensor and peroneus longus tendons. The dorsomedial approach was made just medial to the common synovial sheath of the tibialis cranialis, peroneus tertius, and long digital extensor tendons. The plantarolateral and plantaromedial approaches were made lateral and medial to the tarsal tendon sheath, respectively. Each approach allowed visualization of the distal tibia articulating with the proximal trochlea of the talus. Consistently observed structures included the distal intermediate ridge of the tibia, and the medial and lateral trochlear ridges and trochlear groove of the talus. Lateral and medial malleoli were best assessed from dorsal approaches. From the lateral approaches evaluation of the abaxial surface of the lateral trochlear ridge allowed visualization of the fibulocalcaneal joint. From the plantar approaches additional observed structures included the coracoid process of the calcaneus, plantar trochlea of the talus, and plantar talotibial and talofibular ligaments. In cattle, the dorsolateral and plantarolateral approaches allowed for the best evaluation of the dorsal and plantar aspects of the tarsocrural joint, respectively. © 2017 The American College of Veterinary Surgeons.

In vitro structural properties of braided tendon grafts.

PubMed

Nicklin, S; Waller, C; Walker, P; Chung, W K; Walsh, W R

2000-01-01

In an effort to increase strength in hamstring tendon grafts for anterior cruciate ligament reconstruction, braiding or weaving of the tendons has been suggested. The purpose of this study was to examine the biomechanical properties of two braiding techniques compared with a four-stranded tendon graft using a sheep model. Digital extensor tendons from 5 adult sheep were harvested in 28 matched pairs and randomly allocated to French plait or four-stranded weave. The grafts were tested in a hydraulic testing machine with the tendons secured in brass grips frozen with liquid carbon dioxide. The tendons were preconditioned to a distraction of 1 mm for 10 cycles followed by testing to failure at 50 mm/sec, with a data acquisition rate of 1,000 Hz. The stiffness, ultimate load to failure, and the mode of failure were recorded. All braided samples failed at the midsubstance, while the four-stranded controls failed at the grip interface. There was a significant reduction in strength and stiffness of the braided samples compared with the controls. This study demonstrated that braiding decreases the strength and stiffness of a four-stranded tendon graft by up to 54% and 85%, respectively. This finding is supported by the work of Hearle et al. (1969), who demonstrated that the decrease in strength of fiber bundles is equal to the square of the cosine of the twist angle. The twist angle in our samples was approximately 45 degrees, which equates to a decrease in strength of 50%.

Motor-Neuron Pool Excitability of the Lower Leg Muscles After Acute Lateral Ankle Sprain

PubMed Central

Klykken, Lindsey W.; Pietrosimone, Brian G.; Kim, Kyung-Min; Ingersoll, Christopher D.; Hertel, Jay

2011-01-01

Context: Neuromuscular deficits in leg muscles that are associated with arthrogenic muscle inhibition have been reported in people with chronic ankle instability, yet whether these neuromuscular alterations are present in individuals with acute sprains is unknown. Objective: To compare the effect of acute lateral ankle sprain on the motor-neuron pool excitability (MNPE) of injured leg muscles with that of uninjured contralateral leg muscles and the leg muscles of healthy controls. Design: Case-control study. Setting: Laboratory. Patients or Other Participants: Ten individuals with acute ankle sprains (6 females, 4 males; age = 19.2 ± 3.8 years, height = 169.4 ± 8.5 cm, mass = 66.3 ±11.6 kg) and 10 healthy individuals (6 females, 4 males; age = 20.6 ± 4.0 years, height = 169.9 ± 10.6 cm, mass = 66.3 ± 10.2 kg) participated. Intervention(s): The independent variables were group (acute ankle sprain, healthy) and limb (injured, uninjured). Separate dependent t tests were used to determine differences in MNPE between legs. Main Outcome Measure(s): The MNPE of the soleus, fibularis longus, and tibialis anterior was measured by the maximal Hoffmann reflex (Hmax) and maximal muscle response (Mmax) and was then normalized using the Hmax:Mmax ratio. Results: The soleus MNPE in the ankle-sprain group was higher in the injured limb (Hmax:Mmax = 0.63; 95% confidence interval [CI], 0.46, 0.80) than in the uninjured limb (Hmax:Mmax = 0.47; 95% CI, 0.08, 0.93) (t6 = 3.62, P = .01). In the acute ankle-sprain group, tibialis anterior MNPE tended to be lower in the injured ankle (Hmax:Mmax = 0.06; 95% CI, 0.01, 0.10) than in the uninjured ankle (Hmax:Mmax = 0.22; 95% CI, 0.09, 0.35), but this finding was not different (t9 = −2.01, P = .07). No differences were detected between injured (0.22; 95% CI, 0.14, 0.29) and uninjured (0.25; 95% CI, 0.12, 0.38) ankles for the fibularis longus in the ankle-sprain group (t9 = −0.739, P = .48). We found no side-to-side differences in any muscle among the healthy group. Conclusions: Facilitated MNPE was present in the involved soleus muscle of patients with acute ankle sprains, but no differences were found in the fibularis longus or tibialis anterior muscles. PMID:21669095

Epigenetic regulation of metalloproteinases and their inhibitors in rotator cuff tears

PubMed Central

Caires dos Santos, Leonardo; Martins de Oliveira, Adrielle; Santoro Belangero, Paulo; Antônio Figueiredo, Eduardo; Cohen, Carina; de Seixas Alves, Felipe; Hiromi Yanaguizawa, Wânia; Vicente Andreoli, Carlos; de Castro Pochini, Alberto; Ejnisman, Benno; Cardoso Smith, Marília; de Seixas Alves, Maria Teresa; Cohen, Moises

2017-01-01

Rotator cuff tear is a common orthopedic condition. Metalloproteinases (MMP) and their inhibitors (TIMP) seem to play a role in the development of joint injuries and in the failure of tissue healing. However, the mechanisms of regulation of gene expression in tendons are still unknown. Epigenetic mechanisms, such as DNA methylation and microRNAs regulation, are involved in the dynamic control of gene expression. Here, the mRNA expression and DNA methylation status of MMPs (MMP1, MMP2, MMP3, MMP9, MMP13, and MMP14) and TIMPs (TIMP1-3) and the expression of miR-29 family members in ruptured supraspinatus tendons were compared with non-injured tendons of individuals without this lesion. Additionally, the gene expression and methylation status at the edge of the ruptured tendon were compared with macroscopically non-injured rotator cuff tendon samples from the anterior and posterior regions of patients with tendon tears. Moreover, the possible associations between the molecular alterations and the clinical and histologic characteristics were investigated. Dysregulated expression and DNA methylation of MMP and TIMP genes were found across the rotator cuff tendon samples of patients with supraspinatus tears. These alterations were influenced at least in part by age at surgery, sex, smoking habit, tear size, and duration of symptoms. Alterations in the studied MMP and TIMP genes may contribute to the presence of microcysts, fissures, necrosis, and neovascularization in tendons and may thus be involved in the tendon healing process. In conclusion, MMPs and their inhibitors are regulated by epigenetic modifications and may play a role in rotator cuff tears. PMID:28902861

Magnesium inference screw supports early graft incorporation with inhibition of graft degradation in anterior cruciate ligament reconstruction

PubMed Central

Cheng, Pengfei; Han, Pei; Zhao, Changli; Zhang, Shaoxiang; Zhang, Xiaonong; Chai, Yimin

2016-01-01

Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction. PMID:27210585

Magnesium inference screw supports early graft incorporation with inhibition of graft degradation in anterior cruciate ligament reconstruction

NASA Astrophysics Data System (ADS)

Cheng, Pengfei; Han, Pei; Zhao, Changli; Zhang, Shaoxiang; Zhang, Xiaonong; Chai, Yimin

2016-05-01

Patients after anterior cruciate ligament (ACL) reconstruction surgery commonly encounters graft failure in the initial phase of rehabilitation. The inhibition of graft degradation is crucial for the successful reconstruction of the ACL. Here, we used biodegradable high-purity magnesium (HP Mg) screws in the rabbit model of ACL reconstruction with titanium (Ti) screws as a control and analyzed the graft degradation and screw corrosion using direct pull-out tests, microCT scanning, and histological and immunohistochemical staining. The most noteworthy finding was that tendon graft fixed by HP Mg screws exhibited biomechanical properties substantially superior to that by Ti screws and the relative area of collagen fiber at the tendon-bone interface was much larger in the Mg group, when severe graft degradation was identified in the histological analysis at 3 weeks. Semi-quantitative immunohistochemical results further elucidated that the MMP-13 expression significantly decreased surrounding HP Mg screws with relatively higher Collagen II expression. And HP Mg screws exhibited uniform corrosion behavior without displacement or loosening in the femoral tunnel. Therefore, our results demonstrated that Mg screw inhibited graft degradation and improved biomechanical properties of tendon graft during the early phase of graft healing and highlighted its potential in ACL reconstruction.

Surgical repair of chronic patellar tendon rupture in total knee replacement with ipsilateral hamstring tendons.

PubMed

Spoliti, Marco; Giai Via, Alessio; Padulo, Johnny; Oliva, Francesco; Del Buono, Angelo; Maffulli, Nicola

2016-10-01

Patellar tendon rupture is a serious complication of total knee arthroplasty (TKA). Its reconstruction in patients with chronic ruptures is technically demanding. This article reports the results of surgical reconstruction of neglected patellar tendon rupture in TKA using autologous hamstring tendons. Nine TKA patients (six women and three men) (mean age at index surgery 68 years) with chronic patellar tendon tears underwent reconstruction with ipsilateral hamstrings tendon, leaving the distal insertion in situ. The clinical diagnosis was supported by imaging (anterior-posterior and 30° flexion lateral radiographs). Insall-Salvati index, range of motion, and leg extension test were recorded preoperatively and at last follow-up. The modified Cincinnati rating system and the Kujala score were administered. The patients sustained the patellar tendon tear an average of 8 weeks before the procedure. At final follow-up of 4 years (range 2-8 years), the median of extension lag was 5° (range 0°-15°; DS = 5). The median of post-operative Insall-Salvati index was 1.4 (range 1.3-1.8; SD = 0.15; p = 0.002) compared to the preoperative index of 1.7 (range 1.5-2.2; SD = 0.23). The mean modified Cincinnati and Kujala scores significantly increased compared with the preoperative ones (p < 0.01). At final follow-up, all patients were able to walk without brace or aids, and they were satisfied with the procedure. Based on our retrospective study of nine patients, reconstruction of neglected patellar tendon rupture in TKA with autologous hamstring tendons is feasible and safe, and provides good functional recovery. Case series, Level IV.

Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial.

PubMed

de Almeida, Adriano Marques; Demange, Marco Kawamura; Sobrado, Marcel Faraco; Rodrigues, Marcelo Bordalo; Pedrinelli, André; Hernandez, Arnaldo José

2012-06-01

The patellar tendon has limited ability to heal after harvesting its central third. Platelet-rich plasma (PRP) could improve patellar tendon healing. Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament (ACL) reconstruction with a patellar tendon graft. Randomized controlled trial; Level of evidence, 1. Twenty-seven patients were randomly divided to receive (n = 12) or not receive (n = 15) PRP in the patellar tendon harvest site during ACL reconstruction. The primary outcome was magnetic resonance imaging (MRI) assessment of patellar tendon healing (gap area) after 6 months. Secondary outcomes were questionnaires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups. Patellar tendon gap area was significantly smaller in the PRP group (4.9 ± 5.3 mm(2); 95% confidence interval [CI], 1.1-8.8) than in the control group (9.4 ± 4.4 mm(2); 95% CI, 6.6-12.2; P = .046). Visual analog scale score for pain was lower in the PRP group immediately postoperatively (3.8 ± 1.0; 95% CI, 3.18-4.49) than in the control group (5.1 ± 1.4; 95% CI, 4.24-5.90; P = .02). There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups. We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period. Questionnaire and isokinetic testing results were not different between the groups at 6 months.

Combined Intra- and Extra-articular Reconstruction of the Anterior Cruciate Ligament: The Reconstruction of the Knee Anterolateral Ligament

PubMed Central

Helito, Camilo Partezani; Bonadio, Marcelo Batista; Gobbi, Riccardo Gomes; da Mota e Albuquerque, Roberto Freire; Pécora, José Ricardo; Camanho, Gilberto Luis; Demange, Marco Kawamura

2015-01-01

We present a new technique for the combined intra- and extra-articular reconstruction of the anterior cruciate ligament. Intra-articular reconstruction is performed in an outside-in manner according to the precepts of the anatomic femoral tunnel technique. Extra-articular reconstruction is performed with the gracilis tendon while respecting the anatomic parameters of the origin and insertion points and the path described for the knee anterolateral ligament. PMID:26258037

Intracapsular origin of the long head of the biceps tendon with glenoid avulsion of the glenohumeral ligaments.

PubMed

Parikh, Shital N; Bonnaig, Nicolas; Zbojniewicz, Andrew

2011-11-09

An 18-year-old woman presented with a history of recurrent glenohumeral dislocations involving her right dominant shoulder. Physical examination suggested physiologic hyperlaxity and anterior instability. Magnetic resonance arthrography demonstrated an anomalous intracapsular origin of the long head of the biceps tendon (LHBT), with normal-appearing LHBT in the intertubercular groove. Diagnostic arthroscopy confirmed the absence of the LHBT attachment on the superior labrum. Instead, the LHBT originated from the capsule of the shoulder joint. Diagnostic arthroscopy also revealed glenoid avulsion of the glenohumeral ligaments (GAGL) lesion as a tear in the anterior-inferior capsule near its insertion on the glenoid and labrum. An arthroscopic anterior capsulolabral repair was performed with rotator interval closure by imbrication of superior and middle glenohumeral ligaments. A retrospective review of the magnetic resonance arthrogram identified irregularity and interposition of contrast between the capsule and the anterior-inferior labrum that was reproduced in the abduction-external rotation view corresponding with the GAGL lesion seen at arthroscopy. At 12 months postoperatively, the patient demonstrated full range of motion and no signs of instability. This case report helps to raise awareness about 2 rare shoulder lesions: the anomalous origin of LHBT and the GAGL lesion. Diagnosing such lesions on preoperative magnetic resonance imaging may aid in operative planning and avoid unexpected intraoperative findings. Copyright 2011, SLACK Incorporated.

Tunnel widening prevention with the allo-Achilles tendon graft in anterior cruciate ligament reconstruction: Surgical tips and short term followup

PubMed Central

Suh, Dong Won; Han, Seung Beom; Yeo, Woo Jin; Lee, Won Hee; Kwon, Jae Ho; Kyung, Bong Soo

2017-01-01

Background: Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction can be a serious complication, and there is controversy over how to prevent it. This study aimed to suggest surgical approaches to prevent TW using an allo-Achilles tendon graft, and then to evaluate TW after these surgical tips were applied. Materials and Methods: Sixty two patients underwent ACL reconstruction with an allo-Achilles tendon graft. Four surgical approaches were used: Making a tibial tunnel by bone impaction, intraarticular reamer application, bone portion application for the femoral tunnel, and an additional bone plug application for the tibial tunnel. After more than 1-year, followup radiographs including anteroposterior and lateral views were taken in 29 patients encompassing thirty knees. The diameter of the tunnels at postoperation day 1 (POD1) and at followup was measured and compared. Results: In 18 knees (60%), there were no visible femoral tunnel margins on the radiographs at POD1 or followup. In the other 12 cases, which had visible femoral tunnel margins on followup radiographs, the mean femoral tunnel diameter was 8.6 mm. In the tibial tunnel, the mean diameters did not increase on all three levels (proximal, middle, and distal), and there was no statistically significant difference between the diameters at POD1 and followup. Conclusion: The suggested tips for surgery involving an allo-Achilles tendon graft can effectively prevent TW after ACL reconstruction according to this case series. These surgical tips can prevent TW. PMID:28400663

Anterior cruciate ligament- and hamstring tendon-derived cells: in vitro differential properties of cells involved in ACL reconstruction.

PubMed

Ghebes, Corina Adriana; Kelder, Cindy; Schot, Thomas; Renard, Auke J; Pakvis, Dean F M; Fernandes, Hugo; Saris, Daniel B

2017-04-01

Anterior cruciate ligament (ACL) reconstruction involves the replacement of the torn ligament with a new graft, often a hamstring tendon (HT). Described as similar, the ACL and HT have intrinsic differences related to their distinct anatomical locations. From a cellular perspective, identifying these differences represents a step forward in the search for new cues that enhance recovery after the reconstruction. The purpose of this study was to characterize the phenotype and multilineage potential of ACL- and HT-derived cells. ACL- and HT-derived cells were isolated from tissue harvest from patients undergoing total knee arthroplasty (TKA) or ACL reconstruction. In total, three ACL and three HT donors were investigated. Cell morphology, self-renewal potential (CFU-F), surface marker profiling, expression of tendon/ligament-related markers (PCR) and multilineage potential were analysed for both cell types; both had fibroblast-like morphology and low self-renewal potential. No differences in the expression of tendon/ligament-related genes or a selected set of surface markers were observed between the two cell types. However, differences in their multilineage potential were observed: while ACL-derived cells showed a high potential to differentiate into chondrocytes and adipocytes, but not osteoblasts, HT-derived cells showed poor potential to form adipocytes, chondrocytes and osteoblasts. Our results demonstrated that HT-derived cells have low multilineage potential compared to ACL-derived cells, further highlighting the need for extrinsic signals to fully restore the function of the ACL upon reconstruction. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Abnormal origins of the long head of the biceps tendon can lead to rotator cuff pathology: a report of two cases.

PubMed

Zhang, Alan L; Gates, Cameron H; Link, Thomas M; Ma, C Benjamin

2014-11-01

Previous case reports have highlighted various anomalous origins of the long head of the biceps tendon (LHBT) that do not originate from the superior glenoid labrum or supraglenoid tubercle. Yet, these cases were all reported as incidental findings and were not thought to cause any significant shoulder pathology. We present the magnetic resonance (MR) imaging and clinical treatment of two cases where aberrant intra-articular origins of the long head of the biceps tendon from the anterior edge of the supraspinatus tendon may have contributed to symptomatic rotator cuff pathology. Arthroscopy confirmed MR findings of partial articular-sided supraspinatus lesions in close proximity to the anomalous origins and treatment with tenodesis of the LHBT successfully relieved symptoms. Although rare occurrences with subtle and potentially misleading imaging findings, it is important to be aware of aberrant origins of the LHBT that may contribute to concomitant rotator cuff pathology.

Mechanoactive Scaffold Induces Tendon Remodeling and Expression of Fibrocartilage Markers

PubMed Central

Spalazzi, Jeffrey P.; Vyner, Moira C.; Jacobs, Matthew T.; Moffat, Kristen L.

2008-01-01

Biological fixation of soft tissue-based grafts for anterior cruciate ligament (ACL) reconstruction poses a major clinical challenge. The ACL integrates with subchondral bone through a fibrocartilage enthesis, which serves to minimize stress concentrations and enables load transfer between two distinct tissue types. Functional integration thus requires the reestablishment of this fibrocartilage interface on reconstructed ACL grafts. We designed and characterized a novel mechanoactive scaffold based on a composite of poly-α-hydroxyester nanofibers and sintered microspheres; we then used the scaffold to test the hypothesis that scaffold-induced compression of tendon grafts would result in matrix remodeling and the expression of fibrocartilage interface-related markers. Histology coupled with confocal microscopy and biochemical assays were used to evaluate the effects of scaffold-induced compression on tendon matrix collagen distribution, cellularity, proteoglycan content, and gene expression over a 2-week period. Scaffold contraction resulted in over 15% compression of the patellar tendon graft and upregulated the expression of fibrocartilage-related markers such as Type II collagen, aggrecan, and transforming growth factor-β3 (TGF-β3). Additionally, proteoglycan content was higher in the compressed tendon group after 1 day. The data suggest the potential of a mechanoactive scaffold to promote the formation of an anatomic fibrocartilage enthesis on tendon-based ACL reconstruction grafts. PMID:18512112

Mechanoactive scaffold induces tendon remodeling and expression of fibrocartilage markers.

PubMed

Spalazzi, Jeffrey P; Vyner, Moira C; Jacobs, Matthew T; Moffat, Kristen L; Lu, Helen H

2008-08-01

Biological fixation of soft tissue-based grafts for anterior cruciate ligament (ACL) reconstruction poses a major clinical challenge. The ACL integrates with subchondral bone through a fibrocartilage enthesis, which serves to minimize stress concentrations and enables load transfer between two distinct tissue types. Functional integration thus requires the reestablishment of this fibrocartilage interface on reconstructed ACL grafts. We designed and characterized a novel mechanoactive scaffold based on a composite of poly-alpha-hydroxyester nanofibers and sintered microspheres; we then used the scaffold to test the hypothesis that scaffold-induced compression of tendon grafts would result in matrix remodeling and the expression of fibrocartilage interface-related markers. Histology coupled with confocal microscopy and biochemical assays were used to evaluate the effects of scaffold-induced compression on tendon matrix collagen distribution, cellularity, proteoglycan content, and gene expression over a 2-week period. Scaffold contraction resulted in over 15% compression of the patellar tendon graft and upregulated the expression of fibrocartilage-related markers such as Type II collagen, aggrecan, and transforming growth factor-beta3 (TGF-beta3). Additionally, proteoglycan content was higher in the compressed tendon group after 1 day. The data suggest the potential of a mechanoactive scaffold to promote the formation of an anatomic fibrocartilage enthesis on tendon-based ACL reconstruction grafts.

Biomechanical and clinical factors related to stage I posterior tibial tendon dysfunction.

PubMed

Rabbito, Melissa; Pohl, Michael B; Humble, Neil; Ferber, Reed

2011-10-01

Case control. To investigate differences in arch height, ankle muscle strength, and biomechanical factors in individuals with stage I posterior tibial tendon dysfunction (PTTD) in comparison to healthy individuals. PTTD is a progressive condition, so early recognition and treatment are essential to help delay or reverse the progression. However, no previous studies have investigated stage I PTTD, and no single study has measured static anatomical structure, muscle strength, and gait mechanics in this population. Twelve individuals with stage I PTTD and 12 healthy, age- and gender-matched control subjects, who were engaged in running-related activities, participated in this study. Measurements of arch height index, maximum voluntary ankle invertor muscle strength, and 3-dimensional rearfoot and medial longitudinal arch kinematics during walking were obtained. The runners with PTTD demonstrated significantly lower seated arch height index (P = .02) and greater (P = .03) and prolonged (P = .05) peak rearfoot eversion angle during gait, compared to the healthy runners. No differences were found in standing arch height index values (P = .28), arch rigidity index (P = .06), ankle invertor strength (P = .49), or peak medial longitudinal arch values (P = .49) between groups. The increased foot pronation is hypothesized to place greater strain on the posterior tibialis muscle, which may partially explain the progressive nature of this condition.

Using the Literature to Understand Achilles' Fate.

PubMed

Rakic, Vesna S

2016-05-01

According to Greek mythology, Achilles was fatally wounded in his heel, bled out, and died. Several unproven hypotheses mention poisoning, infection, allergy, hemophilia, thyrotoxic storm (ie, pain and stress), and suicide. The author, a plastic surgeon who often treats chronic wounds, proposes an additional scenario: Although not mortally wounded, Achilles was considered dead, because in his time a wounded hero was as good as a dead hero, so he lived out the remainder of his life as former hero with a chronic wound far away from everyone. To determine whether his injury was enough to cause fatal bleeding and quick death or if other factors might have been in play, a search of the literature was conducted to enhance what is known about Achilles, basically through the tale related in The Iliad and the clinical impact of an Achilles' injury. Search terms utilized included bleeding tibialis posterior artery (3 manuscripts were found) and chronic wound, Achilles tendon (631 manuscripts were located). Although science may not be able to explain how and why Achilles died, the literature supported the conjecture that Achilles probably had a chronic wound with skin and paratenon defect, de- vitalized tendon tissue, bleeding, granulation, and repeated infections. It is interesting to consider the state of his injury and his mind in the making of this legend.

Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report

PubMed Central

2013-01-01

Introduction The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. Case presentation A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a ‘pop’ on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Conclusion Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps tendon ruptures successfully treated with a single-incision endobutton technique, which represents a valid option in managing this difficult problem. PMID:23972255

Clenbuterol, a beta(2)-agonist, retards atrophy in denervated muscles

NASA Technical Reports Server (NTRS)

Zeman, Richard J.; Ludemann, Robert; Etlinger, Joseph D.

1987-01-01

The effects of a beta(2) agonist, clenbuterol, on the protein content as well as on the contractile strength and the muscle fiber cross-sectional area of various denervated muscles from rats were investigated. It was found that denervated soleus, anterior tibialis, and gastrocnemius muscles, but not the extensor digitorum longus, of rats treated for 2-3 weeks with clenbuterol contained 95-110 percent more protein than denervated controls. The twofold difference in the protein content of denervated solei was paralleled by similar changes in contractile strength and muscle fiber cross-sectional area.

The Effect of a Hypobaric, Hypoxic Environment on Acute Skeletal Muscle Edema After Ischemia-Reperfusion Injury in Rats

DTIC Science & Technology

2010-05-15

groups ( P < 0.05). Normobaric normoxia caused greater edema in the gastrocnemius compared with hypobaric hypoxia; the tibialis anterior was not signif...icantly different between groups. The decrease in body weight for NB and HB was 3.4 ± 1.4 and 10.7 ± 1.2 g, respectively ( P < 0.05). Hematocrit was...44.7 ± 0.5 and 42.6 ± 0.6 ( P < 0.05). Conclusions. The hypobaric, hypoxic conditions of simulated medical air evacuation were not associated with

Eccentric and concentric muscle performance following 7 days of simulated weightlessness

NASA Technical Reports Server (NTRS)

Hayes, Judith C.; Roper, Mary L.; Mazzocca, Augustus D.; Mcbrine, John J.; Barrows, Linda H.; Harris, Bernard A.; Siconolfi, Steven F.

1992-01-01

Changes in skeletal muscle strength occur in response to chronic disuse or insufficient functional loading. The purpose of this study was to examine changes in muscle performance of the lower extremity and torso prior to and immediately after 7 days of simulated weightlessness (horizontal bed rest). A Biodex was used to determine concentric and eccentric peak torque and angle at peak torque for the back, abdomen, quadriceps, hamstring, soleus, and tibialis anterior. A reference angle of 0 degrees was set at full extension. Data were analyzed by ANOVA.

Endoscopic or arthroscopic iliopsoas tenotomy for iliopsoas impingement following total hip replacement. A prospective multicenter 64-case series.

PubMed

Guicherd, W; Bonin, N; Gicquel, T; Gedouin, J E; Flecher, X; Wettstein, M; Thaunat, M; Prevost, N; Ollier, E; May, O

2017-12-01

Impingement between the acetabular component and the iliopsoas tendon is a cause of anterior pain after total hip replacement (THR). Treatment can be non-operative, endoscopic or arthroscopic, or by open revision of the acetabular component. Few studies have assessed these options. The present study hypothesis was that endo/arthroscopic treatment provides rapid pain relief with a low rate of complications. A prospective multicenter study included 64 endoscopic or arthroscopic tenotomies for impingement between the acetabular component and the iliopsoas tendon, performed in 8 centers. Mean follow-up was 8months, with a minimum of 6months and no loss to follow-up. Oxford score, patient satisfaction, anterior pain and iliopsoas strength were assessed at last follow-up. Complications and revision procedures were collated. Forty-four percent of patients underwent rehabilitation. At last follow-up, 92% of patients reported pain alleviation. Oxford score, muscle strength and pain in hip flexion showed significant improvement. The complications rate was 3.2%, with complete resolution. Mean hospital stay was 0.8 nights. In 2 cases, arthroscopy revealed metallosis, indicating revision of the acetabular component. The only predictive factor was acetabular projection on oblique view. Rehabilitation significantly improved muscle strength. Endoscopic or arthroscopic tenotomy for impingement between the acetabular component and the iliopsoas tendon following THR significantly alleviated anterior pain in more than 92% of cases. The low complications rate makes this the treatment of choice in case of failure of non-operative management. Arthroscopy also reorients diagnosis in case of associated joint pathology. Projection of the acetabular component on preoperative oblique view is the most predictive criterion, guiding treatment. Copyright © 2017. Published by Elsevier Masson SAS.

The Influence of Task Complexity on Knee Joint Kinetics Following ACL Reconstruction

PubMed Central

Schroeder, Megan J.; Krishnan, Chandramouli; Dhaher, Yasin Y.

2015-01-01

Background Previous research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries. Methods In 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks—step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed. Findings The reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft-specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts. Interpretation The mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint and ultimately osteoarthritis. Given the task-specific and graft-specific differences in joint mechanics detected in this study, care should be taken during the rehabilitation process to mitigate these changes. PMID:26101055

Applications of In Vivo Functional Testing of the Rat Tibialis Anterior for Evaluating Tissue Engineered Skeletal Muscle Repair

PubMed Central

Mintz, Ellen L.; Passipieri, Juliana A.; Lovell, Daniel Y.; Christ, George J.

2016-01-01

Despite the regenerative capacity of skeletal muscle, permanent functional and/or cosmetic deficits (e.g., volumetric muscle loss (VML) resulting from traumatic injury, disease and various congenital, genetic and acquired conditions are quite common. Tissue engineering and regenerative medicine technologies have enormous potential to provide a therapeutic solution. However, utilization of biologically relevant animal models in combination with longitudinal assessments of pertinent functional measures are critical to the development of improved regenerative therapeutics for treatment of VML-like injuries. In that regard, a commercial muscle lever system can be used to measure length, tension, force and velocity parameters in skeletal muscle. We used this system, in conjunction with a high power, bi-phase stimulator, to measure in vivo force production in response to activation of the anterior crural compartment of the rat hindlimb. We have previously used this equipment to assess the functional impact of VML injury on the tibialis anterior (TA) muscle, as well as the extent of functional recovery following treatment of the injured TA muscle with our tissue engineered muscle repair (TEMR) technology. For such studies, the left foot of an anaesthetized rat is securely anchored to a footplate linked to a servomotor, and the common peroneal nerve is stimulated by two percutaneous needle electrodes to elicit muscle contraction and dorsiflexion of the foot. The peroneal nerve stimulation-induced muscle contraction is measured over a range of stimulation frequencies (1-200 Hz), to ensure an eventual plateau in force production that allows for an accurate determination of peak tetanic force. In addition to evaluation of the extent of VML injury as well as the degree of functional recovery following treatment, this methodology can be easily applied to study diverse aspects of muscle physiology and pathophysiology. Such an approach should assist with the more rational development of improved therapeutics for muscle repair and regeneration. PMID:27768064

Applications of In Vivo Functional Testing of the Rat Tibialis Anterior for Evaluating Tissue Engineered Skeletal Muscle Repair.

PubMed

Mintz, Ellen L; Passipieri, Juliana A; Lovell, Daniel Y; Christ, George J

2016-10-07

Despite the regenerative capacity of skeletal muscle, permanent functional and/or cosmetic deficits (e.g., volumetric muscle loss (VML) resulting from traumatic injury, disease and various congenital, genetic and acquired conditions are quite common. Tissue engineering and regenerative medicine technologies have enormous potential to provide a therapeutic solution. However, utilization of biologically relevant animal models in combination with longitudinal assessments of pertinent functional measures are critical to the development of improved regenerative therapeutics for treatment of VML-like injuries. In that regard, a commercial muscle lever system can be used to measure length, tension, force and velocity parameters in skeletal muscle. We used this system, in conjunction with a high power, bi-phase stimulator, to measure in vivo force production in response to activation of the anterior crural compartment of the rat hindlimb. We have previously used this equipment to assess the functional impact of VML injury on the tibialis anterior (TA) muscle, as well as the extent of functional recovery following treatment of the injured TA muscle with our tissue engineered muscle repair (TEMR) technology. For such studies, the left foot of an anaesthetized rat is securely anchored to a footplate linked to a servomotor, and the common peroneal nerve is stimulated by two percutaneous needle electrodes to elicit muscle contraction and dorsiflexion of the foot. The peroneal nerve stimulation-induced muscle contraction is measured over a range of stimulation frequencies (1-200 Hz), to ensure an eventual plateau in force production that allows for an accurate determination of peak tetanic force. In addition to evaluation of the extent of VML injury as well as the degree of functional recovery following treatment, this methodology can be easily applied to study diverse aspects of muscle physiology and pathophysiology. Such an approach should assist with the more rational development of improved therapeutics for muscle repair and regeneration.

Effect of tendon tensioning: an in vitro study in porcine extensor tendons.

PubMed

Figueroa, David; Calvo, Rafael; Vaisman, Alex; Meleán, Patricio; Figueroa, Francisco

2010-06-01

Graft tensioning is a controversial issue in anterior cruciate ligament reconstruction (ACLR) that has not achieved consensus between peers. The purpose of this study is to determine if after tensioning tendon length and resistance to maximal load changes. We performed an in vitro study with 50 porcine extensors tendons. The first group (P=25) was tensioned with 80 N (19.97 lb) for 10 min, using an ACL graft preparation board. The second group (C=25) was used as control and was not tensioned. The average initial (groups P and C) and post tensioning tendon length (group C) were measured; the average initial and post tensioning tendon diameter were measured as well. All samples were fixated in a tube-clamp system connected to a tension sensor. The samples were stressed with continuous and progressive tension until ultimate failure at maximum load (UFML) occurs. The initial mean length was: P before tensioning=13.4 mm+/-1.4 mm (range 10.5-16.5); P after tensioning=13.8 mm+/-1.4 mm (range 11.5-16.5); C=13 mm+/-1.35 mm (p=0.005). The mean diameter was: P=5.6 mm (4.5-6); C=5.5 mm (range 4.5-6) (p>0.05). The UFML was: P=189.7 N (114-336); C=229.9 N (143-365) (p=0.029). Tendon tensioning with 80 N for 10 min produced 3% average elongation. These could be beneficial in ACLR since tendon tensioning decreases elongation of the graft after fixation. Regardless, tendon tensioning is not innocuous since it diminishes their resistance when continuously stressed until complete failure occurs.

Magnetic resonance imaging of injuries to the ankle joint: can it predict clinical outcome?

PubMed

Zanetti, M; De Simoni, C; Wetz, H H; Zollinger, H; Hodler, J

1997-02-01

To predict clinical outcome after ankle sprains on the basis of magnetic resonance (MR) findings. Twenty-nine consecutive patients (mean age 32.9 years, range 13-60 years) were examined clinically and with MR imaging both after trauma and following standardized conservative therapy. Various MR abnormalities were related to a clinical outcome score. There was a tendency for a better clinical outcome in partial, rather than complete, tears of the anterior talofibular ligament and when there was no fluid within the peroneal tendon sheath at the initial MR examination (P = 0.092 for either abnormality). A number of other MR features did not significantly influence clinical outcome, including the presence of a calcaneofibular ligament lesion and a bone bruise of the talar dome. Clinical outcome after ankle sprain cannot consistently be predicted by MR imaging, although MR imaging may be more accurate when the anterior talofibular ligament is only partially torn and there are no signs of injury to the peroneal tendon sheath.

Effect of Achilles tendon loading on plantar fascia tension in the standing foot.

PubMed

Cheung, Jason Tak-Man; Zhang, Ming; An, Kai-Nan

2006-02-01

The plantar fascia, which is one of the major arch-supporting structures of the human foot, sustains high tensions during weight-bearing. A positive correlation between Achilles tendon loading and plantar fascia tension has been reported. Excessive stretching and tightness of the Achilles tendon are thought to be the risk factors of plantar fasciitis but their biomechanical effects on the plantar fascia have not been fully addressed. A three-dimensional finite element model of the human foot and ankle, incorporating geometrical and material nonlinearity, was employed to investigate the loading response of the plantar fascia in the standing foot with different magnitudes of Achilles tendon loading. With the total ground reaction forces of one foot maintained at 350 N to represent half body weight, an increase in Achilles tendon load from (0-700 N) resulted in a general increase in total force and peak plantar pressure at the forefoot of up to about 250%. There was a lateral and anterior shift of the centre of pressure and a reduction in the arch height with an increasing Achilles tendon load as a result of the plantar flexion moment on the calcaneus. From the finite element predictions of simulated balanced standing, Achilles tendon forces of 75% of the total weight on the foot (350 N) were found to provide the closest match of the measured centre of pressure of the subject during balanced standing. Both the weight on the foot and Achilles tendon loading resulted in an increase in tension of the plantar fascia with the latter showing a two-times larger straining effect. Increasing tension on the Achilles tendon is coupled with an increasing strain on the plantar fascia. Overstretching of the Achilles tendon resulting from intense muscle contraction and passive stretching of tight Achilles tendon are plausible mechanical factors for overstraining of the plantar fascia.

Hamstring autograft versus soft-tissue allograft in anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Cvetanovich, Gregory L; Mascarenhas, Randy; Saccomanno, Maristella F; Verma, Nikhil N; Cole, Brian J; Bush-Joseph, Charles A; Bach, Bernard R

2014-12-01

To compare outcomes of anterior cruciate ligament (ACL) reconstruction with hamstring autograft versus soft-tissue allograft by systematic review and meta-analysis. A systematic review of randomized controlled studies comparing hamstring autograft with soft-tissue allograft in ACL reconstruction was performed. Studies were identified by strict inclusion and exclusion criteria. Descriptive statistics were reported. Where possible, the data were pooled and a meta-analysis was performed using RevMan software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). Dichotomous data were reported as risk ratios, whereas continuous data were reported as standardized mean differences and 95% confidence intervals. Heterogeneity was assessed by use of I(2) for each meta-analysis. Study methodologic quality was analyzed with the Modified Coleman Methodology Score and Jadad scale. Five studies with 504 combined patients (251 autograft and 253 allograft; 374 male and 130 female patients) with a mean age of 29.9 ± 2.2 years were included. The allografts used were fresh-frozen hamstring, irradiated hamstring, mixture of fresh-frozen and cryopreserved hamstring, fresh-frozen tibialis anterior, and fresh-frozen Achilles tendon grafts without bone blocks. The mean follow-up period was 47.4 ± 26.9 months, with a mean follow-up rate of 83.3% ± 8.6%. Two studies found a longer operative time with autograft than with allograft (77.1 ± 2.0 minutes v 59.9 ± 0.9 minutes, P = .008). Meta-analysis showed no statistically significant differences between autografts and allografts for any outcome measures (P > .05 for all tests). One study found significantly greater laxity for irradiated allograft than for autograft. The methodologic quality of the 5 studies was poor, with a mean Modified Coleman Methodology Score of 54.4 ± 6.9 and mean Jadad score of 1.6 ± 1.5. On the basis of this systematic review and meta-analysis of 5 randomized controlled trials, there is no statistically significant difference in outcome between patients undergoing ACL reconstruction with hamstring autograft and those undergoing ACL reconstruction with soft-tissue allograft. These results may not extrapolate to younger patient populations. The methodology of the available randomized controlled trials comparing hamstring autograft and soft-tissue allograft is poor. Level II, systematic review of Level I and II studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Partially irreversible paresis of the deep peroneal nerve caused by osteocartilaginous exostosis of the fibula without affecting the tibialis anterior muscle.

PubMed

Paprottka, Felix Julian; Machens, Hans-Günther; Lohmeyer, Jörn Andreas

2012-08-01

Dysfunction of the lower limb's muscles can cause severe impairment and immobilisation of the patient. As one of the leg's major motor and sensory nerves, the deep peroneal nerve (synonym: deep fibular nerve) plays a very important role in muscle innervation in the lower extremities. We report the case of a 19-year-old female patient, who suffered from a brace-like exostosis 6-cm underneath her left fibular head causing a partially irreversible paresis of her deep peroneal nerve. This nerve damage resulted in complete atrophy of her extensor digitorum longus and extensor hallucis longus muscle, and in painful sensory disturbance at her left shin and first web space. The tibialis anterior muscle stayed intact because its motor branch left the deep peroneal nerve proximal to the nerve lesion. Diagnosis was first verified 6 years after the onset of symptoms by a magnetic resonance imaging (MRI) scan of her complete left lower leg. Subsequently, the patient was operated on in our clinic, where a neurolysis was performed and the 4-cm-long osteocartilaginous exostosis was removed. Paralysis was already irreversible but sensibility returned completely after neurolysis. The presented case shows that an osteocartilaginous exostosis can be the cause for partial deep peroneal nerve paresis. If this disorder is diagnosed at an early stage, nerve damage is reversible. Typical for an exostosis is its first appearance during the juvenile growth phase. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Enzyme activity and myoglobin concentration in rat myocardium and skeletal muscles after passive intermittent simulated altitude exposure.

PubMed

Esteva, Santi; Panisello, Pere; Ramon Torrella, Joan; Pages, Teresa; Viscor, Gines

2009-04-01

We studied the effect of intermittent hypobaric hypoxia exposure on lactate dehydrogenase and citrate synthase activities, together with myoglobin content, of rat myocardium, tibialis anterior, and diaphragm muscles. The intermittent hypoxia exposure programme consisted of daily 4-h sessions in a hypobaric chamber (5000 m) over a period of 22 days. Samples were taken at the end of the programme, and 20 and 40 days later, and compared with those of control animals. In myocardium, lactate dehydrogenase activity was significantly depressed in animals 20 days post-exposure (314.6 +/- 15.3 IU . g(-1)) compared with control animals (400 +/- 14.3 IU . g(-1)), while citrate synthase activity and myoglobin concentration showed a significant stepwise increase from control animals (88.2 +/- 3.6 IU . g(-1) and 4.38 +/- 0.13 microm . mg(-1)) to animals 20 days (104.7 +/- 3.7 IU . g(-1) and 5.01 +/- 0.17 microm . mg(-1)) and 40 days post-exposure (108.8 +/- 6.5 IU . g(-1) and 5.11 +/- 0.22 microm . mg(-1)). In contrast, no differences were found in diaphragm and tibialis anterior muscles. Our results show that intermittent hypobaric hypoxia exposure increased the oxidative character of myocardium even 20 days after the hypoxic stimulus has ceased, and that this effect lasts for more than 40 days for citrate synthase activity and myoglobin concentration. These findings support our previous results on skeletal and cardiac muscle capillarization after passive intermittent simulated altitude exposure, thus providing morphofunctional and biochemical evidence for increased cardiac aerobic efficiency.

The influence in airforce soldiers through wearing certain types of army-issue footwear on muscle activity in the lower extremities.

PubMed

Schulze, Christoph; Lindner, Tobias; Schulz, Katharina; Finze, Susanne; Kundt, Guenther; Mittelmeier, Wolfram; Bader, Rainer

2011-01-01

The objective of the study was to analyse the influence of the shape and material of the military footwear worn by soldiers on muscle activity in the lower extremities, and whether such footwear could explain specific strain complaints and traumatic lesions in the region of the lower extremities.37 soldiers (one woman, 36 men) aged between 20 and 53 years underwent a dynamic electromyography (EMG) analysis. Wearing - one pair at a time - five different types of shoes, the subjects were asked to walk on a treadmill, where an EMG of the following muscles was taken: M. tibialis anterior, M. gastrocnemius mediales, M. gastrocnemius laterales, M. peroneus longus and M. rectus femoris.When the subjects wore old-fashioned outdoor jogging shoes increased muscle activity was observed in the region of the M. peroneus longus. This can be interpreted as a sign of the upper ankle joint requiring increased support and thus explain the higher susceptibility to sprains experienced in connection with these shoes. When the subjects wore combat boots, increased activity was observed in the region of the Mm. tibialis anterior and rectus femoris. The specific activity differences that were observed in particular muscles may have influence in the occurrence of certain disorders, especially in untrained recruits. This can be linked to various strain-related disorders such as shin splints and patellofemoral pain. The data obtained using EMG can provide information about the likelihood of a clustering of the complaints experienced by soldiers during training or active service.

Changes of pedaling technique and muscle coordination during an exhaustive exercise.

PubMed

Dorel, Sylvain; Drouet, Jean-Marc; Couturier, Antoine; Champoux, Yvan; Hug, François

2009-06-01

Alterations of the mechanical patterns during an exhaustive pedaling exercise have been previously shown. We designed the present study to test the hypothesis that these alterations in the biomechanics of pedaling, which occur during exhaustive exercise, are linked to changes in the activity patterns of lower limb muscles. Ten well-trained cyclists were tested during a limited time to exhaustion, performing 80% of maximal power tolerated. Pedal force components were measured continuously using instrumented pedals and were synchronized with surface EMG signals measured in 10 lower limb muscles. The results confirmed most of the alterations of the mechanical patterns previously described in the literature. The magnitude of the root mean squared of the EMG during the complete cycle (RMScycle) for tibialis anterior and gastrocnemius medialis decreased significantly (P < 0.05) from 85% and 75% of Tlim, respectively. A higher RMScycle was obtained for gluteus maximus (P < 0.01) and biceps femoris (P < 0.05) from 75% of Tlim. The k values that resulted from the cross-correlation technique indicated that the activities of six muscles (gastrocnemius medialis, gastrocnemius lateralis, tibialis anterior, vastus lateralis, vastus medialis, and rectus femoris) were shifted forward in the cycle at the end of the exercise. The large increases in activity for gluteus maximus and biceps femoris, which are in accordance with the increase in force production during the propulsive phase, could be considered as instinctive coordination strategies that compensate for potential fatigue and loss of force of the knee extensors (i.e., vastus lateralis and vastus medialis) by a higher moment of the hip extensors.

Activation Pattern of Lower Leg Muscles in Running on Asphalt, Gravel and Grass.

PubMed

Dolenec, Aleš; Štirn, Igor; Strojnik, Vojko

2015-07-01

Running is performed on different natural surfaces (outdoor) and artificial surfaces (indoor). Different surface characteristics cause modification of the lower leg muscle activation pattern to adopt ankle stiffness to these characteristics. So the purpose of our investigation was to study changes of lower leg muscles activation pattern in running on different natural running surfaces. Six male and two female runners participated. The participants ran at a freely chosen velocity in trials on asphalt while in trials on gravel, and grass surfaces they were attempting to reach similar velocities as in the trials on asphalt. Muscle activation of the peroneus brevis, tibialis anterior, soleus, and gastrocnemius medialis of the right leg was recorded. Running on asphalt increased average EMG amplitude of the m. tibialis anterior in the pre-activation phase and the m. gastrocnemius medialis in the entire contact phase compared to running on grass from 0.222 ± 0.113 V to 0.276 ± 0.136 V and from 0.214 ± 0.084 V to 0.238 ± 0.088 V, respectively. The average EMG of m. peroneus brevis in pre-activation phase increased from 0.156 ± 0.026 V to 0.184 ± 0.455 V in running on grass in comparison to running on gravel. Running on different surfaces is connected with different activation patterns of lower leg muscles. Running on asphalt requires stiff ankle joints, running on gravel requires greater stability in ankle joints, while running on grass is the least demanding on lower leg muscles.

Gait pattern in myotonic dystrophy (Steinert disease): a kinematic, kinetic and EMG evaluation using 3D gait analysis.

PubMed

Galli, Manuela; Cimolin, Veronica; Crugnola, Veronica; Priano, Lorenzo; Menegoni, Francesco; Trotti, Claudio; Milano, Eva; Mauro, Alessandro

2012-03-15

We investigated the gait pattern of 10 patients with myotonic dystrophy (Steinert disease; 4 females, 6 males; age: 41.5+7.6 years), compared to 20 healthy controls, through manual muscle test and gait analysis, in terms of kinematic, kinetic and EMG data. In most of patients (80%) distal muscle groups were weaker than proximal ones. Weakness at lower limbs was in general moderate to severe and MRC values evidenced a significant correlation between tibialis anterior and gastrocnemius medialis (R=0.91). An overall observation of gait pattern in patients when compared to controls showed that most spatio-temporal parameters (velocity, step length and cadence) were significantly different. As concerns kinematics, patients' pelvic tilt was globally in a higher position than control group, with reduced hip extension ability in stance phase and limited range of motion; 60% of the limbs revealed knee hyperextension during midstance and ankle joints showed a quite physiological position at initial contact and higher dorsiflexion during stance phase if compared to healthy individuals. Kinetic plots evidenced higher hip power during loading response and lower ankle power generation in terminal stance. The main EMG abnormalities were seen in tibialis anterior and gastrocnemius medialis muscles. In this study gait analysis gives objective and quantitative information about the gait pattern and the deviations due to the muscular situation of these patients; these results are important from a clinical point of view and suggest that rehabilitation programs for them should take these findings into account. Copyright © 2011 Elsevier B.V. All rights reserved.

The Influence in Airforce Soldiers Through Wearing Certain Types of Army-Issue Footwear on Muscle Activity in the Lower Extremities

PubMed Central

Schulze, Christoph; Lindner, Tobias; Schulz, Katharina; Finze, Susanne; Kundt, Guenther; Mittelmeier, Wolfram; Bader, Rainer

2011-01-01

The objective of the study was to analyse the influence of the shape and material of the military footwear worn by soldiers on muscle activity in the lower extremities, and whether such footwear could explain specific strain complaints and traumatic lesions in the region of the lower extremities. 37 soldiers (one woman, 36 men) aged between 20 and 53 years underwent a dynamic electromyography (EMG) analysis. Wearing – one pair at a time - five different types of shoes, the subjects were asked to walk on a treadmill, where an EMG of the following muscles was taken: M. tibialis anterior, M. gastrocnemius mediales, M. gastrocnemius laterales, M. peroneus longus and M. rectus femoris. When the subjects wore old-fashioned outdoor jogging shoes increased muscle activity was observed in the region of the M. peroneus longus. This can be interpreted as a sign of the upper ankle joint requiring increased support and thus explain the higher susceptibility to sprains experienced in connection with these shoes. When the subjects wore combat boots, increased activity was observed in the region of the Mm. tibialis anterior and rectus femoris. The specific activity differences that were observed in particular muscles may have influence in the occurrence of certain disorders, especially in untrained recruits. This can be linked to various strain-related disorders such as shin splints and patellofemoral pain. The data obtained using EMG can provide information about the likelihood of a clustering of the complaints experienced by soldiers during training or active service. PMID:21886685

Changes in biomechanics and muscle activation in injured ballet dancers during a jump-land task with turnout (Sissonne Fermée).

PubMed

Lee, Hsing-Hsan; Lin, Chia-Wei; Wu, Hong-Wen; Wu, Tzu-Chuan; Lin, Cheng-Feng

2012-01-01

Large impact loading with abnormal muscle activity and motion patterns may contribute to lower extremity injuries in ballet dancers. Yet, few studies investigated the influence of injury on the ballet movement. The purpose of this study was to find the neuromuscular and biomechanical characteristics in dancers with and without ankle injury during a jump-landing Sissonne Fermée task. Twenty-two ballet dancers were recruited and divided into the injured group (n = 11) and the uninjured group (n = 11). They performed a ballet movement called "Sissonne Fermée" with reflective markers and electrodes attached to their lower extremities. Ground reaction force, joint kinematics, and muscle activity were measured. The injured dancers had greater peak ankle eversion but smaller hindfoot-to-tibial eversion angles. Also, the injured dancers had greater activity of the hamstring of the dominant leg and tibialis anterior of the non-dominant leg during the pre-landing phase. The injured dancers had greater tibialis anterior activity of the dominant leg but less muscle activity in the medial gastrocnemius of the non-dominant leg during the post-landing phase. The injured dancers had a greater co-contraction index in the non-dominant ankle and a lower loading rate. The higher co-contraction indices showed that the injured dancers required more muscle effort to control ankle stability. Furthermore, the injured dancers used a "load avoidance strategy" to protect themselves from re-injury. Neuromuscular control training of the ankle joint for ballet dancers to prevent injury is necessary.

Muscle dependency of corticomuscular coherence in upper and lower limb muscles and training-related alterations in ballet dancers and weightlifters.

PubMed

Ushiyama, Junichi; Takahashi, Yuji; Ushiba, Junichi

2010-10-01

It has been well documented that the 15- to 35-Hz oscillatory activity of the sensorimotor cortex shows coherence with the muscle activity during weak to moderate steady contraction. To investigate the muscle dependency of the corticomuscular coherence and its training-related alterations, we quantified the coherence between electroencephalogram (EEG) from the sensorimotor cortex and rectified electromyogram (EMG) from five upper limb (first dorsal interosseous, flexor carpi radialis, extensor carpi radialis, biceps brachii, triceps brachii) and four lower limb muscles (soleus, tibialis anterior, biceps femoris, rectus femoris), while maintaining a constant force level at 30% of maximal voluntary contraction of each muscle, in 24 untrained, 12 skill-trained (ballet dancers), and 10 strength-trained (weightlifters) individuals. Data from untrained subjects demonstrated the muscle dependency of corticomuscular coherence. The magnitude of the EEG-EMG coherence was significantly greater in the distally located lower limb muscles, such as the soleus and tibialis anterior, than in the upper or other lower limb muscles in untrained subjects (P < 0.05). These results imply that oscillatory coupling between the sensorimotor cortex and spinal motoneurons during steady contraction differs among muscles, according to the functional role of each muscle. In addition, the ballet dancers and weightlifters showed smaller EEG-EMG coherences than the untrained subjects, especially in the lower limb muscles (P < 0.05). These results indicate that oscillatory interaction between the sensorimotor cortex and spinal motoneurons can be changed by long-term specialized use of the muscles and that this neural adaptation may lead to finer control of muscle force during steady contraction.

Inhibition of myostatin signaling through Notch activation following acute resistance exercise.

PubMed

MacKenzie, Matthew G; Hamilton, David Lee; Pepin, Mark; Patton, Amy; Baar, Keith

2013-01-01

Myostatin is a TGFβ family member and negative regulator of muscle size. Due to the complexity of the molecular pathway between myostatin mRNA/protein and changes in transcription, it has been difficult to understand whether myostatin plays a role in resistance exercise-induced skeletal muscle hypertrophy. To circumvent this problem, we determined the expression of a unique myostatin target gene, Mighty, following resistance exercise. Mighty mRNA increased by 6 h (82.9 ± 24.21%) and remained high out to 48 h (56.5 ± 19.67%) after resistance exercise. Further examination of the soleus, plantaris and tibialis anterior muscles showed that the change in Mighty mRNA at 6 h correlated with the increase in muscle size associated with this protocol (R(2) = 0.9996). The increase in Mighty mRNA occurred both independent of Smad2 phosphorylation and in spite of an increase in myostatin mRNA (341.8 ± 147.14% at 3 h). The myostatin inhibitor SKI remained unchanged. However, activated Notch, another potential inhibitor of TGFβ signaling, increased immediately following resistance exercise (83 ± 11.2%) and stayed elevated out to 6 h (78 ± 16.6%). Electroportion of the Notch intracellular domain into the tibialis anterior resulted in an increase in Mighty mRNA (63 ± 13.4%) that was equivalent to the canonical Notch target HES-1 (94.4 ± 7.32%). These data suggest that acute resistance exercise decreases myostatin signaling through the activation of the TGFβ inhibitor Notch resulting in a decrease in myostatin transcriptional activity that correlates well with muscle hypertrophy.

Discharge properties of motor units during steady isometric contractions performed with the dorsiflexor muscles

PubMed Central

Klass, Malgorzata; Duchateau, Jacques; Enoka, Roger M.

2012-01-01

The purpose of this study was to record the discharge characteristics of tibialis anterior motor units over a range of target forces and to import these data, along with previously reported observations, into a computational model to compare experimental and simulated measures of torque variability during isometric contractions with the dorsiflexor muscles. The discharge characteristics of 44 motor units were quantified during brief isometric contractions at torques that ranged from recruitment threshold to an average of 22 ± 14.4% maximal voluntary contraction (MVC) torque above recruitment threshold. The minimal [range: 5.8–19.8 pulses per second (pps)] and peak (range: 8.6–37.5 pps) discharge rates of motor units were positively related to the recruitment threshold torque (R2 ≥ 0.266; P < 0.001). The coefficient of variation for interspike interval at recruitment was positively associated with recruitment threshold torque (R2 = 0.443; P < 0.001) and either decreased exponentially or remained constant as target torque increased above recruitment threshold torque. The variability in the simulated torque did not differ from the experimental values once the recruitment range was set to ∼85% MVC torque, and the association between motor twitch contraction times and peak twitch torque was defined as a weak linear association (R2 = 0.096; P < 0.001). These results indicate that the steadiness of isometric contractions performed with the dorsiflexor muscle depended more on the distributions of mechanical properties than discharge properties across the population of motor units in the tibialis anterior. PMID:22442023

[Changes in titin and myosin heavy chain isoform composition in skeletal muscles of Mongolian gerbil (Meriones unguiculatus) after 12-day spaceflight].

PubMed

Okuneva, A D; Vikhliantsev, I M; Shpagina, M D; Rogachevskiĭ, V V; Khutsian, S S; Poddubnaia, Z A; Grigor'ev, A I

2012-01-01

Changes of titin and myosin heavy chain isoform composition in skeletal muscles (m. soleus, m. gastrocnemius, m. tibialis anterior, m. psoas major) in Mongolian Gerbil (Meriones unguiculatus ) were investigated after 12-day spaceflight on board of Russian space vehicle "Foton-M3". In m. psoas and m. soleus in the gerbils from "Flight" group the expected increase in the content of fast myosin heavy chain isoforms (IIxd and IIa, respectively) were observed. No significant differences were found in the content of IIxd and IIa isoforms of myosin heavy chain in m. tibialis anterior in the gerbils from control group as compared to that in "Flight" group. An unexpected increase in the content of slow myosin heavy chain I isoform and a decrease in the content of fast IIx/d isoform in m. gastrocnemius of the gerbils from "Flight" group were observed. In skeletal muscles of the gerbils from "Flight" group the relative content of titin N2A-isoform was reduced (by 1,2-1,7 times), although the content of its NT-isoform, which was revealed in striated muscles of mammals in our experiments earlier, remained the same. When the content of titin N2A-isoform was decreased, no predictable abnormalities in sarcomeric structure and contractile ability of skeletal muscles in the gerbils from "Flight" group were found. An assumption on the leading role of titin NT-isoform in maintenance of structural and functional properties of striated muscles of mammals was made.

Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and arm pain are absent?

PubMed

Schmid, A B; Soon, B T C; Wasner, G; Coppieters, M W

2012-02-01

Recent studies demonstrated that patients with carpal tunnel syndrome (CTS) have signs of thermal and mechanical hyperalgesia in extra-median territories suggesting an involvement of central pain mechanisms. As previous studies included patients with shoulder/arm symptoms or neck pain, a potential influence of these coexisting disorders cannot be excluded. This study therefore evaluated whether widespread sensory changes (hypoesthesia or hyperalgesia) are present in patients with unilateral CTS in the absence of coexisting disorders. Twenty-six patients with unilateral CTS with symptoms localised to their hand and 26 healthy controls participated in the study. A comprehensive quantitative sensory testing (QST) protocol including thermal and mechanical detection and pain thresholds was performed over the hands (median, ulnar and radial innervation area), lateral elbows, neck and tibialis anterior muscle. Patients with CTS demonstrated thermal and mechanical hypoesthesia in the hand but not at distant sites. Thermal or mechanical hyperalgesia was not identified at any location with traditional QST threshold testing. However, patients with CTS rated the pain during thermal pain testing significantly higher than healthy participants. This was especially apparent for heat pain ratings which were elevated not only in the affected hand but also in the neck and tibialis anterior muscle. In conclusion, CTS alone in the absence of coexisting neck and arm pain does not account for sensory changes outside the affected hand as determined by traditional QST threshold testing. Elevated pain ratings may however be an early indication of central pain mechanisms. © 2011 European Federation of International Association for the Study of Pain Chapters.

Discharge properties of motor units during steady isometric contractions performed with the dorsiflexor muscles.

PubMed

Jesunathadas, Mark; Klass, Malgorzata; Duchateau, Jacques; Enoka, Roger M

2012-06-01

The purpose of this study was to record the discharge characteristics of tibialis anterior motor units over a range of target forces and to import these data, along with previously reported observations, into a computational model to compare experimental and simulated measures of torque variability during isometric contractions with the dorsiflexor muscles. The discharge characteristics of 44 motor units were quantified during brief isometric contractions at torques that ranged from recruitment threshold to an average of 22 ± 14.4% maximal voluntary contraction (MVC) torque above recruitment threshold. The minimal [range: 5.8-19.8 pulses per second (pps)] and peak (range: 8.6-37.5 pps) discharge rates of motor units were positively related to the recruitment threshold torque (R(2) ≥ 0.266; P < 0.001). The coefficient of variation for interspike interval at recruitment was positively associated with recruitment threshold torque (R(2) = 0.443; P < 0.001) and either decreased exponentially or remained constant as target torque increased above recruitment threshold torque. The variability in the simulated torque did not differ from the experimental values once the recruitment range was set to ∼85% MVC torque, and the association between motor twitch contraction times and peak twitch torque was defined as a weak linear association (R(2) = 0.096; P < 0.001). These results indicate that the steadiness of isometric contractions performed with the dorsiflexor muscle depended more on the distributions of mechanical properties than discharge properties across the population of motor units in the tibialis anterior.

Sterilization with electron beam irradiation influences the biomechanical properties and the early remodeling of tendon allografts for reconstruction of the anterior cruciate ligament (ACL).

PubMed

Schmidt, Tanja; Hoburg, Arnd; Broziat, Christine; Smith, Mark D; Gohs, Uwe; Pruss, Axel; Scheffler, Sven

2012-08-01

Although allografts for anterior cruciate ligament (ACL) replacement have shown advantages compared to autografts, their use is limited due to the risk of disease transmission and the limitations of available sterilization methods. Gamma sterilization has shown detrimental effects on graft properties at the high doses required for sufficient pathogen inactivation. In our previous in vitro study on human patellar tendon allografts, Electron beam (Ebeam) irradiation showed less detrimental effects compared to gamma sterilization (Hoburg et al. in Am J Sports Med 38(6):1134-1140, 2010). To investigate the biological healing and restoration of the mechanical properties of a 34 kGy Ebeam treated tendon allograft twenty-four sheep underwent ACL replacement with either a 34 kGy Ebeam treated allograft or a non-sterilized fresh frozen allograft. Biomechanical testing of stiffness, ultimate failure load and AP-laxity as well as histological analysis to investigate cell, vessel and myofibroblast-density were performed after 6 and 12 weeks. Native sheep ACL and hamstring tendons (HAT, each n = 9) served as controls. The results of a previous study analyzing the remodeling of fresh frozen allografts (n = 12) and autografts (Auto, n = 18) with the same study design were also included in the analysis. Statistics were performed using Mann-Whitney U test followed by Bonferroni-Holm correction. Results showed significantly decreased biomechanical properties during the early remodeling period in Ebeam treated grafts and this was accompanied with an increased remodeling activity. There was no recovery of biomechanical function from 6 to 12 weeks in this group in contrast to the results observed in fresh frozen allografts and autografts. Therefore, high dose Ebeam irradiation investigated in this paper cannot be recommended for soft tissue allograft sterilization.

Improving anterior deltoid activity in a musculoskeletal shoulder model - an analysis of the torque-feasible space at the sternoclavicular joint.

PubMed

Ingram, David; Engelhardt, Christoph; Farron, Alain; Terrier, Alexandre; Müllhaupt, Philippe

2016-01-01

Modelling the shoulder's musculature is challenging given its mechanical and geometric complexity. The use of the ideal fibre model to represent a muscle's line of action cannot always faithfully represent the mechanical effect of each muscle, leading to considerable differences between model-estimated and in vivo measured muscle activity. While the musculo-tendon force coordination problem has been extensively analysed in terms of the cost function, only few works have investigated the existence and sensitivity of solutions to fibre topology. The goal of this paper is to present an analysis of the solution set using the concepts of torque-feasible space (TFS) and wrench-feasible space (WFS) from cable-driven robotics. A shoulder model is presented and a simple musculo-tendon force coordination problem is defined. The ideal fibre model for representing muscles is reviewed and the TFS and WFS are defined, leading to the necessary and sufficient conditions for the existence of a solution. The shoulder model's TFS is analysed to explain the lack of anterior deltoid (DLTa) activity. Based on the analysis, a modification of the model's muscle fibre geometry is proposed. The performance with and without the modification is assessed by solving the musculo-tendon force coordination problem for quasi-static abduction in the scapular plane. After the proposed modification, the DLTa reaches 20% of activation.

Change in the Pathologic Supraspinatus: A Three-Dimensional Model of Fiber Bundle Architecture within Anterior and Posterior Regions

PubMed Central

Kim, Soo Y.; Sachdeva, Rohit; Li, Zi; Rosser, Benjamin W. C.

2015-01-01

Supraspinatus tendon tears are common and lead to changes in the muscle architecture. To date, these changes have not been investigated for the distinct regions and parts of the pathologic supraspinatus. The purpose of this study was to create a novel three-dimensional (3D) model of the muscle architecture throughout the supraspinatus and to compare the architecture between muscle regions and parts in relation to tear severity. Twelve cadaveric specimens with varying degrees of tendon tears were used. Three-dimensional coordinates of fiber bundles were collected in situ using serial dissection and digitization. Data were reconstructed and modeled in 3D using Maya. Fiber bundle length (FBL) and pennation angle (PA) were computed and analyzed. FBL was significantly shorter in specimens with large retracted tears compared to smaller tears, with the deeper fibers being significantly shorter than other parts in the anterior region. PA was significantly greater in specimens with large retracted tears, with the superficial fibers often demonstrating the largest PA. The posterior region was absent in two specimens with extensive tears. Architectural changes associated with tendon tears affect the regions and varying depths of supraspinatus differently. The results provide important insights on residual function of the pathologic muscle, and the 3D model includes detailed data that can be used in future modeling studies. PMID:26413533

A Canine Arthroscopic Anterior Cruciate Ligament Reconstruction Model for Study of Synthetic Augmentation of Tendon Allografts.

PubMed

Cook, James L; Smith, Pat; Stannard, James P; Pfeiffer, Ferris; Kuroki, Keiichi; Bozynski, Chantelle C; Cook, Cristi

2017-09-01

Novel graft types, fixation methods, and means for augmenting anterior cruciate ligament (ACL) reconstructions require preclinical validation prior to safe and effective clinical application. The objective of this study was to describe and validate a translational canine model for all-inside arthroscopic complete ACL reconstruction using a quadriceps tendon allograft with internal brace (QTIB). With institutional approval, adult research hounds underwent complete transection of the native ACL followed by all-inside ACL reconstruction using the novel QTIB construct with suspensory fixation ( n  = 10). Contralateral knees were used as nonoperated controls ( n  = 10). Dogs were assessed over a 6-month period using functional, diagnostic imaging, gross, biomechanical, and histologic outcome measures required for preclinical animal models. Study results suggest that the novel QTIB construct used for complete ACL reconstruction can provide sustained knee stability and function without the development of premature osteoarthritis in a rigorous and valid preclinical model. The unique configuration of the QTIB construct-the combination of a tendon allograft with a synthetic suture tape internal brace-allowed for an effective biologic-synthetic load-sharing ACL construct. It prevented early failure, allowed for direct, four-zone graft-to-bone healing, and functional graft remodeling while avoiding problems noted with use of all-synthetic grafts. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The effect of screw taper on interference fit during load to failure at the soft tissue/bone interface.

PubMed

Mann, Charles J; Costi, John J; Stanley, Richard M; Dobson, Peter J

2005-10-01

The effect of screw geometry on the pullout strength of an anterior cruciate ligament reconstruction is well documented. The effect of a truly tapered screw has not been previously investigated. Thirty bovine knees in right and left knee pairs were collected. Superficial digital flexors from the hind legs of sheep were harvested to form a quadruple tendon graft. For each knee pair, one tendon graft was fixed using a tapered screw (n=15) and the other with a non-tapered screw (n=15). Interference screws were manufactured from stainless steel, and apart from the tapered or non-tapered profile were identical. The screws were inserted into a tibial tunnel already containing the tendon graft. The interference fit was tested by extensile load to failure tests. The insertion torque of the screws and first sign of load to failure (by pullout) of the interference fit were recorded. Results were analysed using paired t-tests. The results indicated that tapered screws have significantly higher resistance to interference failure (p=0.007) and insertion torque (p<0.001) than non-tapered screws. The improved biomechanical performance of tapered screws demonstrated in this study may translate into superior clinical results, particularly at the tibial attachment of hamstring anterior cruciate ligament reconstruction, and also of hamstring fixation to the medial femoral condyle for patella instability.

Feasibility and reliability of using an exoskeleton to emulate muscle contractures during walking.

PubMed

Attias, M; Bonnefoy-Mazure, A; De Coulon, G; Cheze, L; Armand, S

2016-10-01

Contracture is a permanent shortening of the muscle-tendon-ligament complex that limits joint mobility. Contracture is involved in many diseases (cerebral palsy, stroke, etc.) and can impair walking and other activities of daily living. The purpose of this study was to quantify the reliability of an exoskeleton designed to emulate lower limb muscle contractures unilaterally and bilaterally during walking. An exoskeleton was built according to the following design criteria: adjustable to different morphologies; respect of the principal lines of muscular actions; placement of reflective markers on anatomical landmarks; and the ability to replicate the contractures of eight muscles of the lower limb unilaterally and bilaterally (psoas, rectus femoris, hamstring, hip adductors, gastrocnemius, soleus, tibialis posterior, and peroneus). Sixteen combinations of contractures were emulated on the unilateral and bilateral muscles of nine healthy participants. Two sessions of gait analysis were performed at weekly intervals to assess the reliability of the emulated contractures. Discrete variables were extracted from the kinematics to analyse the reliability. The exoskeleton did not affect normal walking when contractures were not emulated. Kinematic reliability varied from poor to excellent depending on the targeted muscle. Reliability was good for the bilateral and unilateral gastrocnemius, soleus, and tibialis posterior as well as the bilateral hamstring and unilateral hip adductors. The exoskeleton can be used to replicate contracture on healthy participants. The exoskeleton will allow us to differentiate primary and compensatory effects of muscle contractures on gait kinematics. Copyright © 2016 Elsevier B.V. All rights reserved.

A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

PubMed Central

Marieswaran, M.; Jain, Ishita; Garg, Bhavuk; Sharma, Vijay

2018-01-01

The anterior cruciate ligament is one of the six ligaments in the human knee joint that provides stability during articulations. It is relatively prone to acute and chronic injuries as compared to other ligaments. Repair and self-healing of an injured anterior cruciate ligament are time-consuming processes. For personnel resuming an active sports life, surgical repair or replacement is essential. Untreated anterior cruciate ligament tear results frequently in osteoarthritis. Therefore, understanding of the biomechanics of injury and properties of the native ligament is crucial. An abridged summary of the prominent literature with a focus on key topics on kinematics and kinetics of the knee joint and various loads acting on the anterior cruciate ligament as a function of flexion angle is presented here with an emphasis on the gaps. Briefly, we also review mechanical characterization composition and anatomy of the anterior cruciate ligament as well as graft materials used for replacement/reconstruction surgeries. The key conclusions of this review are as follows: (a) the highest shear forces on the anterior cruciate ligament occur during hyperextension/low flexion angles of the knee joint; (b) the characterization of the anterior cruciate ligament at variable strain rates is critical to model a viscoelastic behavior; however, studies on human anterior cruciate ligament on variable strain rates are yet to be reported; (c) a significant disparity on maximum stress/strain pattern of the anterior cruciate ligament was observed in the earlier works; (d) nearly all synthetic grafts have been recalled from the market; and (e) bridge-enhanced repair developed by Murray is a promising technique for anterior cruciate ligament reconstruction, currently in clinical trials. It is important to note that full extension of the knee is not feasible in the case of most animals and hence the loading pattern of human ACL is different from animal models. Many of the published reviews on the ACL focus largely on animal ACL than human ACL. Further, this review article summarizes the issues with autografts and synthetic grafts used so far. Autografts (patellar tendon and hamstring tendon) remains the gold standard as nearly all synthetic grafts introduced for clinical use have been withdrawn from the market. The mechanical strength during the ligamentization of autografts is also highlighted in this work. PMID:29861784

Glenohumeral instability: evaluation with MR arthrography.

PubMed

Beltran, J; Rosenberg, Z S; Chandnani, V P; Cuomo, F; Beltran, S; Rokito, A

1997-01-01

Magnetic resonance arthrography is superior to other imaging techniques in evaluation of the glenohumeral joint. Normal variants that can be diagnostic pitfalls include the anterosuperior sublabral foramen, the Buford complex, and hyaline cartilage under the labrum. Anteroinferior dislocation is the most frequent cause of anterior glenohumeral instability and produces a constellation of lesions (anteroinferior labral tear, classic and osseous Bankart lesions, Hill-Sachs lesion). Variants of anteroinferior labral tears include anterior labroligamentous periosteal sleeve avulsion and glenoid labral articular disruption. Anterior glenohumeral instability can also involve tears of the anterior or anterosuperior labrum or the glenohumeral ligaments. Posterior glenohumeral instability can involve a posterior labral tear, posterior capsular stripping or laxity; fracture, erosion, or sclerosis and ectopic ossification of the posterior glenoid fossa; reverse Hill-Sachs lesion; McLaughlin fracture; or posterosuperior glenoid impingement. Superior labral anterior and posterior lesions involve the superior labrum with varying degrees of biceps tendon involvement.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kleiner, J.B.; Amiel, D.; Harwood, F.L.

A rabbit model for anterior cruciate ligament (ACL) reconstruction using autogenous patellar tendon was utilized to study the early events of autograft cellular dynamics. Biochemical, autoradiographic, histological, and vascular injection techniques demonstrated that the native autograft cell population rapidly necroses. This repopulation occurs without a vascular contribution; cells entering the autograft are reliant upon synovial fluid nutrition.

Irradiated Hamstring Tendon Allograft Versus Autograft for Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: Midterm Clinical Outcomes.

PubMed

Tian, Shaoqi; Wang, Bin; Liu, Lun; Wang, Yuanhe; Ha, Chengzhi; Li, Qicai; Yang, Xu; Sun, Kang

2016-10-01

Most studies on grafts for anterior cruciate ligament (ACL) reconstruction (ACLR) have been of autografts or nonirradiated allografts with a single-bundle (SB) technique. Outcome reports evaluating anatomic double-bundle (DB) ACLR with a hamstring tendon autograft versus irradiated allograft are rare. To compare the clinical outcomes of arthroscopic anatomic DB ACLR with a hamstring tendon autograft versus irradiated allograft. Randomized controlled trial; Level of evidence, 2. Between 2008 and 2009, a total of 107 patients undergoing arthroscopic DB ACLR were prospectively randomized consecutively into 1 of 2 groups (autograft [Auto] group and irradiated allograft [Ir-Allo] group). All the surgical procedures were performed by the same senior surgeon using the DB reconstruction technique. All irradiated hamstring tendon allografts were sterilized with 2.5 Mrad of irradiation before distribution and were obtained from a single certified tissue bank. Graft fixation on the femoral side was by an Endobutton, and on the tibial side by a bioabsorbable interference screw augmented with a staple. The same rehabilitation protocol was applied to all patients. Before surgery and at a mean of 6.9 years of follow-up, patients were evaluated by the same observer according to objective and subjective clinical evaluations including detailed history, physical examination, radiography, functional knee ligament testing, KT-2000 arthrometer testing, Harner vertical jump and Daniel 1-legged hop tests, Lysholm score, Tegner score, International Knee Documentation Committee (IKDC) standard evaluation form, and Cincinnati knee score. A total of 83 patients (Auto: n = 40 [mean age, 29.2 ± 6.9 years]; Ir-Allo: n = 43 [mean age, 28.6 ± 7.2 years]) fulfilled follow-up and clinical evaluations. No significant differences were found between the 2 groups according to the overall IKDC functional and subjective evaluations as well as testing of activity levels. Significant between-group differences were found when comparing the results at final follow-up according to the Lachman test, anterior drawer test, pivot-shift test, and KT-2000 arthrometer measurements (P < .001). Most importantly, 87.5% of patients in the Auto group and 34.9% in the Ir-Allo group had a side-to-side difference <3 mm. The rate of laxity (side-to-side difference >5 mm) with an irradiated allograft (30.2%) was higher than that with an autograft (7.5%) (P < .001). The failure rate in the Ir-Allo group (30.2%) was higher than that in the Auto group (7.5%) (P < .001). Anterior and rotational stability decreased significantly in the Ir-Allo group; patients in the Ir-Allo group also had a shorter operation time. There were 10.0% (4/40) of patients in the Auto group and 32.6% (19/43) of patients in the Ir-Allo group who had arthritic progression (P < .05). There were no significant differences in postoperative activity levels and functional outcomes between the Auto and Ir-Allo groups. However, a significant increase in anterior and rotational laxity in the Ir-Allo group was found according to evaluations. We do not advocate an irradiated hamstring tendon allograft for DB ACLR. Clinical Trial Register System of The Affiliated Hospital of Qingdao University (qdfy-ky2008-12). © 2016 The Author(s).

Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface.

PubMed

Zhou, Yiqin; Zhang, Jianying; Yang, Jinsong; Narava, Manoj; Zhao, Guangyi; Yuan, Ting; Wu, Haishan; Zheng, Nigel; Hogan, MaCalus V; Wang, James H-C

2017-12-01

Treatment of tendon-bone junction injuries is a challenge because tendon-bone interface often heals poorly and the fibrocartilage zone, which reduces stress concentration, at the interface is not formed. In this study, we used a compound called kartogenin (KGN) with platelet-rich plasma (PRP) to induce the formation of fibrocartilage zone in a rat tendon graft-bone tunnel model. The experimental rats received KGN-PRP or PRP injections in the tendon graft-bone tunnel interface. The control group received saline. After 4, 8 and 12 weeks, Safranin O staining of the tendon graft-bone tunnels revealed abundant proteoglycans in the KGN-PRP group indicating the formation of cartilage-like transition zone. Immunohistochemical and immuno-fluorescence staining revealed collagen types I (Col-I) and II (Col-II) in the newly formed fibrocartilage zone. Both fibrocartilage zone formation and maturation were healing time dependent. In contrast, the PRP and saline control groups had no cartilage-like tissues and minimal Col-I and Col-II staining. Some gaps were also present in the saline control group. Finally, pull-out strength in the KGN-PRP-treated group at 8 weeks was 1.4-fold higher than the PRP-treated group and 1.6-fold higher than the saline control group. These findings indicate that KGN, with PRP as a carrier, promotes the formation of fibrocartilage zone between the tendon graft and bone interface. Thus, KGN-PRP may be used as a convenient cell-free therapy in clinics to promote fibrocartilage zone formation in rotator calf repair and anterior cruciate ligament reconstruction, thereby enhancing the mechanical strength of the tendon-bone interface and hence the clinical outcome of these procedures. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Presence of Bacteria in Spontaneous Achilles Tendon Ruptures.

PubMed

Rolf, Christer G; Fu, Sai-Chuen; Hopkins, Chelsea; Luan, Ju; Ip, Margaret; Yung, Shu-Hang; Friman, Göran; Qin, Ling; Chan, Kai-Ming

2017-07-01

The structural pathology of Achilles tendon (AT) ruptures resembles tendinopathy, but the causes remain unknown. Recently, a number of diseases were found to be attributed to bacterial infections, resulting in low-grade inflammation and progressive matrix disturbance. The authors speculate that spontaneous AT ruptures may also be influenced by the presence of bacteria. Bacteria are present in ruptured ATs but not in healthy tendons. Cross-sectional study; Level of evidence, 3. Patients with spontaneous AT ruptures and patients undergoing anterior cruciate ligament (ACL) reconstruction were recruited for this study. During AT surgical repair, excised tendinopathic tissue was collected, and healthy tendon samples were obtained as controls from hamstring tendon grafts used in ACL reconstruction. Half of every sample was reserved for DNA extraction and the other half for histology. Polymerase chain reaction (PCR) was conducted using 16S rRNA gene universal primers, and the PCR products were sequenced for the identification of bacterial species. A histological examination was performed to compare tendinopathic changes in the case and control samples. Five of 20 AT rupture samples were positive for the presence of bacterial DNA, while none of the 23 hamstring tendon samples were positive. Sterile operating and experimental conditions and tests on samples, controlling for harvesting and processing procedures, ruled out the chance of postoperative bacterial contamination. The species identified predominantly belonged to the Staphylococcus genus. AT rupture samples exhibited histopathological features characteristic of tendinopathy, and most healthy hamstring tendon samples displayed normal tendon features. There were no apparent differences in histopathology between the bacterial DNA-positive and bacterial DNA-negative AT rupture samples. The authors have demonstrated the presence of bacterial DNA in ruptured AT samples. It may suggest the potential involvement of bacteria in spontaneous AT ruptures.

Orthobiologics in Pediatric Sports Medicine.

PubMed

Bray, Christopher C; Walker, Clark M; Spence, David D

2017-07-01

Orthobiologics are biological substances that allow injured muscles, tendons, ligaments, and bone to heal more quickly. They are found naturally in the body; at higher concentrations they can aid in the healing process. These substances include autograft bone, allograft bone, demineralized bone matrix, bone morphogenic proteins, growth factors, stem cells, plasma-rich protein, and ceramic grafts. Their use in sports medicine has exploded in efforts to increase graft incorporation, stimulate healing, and get athletes back to sport with problems including anterior cruciate ligament ruptures, tendon ruptures, cartilage injuries, and fractures. This article reviews orthobiologics and their applications in pediatric sports medicine. Copyright © 2017 Elsevier Inc. All rights reserved.

Experiment K-7-21: Effect of Microgravity on 1: Metabolic Enzymes of Type 1 and Type 2 Muscle Fibers, and on 2: Metabolic Enzymes, Neurotransmitter Amino Acids, and Neurotransmitter Associated Enzymes in Selected Regions of the Central Nervous System. Part 1; Metabolic Enzymes of Individual Muscle Fibers

NASA Technical Reports Server (NTRS)

Lowry, O. H.; Ilyina-Kakueva, E. I.; Krasnov, I. B.; Carter, J. G.; Chi, M. M.-Y.; Choksi, R.; Manchester, J. K.; McDougal, D. B.; Nemeth, P. M.; Pusateri, M. E.

1994-01-01

Individual fibers of any given muscle vary widely in enzyme composition, a fact obscured when enzyme levels of whole muscle are measured. Therefore, the purpose of this part of the study was to assess the effects of microgravity and hind limb suspension on the enzyme patterns within a slow twitch muscle (soleus) and a fast twitch muscle (tibialis anterior).

Thyrotoxicosis Presenting as Unilateral Drop Foot

PubMed Central

Hara, Kenju; Miyata, Hajime; Motegi, Takahide; Shibano, Ken; Ishiguro, Hideaki

2017-01-01

Neuromuscular disorders associated with hyperthyroidism have several variations in their clinical phenotype, such as ophthalmopathy, periodic paralysis, and thyrotoxic myopathy. We herein report an unusual case of thyrotoxic myopathy presenting as unilateral drop foot. Histopathological examinations of the left tibialis anterior muscle showed marked variation in the fiber size, mild inflammatory cell infiltration, and necrotic and regenerated muscle fibers with predominantly type 1 fiber atrophy. Medical treatment with propylthiouracil resulted in complete improvement of the left drop foot. This case expands the phenotype of thyrotoxicosis and suggests that thyrotoxicosis be considered as a possible cause of unilateral drop foot. PMID:28768980

Thyrotoxicosis Presenting as Unilateral Drop Foot.

PubMed

Hara, Kenju; Miyata, Hajime; Motegi, Takahide; Shibano, Ken; Ishiguro, Hideaki

2017-01-01

Neuromuscular disorders associated with hyperthyroidism have several variations in their clinical phenotype, such as ophthalmopathy, periodic paralysis, and thyrotoxic myopathy. We herein report an unusual case of thyrotoxic myopathy presenting as unilateral drop foot. Histopathological examinations of the left tibialis anterior muscle showed marked variation in the fiber size, mild inflammatory cell infiltration, and necrotic and regenerated muscle fibers with predominantly type 1 fiber atrophy. Medical treatment with propylthiouracil resulted in complete improvement of the left drop foot. This case expands the phenotype of thyrotoxicosis and suggests that thyrotoxicosis be considered as a possible cause of unilateral drop foot.

Synovial Sarcoma in the Foot of a 5-Year-Old ChildA Case Report.

PubMed

Lepow, Gary M; Grimmer, Daniel L; Lemar, Onya V; Bridges, Evan A

2016-07-01

The purpose of this case report is to present a rare finding of synovial sarcoma in a 5-year-old child. Most soft-tissue masses of the foot are too often presumed to be small and benign; therefore, compared with soft-tissue sarcomas, they are difficult to clinically differentiate and treat. A 5-year-old girl presented with a painful lesion that was diagnosed as synovial sarcoma after an excisional biopsy was performed. This was an unexpected finding of synovial sarcoma involving the tibialis posterior tendon of her right foot. The patient presented with an 8-month history of tenderness and an antalgic gait. We would like to encourage that all soft-tissue tumors of the foot be preoperatively evaluated with the aid of diagnostic imaging so that a well-planned biopsy assessment can be performed, with adequate margins excised.

A biomechanical comparison of tendon-bone interface motion and cyclic loading between single-row, triple-loaded cuff repairs and double-row, suture-tape cuff repairs using biocomposite anchors.

PubMed

Barber, F Alan; Drew, Otis R

2012-09-01

To compare tendon-bone interface motion and cyclic loading in a single-row, triple-loaded anchor repair with a suture-tape, rip-stop, double-row rotator cuff repair. Using 18 human shoulders from 9 matched cadaveric pairs, we created 2 groups of rotator cuff repairs. Group 1 was a double-row, rip-stop, suture-tape construct. Group 2 was a single-row, triple-loaded construct. Before mechanical testing, the supraspinatus footprint was measured with calipers. A superiorly positioned digital camera optically measured the tendon footprint motion during 60° of humeral internal and external rotation. Specimens were secured at a fixed angle not exceeding 45° in reference to the load. After preloading, each sample was cycled between 10 N and 100 N for 200 cycles at 1 Hz, followed by destructive testing at 33 mm/s. A digital camera with tracking software measured the repair displacement at 100 and 200 cycles. Ultimate load and failure mode for each sample were recorded. The exposed anterior footprint border (6.5% ± 6%) and posterior footprint border (0.9% ± 1.7%) in group 1 were statistically less than the exposed anterior footprint border (30.3% ± 17%) and posterior footprint border (29.8% ± 14%) in group 2 (P = .003 and P < .001, respectively). The maximal internal rotation and external rotation tendon footprint displacements in group 1 (1.6 mm and 1.4 mm, respectively) were less than those in group 2 (both 3.6 mm) (P = .007 and P = .004, respectively). Mean displacement after 100 cycles for group 1 and group 2 was 2.0 mm and 3.2 mm, respectively, and at 200 cycles, mean displacement was 2.5 mm and 4.2 mm, respectively (P = .02). The mean ultimate failure load in group 1 (586 N) was greater than that in group 2 (393 N) (P = .02). The suture-tendon interface was the site of most construct failures. The suture-tape, rip-stop, double-row rotator cuff repair had greater footprint coverage, less rotational footprint displacement, and a greater mean ultimate failure load than the triple-loaded, single-row repair on mechanical testing. No double-row or single-row constructs showed 5 mm of displacement after the first 100 cycles. The most common failure mode for both constructs was suture tearing through the tendon. Differences in cuff fixation influence rotational tendon movement and may influence postoperative healing. Stronger repair constructs still fail at the suture-tendon interface. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Sensitivity of subject-specific models to errors in musculo-skeletal geometry.

PubMed

Carbone, V; van der Krogt, M M; Koopman, H F J M; Verdonschot, N

2012-09-21

Subject-specific musculo-skeletal models of the lower extremity are an important tool for investigating various biomechanical problems, for instance the results of surgery such as joint replacements and tendon transfers. The aim of this study was to assess the potential effects of errors in musculo-skeletal geometry on subject-specific model results. We performed an extensive sensitivity analysis to quantify the effect of the perturbation of origin, insertion and via points of each of the 56 musculo-tendon parts contained in the model. We used two metrics, namely a Local Sensitivity Index (LSI) and an Overall Sensitivity Index (OSI), to distinguish the effect of the perturbation on the predicted force produced by only the perturbed musculo-tendon parts and by all the remaining musculo-tendon parts, respectively, during a simulated gait cycle. Results indicated that, for each musculo-tendon part, only two points show a significant sensitivity: its origin, or pseudo-origin, point and its insertion, or pseudo-insertion, point. The most sensitive points belong to those musculo-tendon parts that act as prime movers in the walking movement (insertion point of the Achilles Tendon: LSI=15.56%, OSI=7.17%; origin points of the Rectus Femoris: LSI=13.89%, OSI=2.44%) and as hip stabilizers (insertion points of the Gluteus Medius Anterior: LSI=17.92%, OSI=2.79%; insertion point of the Gluteus Minimus: LSI=21.71%, OSI=2.41%). The proposed priority list provides quantitative information to improve the predictive accuracy of subject-specific musculo-skeletal models. Copyright © 2012 Elsevier Ltd. All rights reserved.

Arthroscopically assisted acromioclavicular joint reconstruction.

PubMed

Baumgarten, Keith M; Altchek, David W; Cordasco, Frank A

2006-02-01

Arthroscopically assisted acromioclavicular joint reconstruction avoids the large incisions necessary with open reconstructions. This acromioclavicular joint reconstruction technique via the subacromial space does not violate the rotator interval or require screw removal. The patient is placed in a modified beach-chair position. The arthroscope is placed into the subacromial space, and a bursectomy is performed through a lateral subacromial portal. The coracoacromial ligament is released from the acromion with an electrocautery and an arthroscopic elevator. A nonabsorbable suture is passed through the coracoacromial ligament with a suture passer, and an arthroscopic suture grasper is used to deliver both ends of the suture out through the lateral portal. The coracoid is identified and isolated using a radiofrequency ablator placed through the anterior portal while visualizing through the lateral portal. A percutaneous shuttle device is passed through the skin superomedial to the coracoid. The shuttle is visualized entering superior to the coracoid and is passed just medial to the coracoid. Once the tip of the shuttle can be visualized in the recess inferior to the coracoid, the shuttle loop is advanced. A suture grasper is used to deliver both ends of the shuttle out through the anterior portal. A semitendinosus allograft is used to reconstruct the coracoclavicular ligament. A nonabsorbable suture is passed through both ends of the allograft. Three strands of nonabsorbable suture are braided together. The tendon and the braided suture are shuttled around the coracoid. At this point, both the braided suture and the allograft tendon enter the anterior portal, wrap around the coracoid base, and exit the anterior portal. A 3-cm incision is made over the distal clavicle. A hole is drilled through the clavicle with a 5-mm drill. A loop of 22-gauge wire is passed through the hole in the clavicle, and a looped suture is shuttled through the hole. A curved clamp is used to create a tunnel from the acromioclavicular joint, under the deltoid, to the anterior portal. The ends of the braided suture and the tendon sutures are grasped by the clamp and pulled out the acromioclavicular joint incision. The limbs of the braided suture and the tendon suture that pass medial to the coracoid are shuttled through the hole in the clavicle using the looped suture that was previously passed through the clavicle. The acromioclavicular joint is reduced by pushing down on the distal clavicle with a bone tamp while simultaneously lifting the acromion upward by superiorly loading the humerus at the elbow. Once the acromioclavicular joint is reduced or slightly over-reduced, the braided suture is tied down securely. The acromioclavicular joint should remain reduced even after the manual reduction maneuver is released. The semitendinosus allograft is tensioned around the distal end of the clavicle and sutured to itself with a nonabsorbable suture. The released coracoacromial ligament is retrieved from the clavicular incision and sutured to the distal clavicle and semitendinosus allograft. The incision is closed in standard fashion, and a sling is applied.

[Foster Modification of Full Tendon Transposition of Vertical Rectus Muscles for Sixth Nerve Palsy].

PubMed

Heede, Santa

2018-04-11

Since 1907 a variety of muscle transposition procedures for the treatment of abducens nerve palsy has been established internationally. Full tendon transposition of the vertical rectus muscle was initially described by O'Connor 1935 and then augmented by Foster 1997 with addition of posterior fixation sutures on the vertical rectus muscle. Full tendon transposition augmented by Foster belongs to the group of the most powerful surgical techniques to improve the abduction. Purpose of this study was to evaluate the results of full tendon vertical rectus transposition augmented with lateral fixation suture for patients with abducens nerve palsy. Full tendon transpositions of vertical rectus muscles augmented with posterior fixation suture was performed in 2014 on five patients with abducens nerve palsy. Two of the patients received Botox injections in the medial rectus muscle: one of them three months after the surgery and another during the surgery. One of the patients had a combined surgery of the horizontal muscles one year before. On three of the patients, who received a pure transposition surgery, the preoperative deviation at the distance (mean: + 56.6 pd; range: + 40 to + 80 pd) was reduced by a mean of 39.6 pd (range 34 to 50 pd), the abduction was improved by a mean of 3 mm (range 2 to 4 mm). The other two patients, who received besides the transposition procedure additional surgeries of the horizontal muscles, the preoperative deviation at the distance (+ 25 and + 126 pd respectively) was reduced by 20 and 81 pd respectively. The abduction was improved by 4 and 8 mm respectively. After surgery two patients developed a vertical deviation with a maximum of 4 pd. None of the patients had complications or signs of anterior segment ischemia. The elevation and/or depression was only marginally affected. There was no diplopia in up- or downgaze. Full tendon transposition of vertical rectus muscles, augmented with lateral posterior fixation suture is a safe and effective treatment method for abducens nerve palsy and in most cases recession of the medial rectus can be avoided. Upgaze and downgaze are affected very slightly. Diverse studies have shown that the risk of anterior segment ischemia is low. Georg Thieme Verlag KG Stuttgart · New York.

Bioresorbable pins and interference screws for fixation of hamstring tendon grafts in anterior cruciate ligament reconstruction surgery: a randomized controlled trial.

PubMed

Stengel, Dirk; Casper, Dirk; Bauwens, Kai; Ekkernkamp, Axel; Wich, Michael

2009-09-01

Biodegradable cross-pins have been shown to provide higher failure loads than do screws for fixation of hamstring tendons under laboratory conditions. To compare the clinical results of biodegradable pins (RigidFix) and interference screws (BioCryl) for fixation of hamstring grafts in arthroscopically assisted anterior cruciate ligament reconstruction. Study Design Randomized controlled trial; Level of evidence, 1. To test the hypothesis of a difference of 1.0 +/- 1.2 mm in anterior knee laxity between the two fixation options, 54 patients were randomly assigned to groups via a block randomization scheme and sealed envelopes. All patients underwent standardized hamstring graft reconstruction and had similar postoperative aftercare by an accelerated rehabilitation protocol. Measures assessed at baseline and after 1 and 2 years of follow-up included (1) the side-to-side difference in anterior laxity (KT-1000 arthrometer), (2) Short Form 36 physical and mental component scores, and (3) the International Knee Documentation Committee form scores. After 1 and 2 years, 26 and 21 patients in the BioCryl group and 28 and 24 patients in the RigidFix group were available for follow-up examination. No significant difference was noted in instrumented anterior translation between BioCryl and RigidFix fixation: 1 year, 0.11 (95% CI, -0.60 to 0.82; P = .7537); 2 years, 0.33 (95% CI, -0.43 to 1.08 mm; P = .3849). Also, there were no significant differences in the mean physical and mental component scores and International Knee Documentation Committee form scores and in overall complication and surgical revision rates. A pin dislocation was classified as the sole procedure-specific serious adverse event. Bioresorbable pins do not provide better clinical results than do resorbable interference screws for hamstring graft fixation in anterior cruciate ligament reconstruction surgery.

Multidisciplinary approach to the persistent double distal tendon of the biceps brachii.

PubMed

Blasi, Marc; de la Fuente, Javier; Martinoli, Carlo; Blasi, Juan; Pérez-Bellmunt, Albert; Domingo, Tomás; Miguel-Pérez, Maribel

2014-01-01

The aim of this study is to correlate the ultrasound (US) appearance of the persistent double or bifid distal tendon of the biceps brachii muscle with anatomical and histological data. This will provide a new model to study the pathological distal biceps brachii tendon (DBBT). The DBBT of 20 cadaveric elbows were examined with linear array broadband US transducers (frequency band 14-6 MHz) using an anterior approach. Trypan blue dye was injected underneath the paratenon under US guidance in 16 specimens. After they were dissected, five of them were processed to obtain histological slices stained with hematoxylin-eosin and antiserum to protein S100. At US, the DBBT is a tendon in which the fascicles are organized in two different hyperechoic components separated by a hyperechoic septum related to the endotenon. The endotenon is lax, flexible, and makes folding and gliding of the two portions feasible. The DBBT is surrounded by a hyperechoic paratenon adjacent to the tendon surface, which is only differentiable by US when dye is interposed between such structures. The connective septum of endotenon located between the two main components of the DBBT is responsible for the US image of two separate tendons and functionally enables it to work as two separate entities, thus allowing respective folding and gliding. The paratenon surrounding the lacertus fibrosus and the DBBT plays an important stabilization role, enabling them to change shape and arrangement during joint motion. It is also an important conduit for nerves and blood vessels.

Medial gastrocnemius structure and gait kinetics in spastic cerebral palsy and typically developing children: A cross-sectional study.

PubMed

Martín Lorenzo, Teresa; Rocon, Eduardo; Martínez Caballero, Ignacio; Lerma Lara, Sergio

2018-05-01

To compare medial gastrocnemius muscle-tendon structure, gait propulsive forces, and ankle joint gait kinetics between typically developing children and those with spastic cerebral palsy, and to describe significant associations between structure and function in children with spastic cerebral palsy.A sample of typically developing children (n = 9 /16 limbs) and a sample of children with spastic cerebral palsy (n = 29 /43 limbs) were recruited. Ultrasound and 3-dimensional motion capture were used to assess muscle-tendon structure, and propulsive forces and ankle joint kinetics during gait, respectively.Children with spastic cerebral palsy had shorter fascicles and muscles, and longer Achilles tendons than typically developing children. Furthermore, total negative power and peak negative power at the ankle were greater, while total positive power, peak positive power, net power, total vertical ground reaction force, and peak vertical and anterior ground reaction forces were smaller compared to typically developing children. Correlation analyses revealed that smaller resting ankle joint angles and greater maximum dorsiflexion in children with spastic cerebral palsy accounted for a significant decrease in peak negative power. Furthermore, short fascicles, small fascicle to belly ratios, and large tendon to fascicle ratios accounted for a decrease in propulsive force generation.Alterations observed in the medial gastrocnemius muscle-tendon structure of children with spastic cerebral palsy may impair propulsive mechanisms during gait. Therefore, conventional treatments should be revised on the basis of muscle-tendon adaptations.

Bone morphogenetic protein 7 (BMP-7) influences tendon-bone integration in vitro.

PubMed

Schwarting, Tim; Lechler, Philipp; Struewer, Johannes; Ambrock, Marius; Frangen, Thomas Manfred; Ruchholtz, Steffen; Ziring, Ewgeni; Frink, Michael

2015-01-01

Successful graft ingrowth following reconstruction of the anterior cruciate ligament is governed by complex biological processes at the tendon-bone interface. The aim of this study was to investigate in an in vitro study the effects of bone morphogenetic protein 7 (BMP-7) on tendon-bone integration. To study the biological effects of BMP-7 on the process of tendon-bone-integration, two independent in vitro models were used. The first model involved the mono- and coculture of bovine tendon specimens and primary bovine osteoblasts with and without BMP-7 exposure. The second model comprised the mono- and coculture of primary bovine osteoblasts and fibroblasts. Alkaline phosphatase (ALP), lactate dehydrogenase (LDH), lactate and osteocalcin (OCN) were analyzed by ELISA. Histological analysis and electron microscopy of the tendon specimens were performed. In both models, positive effects of BMP-7 on ALP enzyme activity were observed (p<0.001). Additionally, similar results were noted for LDH activity and lactate concentration. BMP-7 stimulation led to a significant increase in OCN expression. Whereas the effects of BMP-7 on tendon monoculture peaked during an early phase of the experiment (p<0.001), the cocultures showed a maximal increase during the later stages (p<0.001). The histological analysis showed a stimulating effect of BMP-7 on extracellular matrix formation. Organized ossification zones and calcium carbonate-like structures were only observed in the BMP-stimulated cell cultures. This study showed the positive effects of BMP-7 on the biological process of tendon-bone integration in vitro. Histological signs of improved mineralization were paralleled by increased rates of osteoblast-specific protein levels in primary bovine osteoblasts and fibroblasts. Our findings indicated a role for BMP-7 as an adjuvant therapeutic agent in the treatment of ligamentous injuries, and they emphasized the importance of the transdifferentiation process of tendinous fibroblasts at the tendon-bone interface.

ANTERIOR CRUCIATE LIGAMENT INJURY: TREATMENT AND REHABILITATION. CURRENT PERSPECTIVES AND TRENDS

PubMed Central

Arliani, Gustavo Gonçalves; Astur, Diego da Costa; Kanas, Michel; Kaleka, Camila Cohen; Cohen, Moises

2015-01-01

Objective: The aim of this study was to evaluate the procedures used by knee surgeons in Brazil for treating and rehabilitating anterior cruciate ligament injuries. Methods: A questionnaire consisting of 21 closed questions was developed, addressing topics relating to treatment and rehabilitation after anterior cruciate ligament reconstruction. The questionnaire was applied to Brazilian knee surgeons during the three days of the 42nd Brazilian Congress of Orthopedics and Traumatology in 2010. Results: A total of 226 surgeons filled out the questionnaire completely. The most commonly used types of graft were hamstrings tendons and the central third of the ipsilateral patellar tendon, which were used by 82.3% and 53.5% of the sample, respectively. The technique of reconstruction with a single transtibial band was the first preference and was used by 66.4% of the participants. A period of 1 to 4 weeks between injury and surgical procedure was considered ideal by most participants (52.65%). Complaints from patients that the knee was ‘giving way’ or unstable and presence of a positive pivot shift maneuver were the most decisive factors considered in making the decision to operate the patient. Patient satisfaction and absence of complaints of instability during the postoperative period were the criteria deemed to be most important for the surgery to be considered a success. Conclusions: There are clearly evolving trends in treating and rehabilitating the anterior cruciate ligament in Brazil. However, more prospective controlled studies are needed in order to evaluate the clinical and scientific benefits of these trends. PMID:27042620

Early changes in tissue amino acid metabolism and nutrient routing in rats fed a high-fat diet: evidence from natural isotope abundances of nitrogen and carbon in tissue proteins.

PubMed

Mantha, Olivier L; Polakof, Sergio; Huneau, Jean-François; Mariotti, François; Poupin, Nathalie; Zalko, Daniel; Fouillet, Helene

2018-05-01

Little is known about how diet-induced obesity and insulin resistance affect protein and amino acid (AA) metabolism in tissues. The natural relative abundances of the heavy stable isotopes of C (δ 13C) and N (δ 15N) in tissue proteins offer novel and promising biomarkers of AA metabolism. They, respectively, reflect the use of dietary macronutrients for tissue AA synthesis and the relative metabolic use of tissue AA for oxidation v. protein synthesis. In this study, δ 13C and δ 15N were measured in the proteins of various tissues in young adult rats exposed perinatally and/or fed after weaning with a normal- or a high-fat (HF) diet, the aim being to characterise HF-induced tissue-specific changes in AA metabolism. HF feeding was shown to increase the routing of dietary fat to all tissue proteins via non-indispensable AA synthesis, but did not affect AA allocation between catabolic and anabolic processes in most tissues. However, the proportion of AA directed towards oxidation rather than protein synthesis was increased in the small intestine and decreased in the tibialis anterior muscle and adipose tissue. In adipose tissue, the AA reallocation was observed in the case of perinatal or post-weaning exposure to HF, whereas in the small intestine and tibialis anterior muscle the AA reallocation was only observed after HF exposure that covered both the perinatal and post-weaning periods. In conclusion, HF exposure induced an early reorganisation of AA metabolism involving tissue-specific effects, and in particular a decrease in the relative allocation of AA to oxidation in several peripheral tissues.

Blood pressure and the contractility of a human leg muscle.

PubMed

Luu, Billy L; Fitzpatrick, Richard C

2013-11-01

These studies investigate the relationships between perfusion pressure, force output and pressor responses for the contracting human tibialis anterior muscle. Eight healthy adults were studied. Changing the height of tibialis anterior relative to the heart was used to control local perfusion pressure. Electrically stimulated tetanic force output was highly sensitive to physiological variations in perfusion pressure showing a proportionate change in force output of 6.5% per 10 mmHg. This perfusion-dependent change in contractility begins within seconds and is reversible with a 53 s time constant, demonstrating a steady-state equilibrium between contractility and perfusion pressure. These stimulated contractions did not produce significant cardiovascular responses, indicating that the muscle pressor response does not play a major role in cardiovascular regulation at these workloads. Voluntary contractions at forces that would require constant motor drive if perfusion pressure had remained constant generated a central pressor response when perfusion pressure was lowered. This is consistent with a larger cortical drive being required to compensate for the lost contractility with lower perfusion pressure. The relationship between contractility and perfusion for this large postural muscle was not different from that of a small hand muscle (adductor pollicis) and it responded similarly to passive peripheral and active central changes in arterial pressure, but extended over a wider operating range of pressures. If we consider that, in a goal-oriented motor task, muscle contractility determines central motor output and the central pressor response, these results indicate that muscle would fatigue twice as fast without a pressor response. From its extent, timing and reversibility we propose a testable hypothesis that this change in contractility arises through contraction- and perfusion-dependent changes in interstitial K(+) concentration.

Blood pressure and the contractility of a human leg muscle

PubMed Central

Luu, Billy L; Fitzpatrick, Richard C

2013-01-01

These studies investigate the relationships between perfusion pressure, force output and pressor responses for the contracting human tibialis anterior muscle. Eight healthy adults were studied. Changing the height of tibialis anterior relative to the heart was used to control local perfusion pressure. Electrically stimulated tetanic force output was highly sensitive to physiological variations in perfusion pressure showing a proportionate change in force output of 6.5% per 10 mmHg. This perfusion-dependent change in contractility begins within seconds and is reversible with a 53 s time constant, demonstrating a steady-state equilibrium between contractility and perfusion pressure. These stimulated contractions did not produce significant cardiovascular responses, indicating that the muscle pressor response does not play a major role in cardiovascular regulation at these workloads. Voluntary contractions at forces that would require constant motor drive if perfusion pressure had remained constant generated a central pressor response when perfusion pressure was lowered. This is consistent with a larger cortical drive being required to compensate for the lost contractility with lower perfusion pressure. The relationship between contractility and perfusion for this large postural muscle was not different from that of a small hand muscle (adductor pollicis) and it responded similarly to passive peripheral and active central changes in arterial pressure, but extended over a wider operating range of pressures. If we consider that, in a goal-oriented motor task, muscle contractility determines central motor output and the central pressor response, these results indicate that muscle would fatigue twice as fast without a pressor response. From its extent, timing and reversibility we propose a testable hypothesis that this change in contractility arises through contraction- and perfusion-dependent changes in interstitial K+ concentration. PMID:24018946

Antidepressants Increase REM Sleep Muscle Tone in Patients with and without REM Sleep Behavior Disorder.

PubMed

McCarter, Stuart J; St Louis, Erik K; Sandness, David J; Arndt, Katlyn; Erickson, Maia; Tabatabai, Grace; Boeve, Bradley F; Silber, Michael H

2015-06-01

REM sleep behavior disorder (RBD) is associated with antidepressant treatment, especially in younger patients; but quantitative REM sleep without atonia (RSWA) analyses of psychiatric RBD patients remain limited. We analyzed RSWA in adults receiving antidepressants, with and without RBD. We comparatively analyzed visual, manual, and automated RSWA between RBD and control groups. RSWA metrics were compared between groups, and regression was used to explore associations with clinical variables. Tertiary-care sleep center. Participants included traditional RBD without antidepressant treatment (n = 30, 15 Parkinson disease [PD-RBD] and 15 idiopathic); psychiatric RBD receiving antidepressants (n = 30); and adults without RBD, including antidepressant-treated psychiatric (n = 30), untreated psychiatric (n = 15), and OSA (n = 60) controls. N/A. RSWA was highest in traditional and psychiatric RBD, intermediate in treated psychiatric controls, and lowest in untreated psychiatric and OSA controls (P < 0.01). RSWA distribution and type also differed between antidepressant-treated patients having higher values in anterior tibialis, and PD-RBD with higher submentalis and tonic RSWA. Psychiatric RBD had significantly younger age at onset than traditional RBD patients (P < 0.01). Antidepressant treatment was associated with elevated REM sleep without atonia (RSWA) even without REM sleep behavior disorder (RBD), suggesting that antidepressants, not depression, promote RSWA. Differences in RSWA distribution and type were also seen, with higher anterior tibialis RSWA in antidepressant-treated patients and higher tonic RSWA in Parkinson disease-RBD patients, which could aid distinction between RBD subtypes. These findings suggest that antidepressants may mediate different RSWA mechanisms or, alternatively, that RSWA type and distribution evolve during progressive neurodegeneration. Further prospective RSWA analyses are necessary to clarify the relationships between antidepressant treatment, psychiatric disease, and RBD. © 2015 Associated Professional Sleep Societies, LLC.

Surface electromyography and plantar pressure during walking in young adults with chronic ankle instability.

PubMed

Koldenhoven, Rachel M; Feger, Mark A; Fraser, John J; Saliba, Susan; Hertel, Jay

2016-04-01

Lateral ankle sprains are common and can manifest into chronic ankle instability (CAI) resulting in altered gait mechanics that may lead to subsequent ankle sprains. Our purpose was to simultaneously analyse muscle activation patterns and plantar pressure distribution during walking in young adults with and without CAI. Seventeen CAI and 17 healthy subjects walked on a treadmill at 4.8 km/h. Plantar pressure measures (pressure-time integral, peak pressure, time to peak pressure, contact area, contact time) of the entire foot and nine specific foot regions and medial-lateral location of centre of pressure (COP) were measured. Surface electromyography (EMG) root mean square (RMS) amplitudes throughout the entire stride cycle and area under RMS curve for 100 ms pre-initial contact (IC) and 200 ms post-IC for anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius were collected. The CAI group demonstrated a more lateral COP throughout the stance phase (P < 0.001 and Cohen's d > 0.9 for all 10 comparisons) and significantly increased peak pressure (P = 0.025) and pressure-time integral (P = 0.049) under the lateral forefoot. The CAI group had lower anterior tibialis RMS areas (P < 0.001) and significantly higher peroneus longus, medial gastrocnemius, and gluteus medius RMS areas during 100 ms pre-IC (P < 0.003). The CAI group had higher gluteus medius sEMG amplitudes during the final 50 % of stance and first 25% of swing (P < 0.05). The CAI group had large lateral deviations of their COP location throughout the entire stance phase and increased gluteus medius muscle activation amplitude during late stance through early swing phase. III.

Neuromuscular Responses of Elite Skaters During Different Roller Figure Skating Jumps

PubMed Central

Pantoja, Patrícia Dias; Mello, André; Liedtke, Giane Veiga; Kanitz, Ana Carolina; Cadore, Eduardo Lusa; Pinto, Stephanie Santana; Alberton, Cristine Lima; Kruel, Luiz Fernando Martins

2014-01-01

This study aimed to describe the neuromuscular activity of elite athletes who performed various roller figure skating jumps, to determine whether the muscle activation is greater during jumps with more rotations and in which phase the muscles are more active. This study also aimed to analyze if there is any difference in the muscle activity pattern between female and male skaters. Four elite skaters were evaluated, and each participated in two experimental sessions. During the first session, anthropometric data were collected, and the consent forms were signed. For the second session, neuromuscular data were collected during jumps, which were performed with skates at a rink. The following four roller figure skating jumps were evaluated: single Axel, double Axel, double Mapes and triple Mapes. The neuromuscular activity of the following seven muscles was obtained with an electromyograph which was fixed to the waist of each skater with a strap: biceps femoris, lateral gastrocnemius, tibialis anterior, rectus femoris, vastus lateralis, vastus medialis and gluteus maximus. The signal was transmitted wirelessly to a laptop. During the roller figure skating jumps, the lateral gastrocnemius, rectus femoris, vastus lateralis, biceps femoris and gluteus maximus, showed more activation during the jumps with more rotations, and the activation mainly occurred during the propulsion and flight phases. Female skaters demonstrated higher muscle activities in tibialis anterior, vastus lateralis, vastus medialis and gluteus maximus during the landing phase of the triple Mapes, when compared to their male counterparts. The results obtained in this study should be considered when planning training programs with specific exercises that closely resemble the roller figure skating jumps. This may be important for the success of elite skaters in competitions. PMID:25114728

Cardiovascular regulation during head-up tilt in healthy 20-30-year-old and 70-75-year-old men.

PubMed

Gabbett, T J; Weston, S B; Barrett, R S; Gass, G C

2001-02-01

This study compared the heart rate, finger arterial pressure (AP) and electromyographic (EMG) activity of selected anti-gravity muscles during the initial and prolonged phases of orthostatic stress in healthy young and older men. Beat-by-beat recordings of heart rate, finger systolic pressure, diastolic pressure and mean AP were made during supine rest and 5 min of 90 degrees head-up tilt (HUT) in 18 young (23+/-1 years) and 15 older (73+/-1 years) men. The EMG activity of the soleus, tibialis anterior and vastus medialis muscles was recorded. During the first 30 s following 90 degrees HUT (immediate response), the young men exhibited significant (P<0.05) decreases in finger systolic pressure, diastolic pressure and mean AP, followed by a sustained increase in finger AP during the 5 min following 90 degrees HUT (prolonged response). The immediate and prolonged finger AP and diastolic pressure responses were not significantly different (P>0.05) from the values at supine rest for the older men. The mean root mean square EMG activity of the soleus, tibialis anterior and vastus medialis muscles during 90 degrees HUT was not significantly different (P>0.05) from that at supine rest for either group. These results demonstrate that, when compared with healthy older men, young men show larger reductions in finger AP during the initial phase of orthostatic stress. However, during the prolonged phase of orthostatic stress, older men maintain resting finger AP, whereas young men demonstrate a reflex overshoot in finger AP. Finally, differences in lower-limb anti-gravity muscle activation do not account for the contrasting finger AP responses of healthy young and older men.

Effects of spinal cord injury-induced changes in muscle activation on foot drag in a computational rat ankle model

PubMed Central

Hillen, Brian K.; Jindrich, Devin L.; Abbas, James J.; Yamaguchi, Gary T.

2015-01-01

Spinal cord injury (SCI) can lead to changes in muscle activation patterns and atrophy of affected muscles. Moderate levels of SCI are typically associated with foot drag during the swing phase of locomotion. Foot drag is often used to assess locomotor recovery, but the causes remain unclear. We hypothesized that foot drag results from inappropriate muscle coordination preventing flexion at the stance-to-swing transition. To test this hypothesis and to assess the relative contributions of neural and muscular changes on foot drag, we developed a two-dimensional, one degree of freedom ankle musculoskeletal model with gastrocnemius and tibialis anterior muscles. Anatomical data collected from sham-injured and incomplete SCI (iSCI) female Long-Evans rats as well as physiological data from the literature were used to implement an open-loop muscle dynamics model. Muscle insertion point motion was calculated with imposed ankle trajectories from kinematic analysis of treadmill walking in sham-injured and iSCI animals. Relative gastrocnemius deactivation and tibialis anterior activation onset times were varied within physiologically relevant ranges based on simplified locomotor electromyogram profiles. No-atrophy and moderate muscle atrophy as well as normal and injured muscle activation profiles were also simulated. Positive moments coinciding with the transition from stance to swing phase were defined as foot swing and negative moments as foot drag. Whereas decreases in activation delay caused by delayed gastrocnemius deactivation promote foot drag, all other changes associated with iSCI facilitate foot swing. Our results suggest that even small changes in the ability to precisely deactivate the gastrocnemius could result in foot drag after iSCI. PMID:25673734

Structure of cortical cytoskeleton in fibers of mouse muscle cells after being exposed to a 30-day space flight on board the BION-M1 biosatellite.

PubMed

Ogneva, I V; Maximova, M V; Larina, I M

2014-05-15

The aim of the work was to analyze changes in the organization of the cortical cytoskeleton in fibers of the mouse soleus muscle, tibialis anterior muscle and left ventricular cardiomyocytes after completion of a 30-day space flight on board the BION-M1 biosatellite (Russia, 2013). The transversal stiffness of the cortical cytoskeleton of the cardiomyocytes and fibers of the skeletal muscles did not differ significantly within the study groups compared with the vivarium control group. The content of beta- and gamma-actin in the membranous fraction of proteins in the left ventricular cardiomyocytes did not differ significantly within all study groups and correlated with the transversal stiffness. A similar situation was revealed in fibers of the soleus muscle and tibialis anterior muscle. At the same time, the content of beta-actin in the cytoplasmic fraction of proteins was found to be decreased in all types of studied tissues compared with the control levels in the postflight group, with lowered beta-actin gene expression rates in the postflight group. After completion of the space flight, the content of alpha-actinin-4 was found to be reduced in the membranous fraction of proteins from the mouse cardiomyocytes, while its content in the cytoplasmic fraction of proteins did not change significantly. Furthermore, gene expression rates of this protein were decreased at the time of dissection (it was started after 13 h after landing). At the same time, the content of alpha-actinin-1 decreased in the membranous fraction and increased in the cytoplasmic fraction of proteins from the soleus muscle fibers. Copyright © 2014 the American Physiological Society.

Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: A preliminary clinical trial.

PubMed

Téllez-García, Mario; de-la-Llave-Rincón, Ana I; Salom-Moreno, Jaime; Palacios-Ceña, Maria; Ortega-Santiago, Ricardo; Fernández-de-Las-Peñas, César

2015-07-01

The objective of the current study was to determine the short-term effects of trigger point dry needling (TrP-DN) alone or combined with neuroscience education on pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical low back pain (LBP). Twelve patients with LBP were randomly assigned to receive either TrP-DN (TrP-DN) or TrP-DN plus neuroscience education (TrP-DN + EDU). Pain intensity (Numerical Pain Rating Scale, 0-10), disability (Roland-Morris Disability Questionnaire-RMQ-, Oswestry Low Back Pain Disability Index-ODI), kinesiophobia (Tampa Scale of Kinesiophobia-TSK), and pressure pain thresholds (PPT) over the C5-C6 zygapophyseal joint, transverse process of L3 vertebra, second metacarpal, and tibialis anterior muscle were collected at baseline and 1-week after the intervention. Patients treated with TrP-DN + EDU experienced a significantly greater reduction of kinesiophobia (P = 0.008) and greater increases in PPT over the transverse process of L3 (P = 0.049) than those patients treated only with TrP-DN. Both groups experienced similar decreases in pain, ODI and RMQ, and similar increases in PPT over the C5/C6 joint, second metacarpal, and tibialis anterior after the intervention (all, P > 0.05). The results suggest that TrP-DN was effective for improving pain, disability, kinesiophobia and widespread pressure sensitivity in patients with mechanical LBP at short-term. The inclusion of a neuroscience educational program resulted in a greater improvement in kinesiophobia. Copyright © 2014 Elsevier Ltd. All rights reserved.

Adults with patellofemoral pain do not exhibit manifestations of peripheral and central sensitization when compared to healthy pain-free age and sex matched controls – An assessor blinded cross-sectional study

PubMed Central

Rathleff, Camilla Rams; Stephenson, Aoife; Mellor, Rebecca; Matthews, Mark; Crossley, Kay; Vicenzino, Bill

2017-01-01

Patellofemoral Pain (PFP) is highly prevalent among adults and adolescents. Localized mechanical hyperalgesia around the knee and tibialis anterior have been observed in people with PFP, but limited knowledge of potential manifestations of central sensitisation exists. The aims of this study were to study conditioned pain modulation (CPM) and wide-spread hyperalgesia in adults with PFP. This assessor-blinded cross-sectional study design compared CPM and mechanical pressure pain thresholds (PPT) between 33 adults (23 females) diagnosed with PFP and 32 age and sex matched pain-free controls. The investigator taking the PPT measurements was blinded to which participants had PFP. PPTs were reliably measured using a Somedic hand-held pressure algometer at three sites: 1) The centre of the patella, 2) the tibialis anterior muscle and 3) a remote site on the lateral epicondyle. For the assessment of CPM, experimental pain was induced to the contralateral hand by immersion into a cold water bath (conditioning stimulus), and assessment of PPTs (the test stimulus) was performed before and immediately after the conditioning stimulation. On average, the CPM paradigm induced a significant increase in PPTs across the three sites (6.3–13.5%, P<0.05), however there was no difference in CPM between young adults with PFP compared to the control group, (F(1,189) = 0.39, P = 0.89). There was no difference in mechanical PPTs between the two groups (F(1,189) = 0.03, P = 0.86). Contrary to our a-priori hypothesis, we found no difference in CPM or PPT between young adults with PFP and age and sex matched pain-free controls. PMID:29220355

Modulation of plantar pressure and gastrocnemius activity during gait using electrical stimulation of the tibialis anterior in healthy adults

PubMed Central

Ueno, Mizuki; Yoshikawa, Yoshiyuki; Terashi, Hiroto; Fujino, Hidemi

2018-01-01

High plantar flexor moment during the stance phase is known to cause high plantar pressure under the forefoot; however, the effects on plantar pressure due to a change of gastrocnemius medialis (GM) activity during gait, have not been investigated to date. Reciprocal inhibition is one of the effects of electrical stimulation (ES), and is the automatic antagonist alpha motor neuron inhibition which is evoked by excitation of the agonist muscle. The aim of this study was to investigate the influences of ES of the tibialis anterior (TA) on plantar pressure and the GM activity during gait in healthy adults. ES was applied to the TAs of twenty healthy male adults for 30 minutes at the level of intensity that causes a full range of dorsiflexion in the ankle (frequency; 50 Hz, on-time; 10 sec, off-time; 10 sec). Subjects walked 10 meters before and after ES, and we measured the peak plantar pressure (PP), pressure time integral (PTI), and gait parameters by using an F-scan system. The percentage of integrated electromyogram (%IEMG), active time, onset time, peak time, and cessation time of TA and GM were calculated. PP and PTI under the forefoot, rear foot, and total plantar surface significantly decreased after the application of ES. Meanwhile, changes of gait parameters were not observed. %IEMG and the active time of both muscles did not change; however, onset time and peak time of GM became significantly delayed. ES application to the TA delayed the timing of onset and peak in the GM, and caused the decrease of plantar pressure during gait. The present results suggest that ES to the TA could become a new method for the control of plantar pressure via modulation of GM activity during gait. PMID:29746498

Fatigue-induced changes in group IV muscle afferent activity: differences between high- and low-frequency electrically induced fatigues.

PubMed

Darques, J L; Jammes, Y

1997-03-07

Recordings of group IV afferent activity of tibialis anterior muscle were performed in paralysed rabbits during runs of electrically induced fatigue produced by direct muscle stimulation at a high (100 Hz, high-frequency fatigue HFF) or a low rate (10 Hz, low-frequency fatigue LFF). In addition to analysis of afferent nerve action potentials, muscle force and compound muscle action potentials (M waves) elicited by direct muscle stimulation with single shocks were recorded. Changes in M wave configuration were used as an index of the altered propagation of membrane potentials and the associated efflux of potassium from muscle fibers. The data show that increased group IV afferent activity occurred during LFF as well as HFF trials and developed parallel with force failure. Enhanced afferent activity was significantly higher during LFF (maximal delta f(impulses) = 249 +/- 35%) than HFF (147 +/- 45%). No correlation was obtained between the responses of group IV afferents to LFF or to pressure exerted on tibialis anterior muscle. On the other hand, decreased M wave amplitude was minimal with LFF while it was pronounced with HFF. Close correlations were found between fatigue-induced activation of group IV afferents and decreases in force or M wave amplitude, but their strength was significantly higher with LFF compared to HFF. Thus, electrically induced fatigue activates group IV muscle afferents with a prominent effect of low-frequency stimulation. The mechanism of muscle afferent stimulation does not seem to be due to the sole increase in extracellular potassium concentration, but also by the efflux of muscle metabolites, present during fatiguing contractions at low rate of stimulation.

Mechanisms of topical analgesics in relieving pain in an animal model of muscular inflammation.

PubMed

Duan, Wan-Ru; Lu, Jie; Xie, Yi-Kuan

2013-09-01

To investigate the possible mechanisms of topical analgesics in relieving pain in an animal model of muscular inflammation. Adult Sprague-Dawley rats of both sexes were injected with complete Freund's adjuvant to induce inflammation in the anterior tibialis muscle of left hindlimb. One of two types of topical analgesics: Xiaotong Tiegao (XTT), a Tibetan herb compound, or Capzasin (CAP), a cream containing 0.1% capsaicin, was applied to the skin over the inflamed anterior tibialis muscle. The following experiments were performed: pain behavioral tests, evaluation of plasma extravasation in the affected limb, and electrophysiological recordings of afferent nerve fibers. The behavioral experiments demonstrated that applications of either type of topical analgesic to the skin over the inflamed muscle significantly reduced muscular inflammatory pain, as indicated by the increased weight bearing capacity on the affected hindlimb (with latencies of 10 minutes for XTT and 1-2 hours for CAP). Meanwhile, both analgesics caused plasma extravasation in the affected skin. Electrophysiological recordings from the afferent fibers in the related cutaneous nerve indicated that topical analgesics selectively activated C-fibers, but not A-fibers innervating the same region of receptive field. The latency and duration of C-fiber activation was similar to those of the reduction of muscular inflammatory pain. On the contrary, topical analgesics substantially decreased C-fiber afferent spontaneous firing in the nerve innervating the inflamed muscle. Moreover, denervation of the affected skin blocked the analgesic effects of both topical analgesics in muscular inflammatory pain. This study suggests that topical analgesics may reduce the nociceptive input from inflamed muscles via a reflex mechanism by activating the cutaneous nociceptive afferents. Wiley Periodicals, Inc.

Selective reinnervation: a comparison of recovery following microsuture and conduit nerve repair.

PubMed

Evans, P J; Bain, J R; Mackinnon, S E; Makino, A P; Hunter, D A

1991-09-20

Selective reinnervation was studied by comparing the regeneration across a conventional neurorraphy versus a conduit nerve repair. Lewis rats underwent right sciatic nerve transection followed by one of four different nerve repairs (n = 8/group). In groups I and II a conventional neurorraphy was performed and in groups III and IV the proximal and distal stumps were coapted by use of a silicone conduit with an interstump gap of 5 mm. The proximal and distal stumps in groups I and III were aligned anatomically correct and the proximal stump was rotated 180 degrees in groups II and IV (i.e. proximal peroneal nerve opposite the distal tibial nerve and the proximal tibial nerve opposite the distal peroneal nerve). By 14 weeks, there was an equivalent, but incomplete return in sciatic function index (SFI) in groups I, III, and IV as measured by walking track analysis. However, the SFI became unmeasurable by 6 weeks in all group II animals. At 14 weeks, the percent innervation of the tibialis anterior and medial gastronemius muscles by the peroneal and tibial nerves respectively was estimated by selective compound muscle action potential amplitude recordings. When fascicular alignment was reversed, there was greater tibial (P = 0.02) and lesser peroneal (P = 0.005) innervation of the gastrocnemius muscle in the conduit (group IV) versus the neurorraphy (group II) group. This suggests that the gastrocnemius muscle may be selectively reinnervated by the tibial nerve. However, there was no evidence of selective reinnervation of the tibialis anterior muscle. Despite these differences, the functional recovery in both conduit repair groups (III and IV) was equivalent to a correctly aligned microsuture repair (group I) and superior to that in the incorrectly aligned microsuture repair (group II).

Skeletal muscle morphology and contractile function in relation to muscle denervation in diabetic neuropathy

PubMed Central

Major, Brendan; Kimpinski, Kurt; Doherty, Timothy J.; Rice, Charles L.

2013-01-01

The objective of the study was to assess the effects of diabetic polyneuropathy (DPN) on muscle contractile properties in humans, and how these changes are related to alterations in muscle morphology and denervation. Patients with DPN (n = 12) were compared with age- and sex-matched controls (n = 12). Evoked and voluntary contractile properties, including stimulated twitch responses and maximal voluntary contractions, of the dorsiflexor muscles were assessed using an isometric ankle dynamometer. Motor unit number estimates (MUNE) of the tibialis anterior (TA) were performed via quantitative electromyography and decomposition-enhanced spike-triggered averaging. Peak tibialis anterior (TA) cross-sectional area (CSA; cm2), and relative proportion of contractile to noncontractile tissue (%) was determined from magnetic resonance images. Patients with DPN demonstrated decreased strength (−35%) and slower (−45%) dorsiflexion contractile properties for both evoked and voluntary contractions (P < 0.05). These findings were not accounted for by differences in voluntary activation (P > 0.05) or antagonist coactivation (P > 0.05). Additionally, patients with DPN were weaker when strength was normalized to TA total CSA (−30%; P < 0.05) or contractile tissue CSA (−26%; P < 0.05). In the DPN patient group, TA MUNEs were negatively related to both % noncontractile tissue (P < 0.05; r = 0.72) and twitch half-relaxation time (P < 0.05; r = 0.60), whereas no relationships were found between these variables in controls (P > 0.05). We conclude that patients with DPN demonstrated reduced strength and muscle quality as well as contractile slowing. This process may contribute to muscle power loss and functional impairments reported in patients with DPN, beyond the loss of strength commonly observed. PMID:24356519

Low-Level Laser Therapy (808 nm) Reduces Inflammatory Response and Oxidative Stress in Rat Tibialis Anterior Muscle After Cryolesion

PubMed Central

Assis, Lívia; Moretti, Ana I.S.; Abrahão, Thalita B.; Cury, Vivian; Souza, Heraldo P.; Hamblin, Michael R.; Parizotto, Nivaldo A.

2012-01-01

Background and Objective Muscle regeneration is a complex phenomenon, involving coordinated activation of several cellular responses. During this process, oxidative stress and consequent tissue damage occur with a severity that may depend on the intensity and duration of the inflammatory response. Among the therapeutic approaches to attenuate inflammation and increase tissue repair, low-level laser therapy (LLLT) may be a safe and effective clinical procedure. The aim of this study was to evaluate the effects of LLLT on oxidative/nitrative stress and inflammatory mediators produced during a cryolesion of the tibialis anterior (TA) muscle in rats. Material and Methods Sixty Wistar rats were randomly divided into three groups (n = 20): control (BC), injured TA muscle without LLLT (IC), injured TA muscle submitted to LLLT (IRI). The injured region was irradiated daily for 4 consecutive days, starting immediately after the lesion using a AlGaAs laser (continuous wave, 808 nm, tip area of 0.00785 cm2, power 30 mW, application time 47 seconds, fluence 180 J/cm2; 3.8 mW/cm2; and total energy 1.4 J). The animals were sacrificed on the fourth day after injury. Results LLLT reduced oxidative and nitrative stress in injured muscle, decreased lipid peroxidation, nitrotyrosine formation and NO production, probably due to reduction in iNOS protein expression. Moreover, LLLT increased SOD gene expression, and decreased the inflammatory response as measured by gene expression of NF-kβ and COX-2 and by TNF-α and IL-1β concentration. Conclusion These results suggest that LLLT could be an effective therapeutic approach to modulate oxidative and nitrative stress and to reduce inflammation in injured muscle. PMID:23001637

Multiple pathological events in exercised dystrophic mdx mice are targeted by pentoxifylline: outcome of a large array of in vivo and ex vivo tests.

PubMed

Burdi, Rosa; Rolland, Jean-François; Fraysse, Bodvael; Litvinova, Karina; Cozzoli, Anna; Giannuzzi, Viviana; Liantonio, Antonella; Camerino, Giulia Maria; Sblendorio, Valeriana; Capogrosso, Roberta Francesca; Palmieri, Beniamino; Andreetta, Francesca; Confalonieri, Paolo; De Benedictis, Leonarda; Montagnani, Monica; De Luca, Annamaria

2009-04-01

The phosphodiesterases inhibitor pentoxifylline gained attention for Duchenne muscular dystrophy therapy for its claimed anti-inflammatory, antioxidant, and antifibrotic action. A recent finding also showed that pentoxifylline counteracts the abnormal overactivity of a voltage-independent calcium channel in myofibers of dystrophic mdx mice. The possible link between workload, altered calcium homeostasis, and oxidative stress pushed toward a more detailed investigation. Thus a 4- to 8-wk treatment with pentoxifylline (50 mg x kg(-1) x day(-1) ip) was performed in mdx mice, undergoing or not a chronic exercise on treadmill. In vivo, the treatment partially increased forelimb strength and enhanced resistance to treadmill running in exercised animals. Ex vivo, pentoxifylline restored the mechanical threshold, an electrophysiological index of calcium homeostasis, and reduced resting cytosolic calcium in extensor digitorum longus muscle fibers. Mn quenching and patch-clamp technique confirmed that this effect was paralleled by a drug-induced reduction of membrane permeability to calcium. The treatment also significantly enhanced isometric tetanic tension in mdx diaphragm. The plasma levels of creatine kinase and reactive oxygen species were both significantly reduced in treated-exercised animals. Dihydroethidium staining, used as an indicator of reactive oxygen species production, showed that pentoxifylline significantly reduced the exercise-induced increase in fluorescence in the mdx tibialis anterior muscle. A significant decrease in connective tissue area and profibrotic cytokine transforming growth factor-beta(1) was solely found in tibialis anterior muscle. In both diaphragm and gastrocnemius muscle, a significant increase in neural cell adhesion molecule-positive area was instead observed. This data supports the interest toward pentoxifylline and allows insight in the level of cross talk between pathogenetic events in workloaded dystrophic muscle.

Extracorporeal circulation as a new experimental pathway for myoblast implantation in mdx mice.

PubMed

Torrente, Y; D'Angelo, M G; Del Bo, R; DeLiso, A; Casati, R; Benti, R; Corti, S; Comi, G P; Gerundini, P; Anichini, A; Scarlato, G; Bresolin, N

1999-01-01

The deficiency of dystrophin, a sarcolemmal associated protein, is responsible for Duchenne muscular dystrophy (DMD). Gene replacement is attractive as a potential therapy. In this article, we describe a new method for myoblast transplantation and expression of dystrophin in skeletal muscle tissue of dystrophin-deficient mdx mouse through iliac vessels extracorporeal circulation. We evaluated the extracorporeal circulation as an alternative route of delivering myoblasts to the target tissue. Two series of experiments were performed with the extracorporeal circulation. In a first series, L6 rat myoblasts, transfected with LacZ reporter gene, were perfused in limbs of 15 rats. In the second series, the muscle limbs of three 6-8-week-old mdx were perfused with myoblasts of donor C57BL10J mice. Before these perfusions, the right tibialis anterior (TA) muscle of the rats and mdx was injected three times at several sites with bupivacaine (BPVC) and hyaluronidase. The ability of injected cells to migrate in the host tissue was assessed in rats by technetium-99m cell labeling. No radioactivity was detected in the lungs, bowels, and liver of animals treated with extracorporeal circulation. The tissue integration and viability of the myoblasts were ultimately confirmed by genetic and histochemical analysis of LacZ reporter gene. Following a single extracorporeal perfusion of myoblasts from donor C57BL10J, sarcolemmal expression of dystrophin was observed in clusters of myofibers in tibialis anterior muscles previously treated with BPVC and hyaluronidase. Furthermore, large clusters of dystrophin-positive fibers were observed in muscles up to 21 days after repeated treatments. These clusters represented an average of 4.2% of the total muscle fibers. These results demonstrate that the extracorporeal circulation allows selective myoblast-mediated gene transfer to muscles, opening new perspectives in muscular dystrophy gene therapy.

Changes in serum enzyme activities after injection of bupivacaine into rat tibialis anterior.

PubMed

Nosaka, K

1996-08-01

This study investigated the time course of changes in serum creatine kinase (CK), aspartate aminotransferase (AST), and alanine amino-transferase (ALT) activities after intramuscular injection of bupivacaine into the tibialis anterior (TA) of rats. Morphological changes in muscle cells, relationships between the amount of increase in the enzyme activities and the muscle mass damaged, and responses of serum enzymes to additional injections of bupivacaine hydrochloride (BPVC) were also examined. Adult male Wistar rats (24 wk) were placed into one of four groups. Group A (n = 7) was a control, and no injection was applied. Saline solution (0.5 ml of 0.9%) was injected into the right TA for group B (n = 5). BPVC (0.5 ml of 0.5%) was injected into the right TA for group C (n = 9) and into both the right and left TA for group D (n = 9). No increases in CK, AST, and ALT were observed for groups A and B. After BPVC injection, groups C and D showed significant (P < 0.01) increases in serum enzyme activities. CK peaked 4 h after BPVC injection, and AST and ALT peaked 12 h postinjection, then returned to the baseline by the time infiltration of mononuclear cells into the damaged muscle cells progressed. The amount of enzyme increase was significantly larger (P < 0.01) for group D compared with group C. Injection of BPVC into the right then into the left TA 4 h later displayed a bipolar response, and the second injection into the TA 12 wk after the first injection resulted in smaller increase in serum enzyme activities. It appeared that increases in serum enzyme activities reflected muscle damage; however, changes in enzymes occurred in the early stage of myonecrosis.

Histomorphometric analysis of the response of rat skeletal muscle to swimming, immobilization and rehabilitation.

PubMed

Nascimento, C C F; Padula, N; Milani, J G P O; Shimano, A C; Martinez, E Z; Mattiello-Sverzut, A C

2008-09-01

The objective of the present study was to determine to what extent, if any, swimming training applied before immobilization in a cast interferes with the rehabilitation process in rat muscles. Female Wistar rats, mean weight 260.52 +/- 16.26 g, were divided into 4 groups of 6 rats each: control, 6 weeks under baseline conditions; trained, swimming training for 6 weeks; trained-immobilized, swimming training for 6 weeks and then immobilized for 1 week; trained-immobilized-rehabilitated, swimming training for 6 weeks, immobilized for 1 week and then remobilized with swimming for 2 weeks. The animals were then sacrificed and the soleus and tibialis anterior muscles were dissected, frozen in liquid nitrogen and processed histochemically (H&E and mATPase). Data were analyzed statistically by the mixed effects linear model (P < 0.05). Cytoarchitectural changes such as degenerative characteristics in the immobilized group and regenerative characteristics such as centralized nucleus, fiber size variation and cell fragmentation in the groups submitted to swimming were more significant in the soleus muscle. The diameters of the lesser soleus type 1 and type 2A fibers were significantly reduced in the trained-immobilized group compared to the trained group (P < 0.001). In the tibialis anterior, there was an increase in the number of type 2B fibers and a reduction in type 2A fibers when trained-immobilized rats were compared to trained rats (P < 0.001). In trained-immobilized-rehabilitated rats, there was a reduction in type 2B fibers and an increase in type 2A fibers compared to trained-immobilized rats (P < 0.009). We concluded that swimming training did not minimize the deleterious effects of immobilization on the muscles studied and that remobilization did not favor tissue re-adaptation.

Dynamic characteristics of T2*-weighted signal in calf muscles of peripheral artery disease during low-intensity exercise.

PubMed

Li, Zhijun; Muller, Matthew D; Wang, Jianli; Sica, Christopher T; Karunanayaka, Prasanna; Sinoway, Lawrence I; Yang, Qing X

2017-07-01

To evaluate the dynamic characteristics of T2* -weighted signal change in exercising skeletal muscle of healthy subjects and peripheral artery disease (PAD) patients under a low-intensity exercise paradigm. Nine PAD patients and nine age- and sex-matched healthy volunteers underwent a low-intensity exercise paradigm while magnetic resonance imaging (MRI) (3.0T) was obtained. T2*-weighted signal time-courses in lateral gastrocnemius, medial gastrocnemius, soleus, and tibialis anterior were acquired and analyzed. Correlations were performed between dynamic T2*-weighted signal and changes in heart rate, mean arterial pressure, leg pain, and perceived exertion. A significant signal decrease was observed during exercise in soleus and tibialis anterior of healthy participants (P = 0.0007-0.04 and 0.001-0.009, respectively). In PAD, negative signals were observed (P = 0.008-0.02 and 0.003-0.01, respectively) in soleus and lateral gastrocnemius during the early exercise stage. Then the signal gradually increased above the baseline in the lateral gastrocnemius during and after exercise in six of the eight patients who completed the study. This signal increase in patients' lateral gastrocnemius was significantly greater than in healthy subjects' during the later exercise stage (two-sample t-tests, P = 0.001-0.03). Heart rate and mean arterial pressure responses to exercise were significantly higher in PAD than healthy subjects (P = 0.036 and 0.008, respectively) and the patients experienced greater leg pain and exertion (P = 0.006 and P = 0.0014, respectively). During low-intensity exercise, there were different dynamic T2*-weighted signal behavior in the healthy and PAD exercising muscles. 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:40-48. © 2016 International Society for Magnetic Resonance in Medicine.

Selective modification of the pyruvate dehydrogenase kinase isoform profile in skeletal muscle in hyperthyroidism: implications for the regulatory impact of glucose on fatty acid oxidation.

PubMed

Sugden, M C; Lall, H S; Harris, R A; Holness, M J

2000-11-01

The pyruvate dehydrogenase kinases (PDK1-4) regulate glucose oxidation through inhibitory phosphorylation of the pyruvate dehydrogenase complex (PDC). Immunoblot analysis with antibodies raised against recombinant PDK isoforms demonstrated changes in PDK isoform expression in response to experimental hyperthyroidism (100 microg/100 g body weight; 3 days) that was selective for fast-twitch vs slow-twitch skeletal muscle in that PDK2 expression was increased in the fast-twitch skeletal muscle (the anterior tibialis) (by 1. 6-fold; P<0.05) but not in the slow-twitch muscle (the soleus). PDK4 protein expression was increased by experimental hyperthyroidism in both muscle types, there being a greater response in the anterior tibialis (4.2-fold increase; P<0.05) than in the soleus (3.2-fold increase; P<0.05). The hyperthyroidism-associated up-regulation of PDK4 expression was observed in conjunction with suppression of skeletal-muscle PDC activity, but not suppression of glucose uptake/phosphorylation, as measured in vivo in conscious unrestrained rats (using the 2-[(3)H]deoxyglucose technique). We propose that increased PDK isoform expression contributes to the pathology of hyperthyroidism and to PDC inactivation by facilitating the operation of the glucose --> lactate --> glucose (Cori) and glucose --> alanine --> glucose cycles. We also propose that enhanced relative expression of the pyruvate-insensitive PDK isoform (PDK4) in skeletal muscle in hyperthyroidism uncouples glycolytic flux from pyruvate oxidation, sparing pyruvate for non-oxidative entry into the tricarboxylic acid (TCA) cycle, and thereby supporting entry of acetyl-CoA (derived from fatty acid oxidation) into the TCA cycle.

Effects of spinal cord injury-induced changes in muscle activation on foot drag in a computational rat ankle model.

PubMed

Hillen, Brian K; Jindrich, Devin L; Abbas, James J; Yamaguchi, Gary T; Jung, Ranu

2015-04-01

Spinal cord injury (SCI) can lead to changes in muscle activation patterns and atrophy of affected muscles. Moderate levels of SCI are typically associated with foot drag during the swing phase of locomotion. Foot drag is often used to assess locomotor recovery, but the causes remain unclear. We hypothesized that foot drag results from inappropriate muscle coordination preventing flexion at the stance-to-swing transition. To test this hypothesis and to assess the relative contributions of neural and muscular changes on foot drag, we developed a two-dimensional, one degree of freedom ankle musculoskeletal model with gastrocnemius and tibialis anterior muscles. Anatomical data collected from sham-injured and incomplete SCI (iSCI) female Long-Evans rats as well as physiological data from the literature were used to implement an open-loop muscle dynamics model. Muscle insertion point motion was calculated with imposed ankle trajectories from kinematic analysis of treadmill walking in sham-injured and iSCI animals. Relative gastrocnemius deactivation and tibialis anterior activation onset times were varied within physiologically relevant ranges based on simplified locomotor electromyogram profiles. No-atrophy and moderate muscle atrophy as well as normal and injured muscle activation profiles were also simulated. Positive moments coinciding with the transition from stance to swing phase were defined as foot swing and negative moments as foot drag. Whereas decreases in activation delay caused by delayed gastrocnemius deactivation promote foot drag, all other changes associated with iSCI facilitate foot swing. Our results suggest that even small changes in the ability to precisely deactivate the gastrocnemius could result in foot drag after iSCI. Copyright © 2015 the American Physiological Society.

Effects of two types of foot orthoses on lower limb muscle activity before and after a one-month period of wear.

PubMed

Moisan, Gabriel; Cantin, Vincent

2016-05-01

The purpose of this study was to quantify the effects of two types of foot orthoses (FOs) on muscle activity during walking. Twenty-one healthy participants were recruited to walk on a five-meter walkway with a control condition (no FOs) and two experimental conditions (FOs and FOs with lateral bar). The experimental protocol was performed before and after a one-month period of wear for each experimental condition. Electromyographic signals were recorded for six muscles (gluteus medius, vastus lateralis, medial gastrocnemius, lateral gastrocnemius, peroneus longus and tibialis anterior). Mean muscle activity was analyzed during the contact, the combined midstance/terminal stance and the pre-swing phases of gait. Peak amplitude and time to peak amplitude were quantified during the stance phase. Unacceptable level of variability was observed between the testing sessions. Therefore, no comparisons were performed to compare the effects of the experimental conditions between testing sessions. After a one-month period of wear, FOs with lateral bar decreased peak amplitude and mean activity of the peroneus longus muscle during the combined midstance/terminal stance phase and FOs decreased peak amplitude and mean activity of the tibialis anterior muscle during the contact phase compared to a control condition. In conclusion, repeated-test design should be used with caution when assessing the muscular adaptation to the wear of FOs for a certain period of time. More studies are needed to determine if the decreased activity of the peroneus longus muscle could be of benefit to treat pathologies such as peroneal tendinopathy or lateral ankle instability. Copyright © 2016 Elsevier B.V. All rights reserved.

Cancer cachexia-induced muscle atrophy: evidence for alterations in microRNAs important for muscle size.

PubMed

Lee, David E; Brown, Jacob L; Rosa-Caldwell, Megan E; Blackwell, Thomas A; Perry, Richard A; Brown, Lemuel A; Khatri, Bhuwan; Seo, Dongwon; Bottje, Walter G; Washington, Tyrone A; Wiggs, Michael P; Kong, Byung-Whi; Greene, Nicholas P

2017-05-01

Muscle atrophy is a hallmark of cancer cachexia resulting in impaired function and quality of life and cachexia is the immediate cause of death for 20-40% of cancer patients. Multiple microRNAs (miRNAs) have been identified as being involved in muscle development and atrophy; however, less is known specifically on miRNAs in cancer cachexia. The purpose of this investigation was to examine the miRNA profile of skeletal muscle atrophy induced by cancer cachexia to uncover potential miRNAs involved with this catabolic condition. Phosphate-buffered saline (PBS) or Lewis lung carcinoma cells (LLC) were injected into C57BL/6J mice at 8 wk of age. LLC animals were allowed to develop tumors for 4 wk to induce cachexia. Tibialis anterior muscles were extracted and processed to isolate small RNAs, which were used for miRNA sequencing. Sequencing results were assembled with mature miRNAs, and functions of miRNAs were analyzed by Ingenuity Pathway Analysis. LLC animals developed tumors that contributed to significantly smaller tibialis anterior muscles (18.5%) and muscle cross-sectional area (40%) compared with PBS. We found 371 miRNAs to be present in the muscle above background levels. Of these, nine miRNAs were found to be differentially expressed. Significantly altered groups of miRNAs were categorized into primary functionalities including cancer, cell-to-cell signaling, and cellular development among others. Gene network analysis predicted specific alterations of factors contributing to muscle size including Akt, FOXO3, and others. These results create a foundation for future research into the sufficiency of targeting these genes to attenuate muscle loss in cancer cachexia. Copyright © 2017 the American Physiological Society.

Muscle MRS detects elevated PDE/ATP ratios prior to fatty infiltration in Becker muscular dystrophy.

PubMed

Wokke, B H; Hooijmans, M T; van den Bergen, J C; Webb, A G; Verschuuren, J J; Kan, H E

2014-11-01

Becker muscular dystrophy (BMD) is characterized by progressive muscle weakness. Muscles show structural changes (fatty infiltration, fibrosis) and metabolic changes, both of which can be assessed using MRI and MRS. It is unknown at what stage of the disease process metabolic changes arise and how this might vary for different metabolites. In this study we assessed metabolic changes in skeletal muscles of Becker patients, both with and without fatty infiltration, quantified via Dixon MRI and (31) P MRS. MRI and (31) P MRS scans were obtained from 25 Becker patients and 14 healthy controls using a 7 T MR scanner. Five lower-leg muscles were individually assessed for fat and muscle metabolite levels. In the peroneus, soleus and anterior tibialis muscles with non-increased fat levels, PDE/ATP ratios were higher (P < 0.02) compared with controls, whereas in all muscles with increased fat levels PDE/ATP ratios were higher compared with healthy controls (P ≤ 0.05). The Pi /ATP ratio in the peroneus muscles was higher in muscles with increased fat fractions (P = 0.005), and the PCr/ATP ratio was lower in the anterior tibialis muscles with increased fat fractions (P = 0.005). There were no other significant changes in metabolites, but an increase in tissue pH was found in all muscles of the total group of BMD patients in comparison with healthy controls (P < 0.05). These findings suggest that (31) P MRS can be used to detect early changes in individual muscles of BMD patients, which are present before the onset of fatty infiltration. Copyright © 2014 John Wiley & Sons, Ltd.

[Acupuncture combined with rehabilitation training for foot drop after stroke].

PubMed

Qi, Yujun; Shen, Juan

2016-07-12

To compare the clinical efficacy difference between acupuncture combined with rehabilitation and simple rehabilitation for foot drop after stroke. Ninety-eight patients were randomly divided into a combination group and a rehabilitation group, 49 cases in each one. Acupuncture and rehabilitation were used in the combination group. The acupoints were Yanglingquan (GB 34), Zusanli (ST 36), Guangming (GB 37), Xuanzhong (GB 39), Sanyinjiao (SP 6), etc., while rehabilitation included training for musculi hippicus strength and musculi triceps surae. Only the same rehabilitation was applied in the rehabilitation group. The treatment was given six times a week for continuous six weeks. Musculi hippicus force, shank triceps spasticity, toe flexion improvement and the maximum integral EMG (iEMG) of the musculi tibialis anterior and caput laterale musculi gastrocnemii were compared between the two groups,and the effects were evaluated. After treatment, the musculi hippicus force, iEMG of musculi tibialis anterior and caput laterale musculi gastrocnemii, the function scores of the lower limbs by Fugl-Meyer of the two groups were better than those before treatment (all P <0.05), with the better effect in the combination group (all P <0.05). And the scores of shank triceps tension were decreased in the two groups (both P <0.05), more apparently for the combination therapy ( P <0.05). The improvement rate of toe flexion of the combination group was 87.76% (43/49), which was obviously higher than 69.39% (34/49) of the rehabilitation group ( P <0.05). The cured rate of the combination group was 48.98%(24/49), and it was better than 28.57% (14/49) of the rehabilitation group ( P <0.05). Acupuncture combined with rehabilitation achieves better effect than simple rehabilitation for foot drop after stroke.

Low-level laser therapy (808 nm) reduces inflammatory response and oxidative stress in rat tibialis anterior muscle after cryolesion.

PubMed

Assis, Lívia; Moretti, Ana I S; Abrahão, Thalita B; Cury, Vivian; Souza, Heraldo P; Hamblin, Michael R; Parizotto, Nivaldo A

2012-11-01

Muscle regeneration is a complex phenomenon, involving coordinated activation of several cellular responses. During this process, oxidative stress and consequent tissue damage occur with a severity that may depend on the intensity and duration of the inflammatory response. Among the therapeutic approaches to attenuate inflammation and increase tissue repair, low-level laser therapy (LLLT) may be a safe and effective clinical procedure. The aim of this study was to evaluate the effects of LLLT on oxidative/nitrative stress and inflammatory mediators produced during a cryolesion of the tibialis anterior (TA) muscle in rats. Sixty Wistar rats were randomly divided into three groups (n = 20): control (BC), injured TA muscle without LLLT (IC), injured TA muscle submitted to LLLT (IRI). The injured region was irradiated daily for 4 consecutive days, starting immediately after the lesion using a AlGaAs laser (continuous wave, 808 nm, tip area of 0.00785 cm(2) , power 30 mW, application time 47 seconds, fluence 180 J/cm(2) ; 3.8 mW/cm(2) ; and total energy 1.4 J). The animals were sacrificed on the fourth day after injury. LLLT reduced oxidative and nitrative stress in injured muscle, decreased lipid peroxidation, nitrotyrosine formation and NO production, probably due to reduction in iNOS protein expression. Moreover, LLLT increased SOD gene expression, and decreased the inflammatory response as measured by gene expression of NF-kβ and COX-2 and by TNF-α and IL-1β concentration. These results suggest that LLLT could be an effective therapeutic approach to modulate oxidative and nitrative stress and to reduce inflammation in injured muscle. Copyright © 2012 Wiley Periodicals, Inc.

Distribution of muscle fibre conduction velocity for representative samples of motor units in the full recruitment range of the tibialis anterior muscle.

PubMed

Del Vecchio, A; Negro, F; Felici, F; Farina, D

2018-02-01

Motor units are recruited in an orderly manner according to the size of motor neurones. Moreover, because larger motor neurones innervate fibres with larger diameters than smaller motor neurones, motor units should be recruited orderly according to their conduction velocity (MUCV). Because of technical limitations, these relations have been previously tested either indirectly or in small motor unit samples that revealed weak associations between motor unit recruitment threshold (RT) and MUCV. Here, we analyse the relation between MUCV and RT for large samples of motor units. Ten healthy volunteers completed a series of isometric ankle dorsiflexions at forces up to 70% of the maximum. Multi-channel surface electromyographic signals recorded from the tibialis anterior muscle were decomposed into single motor unit action potentials, from which the corresponding motor unit RT, MUCV and action potential amplitude were estimated. Established relations between muscle fibre diameter and CV were used to estimate the fibre size. Within individual subjects, the distributions of MUCV and fibre diameters were unimodal and did not show distinct populations. MUCV was strongly correlated with RT (mean (SD) R 2  = 0.7 (0.09), P < 0.001; 406 motor units), which supported the hypothesis that fibre diameter is associated with RT. The results provide further evidence for the relations between motor neurone and muscle fibre properties for large samples of motor units. The proposed methodology for motor unit analysis has also the potential to open new perspectives in the study of chronic and acute neuromuscular adaptations to ageing, training and pathology. © 2017 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

[Desmin content and transversal stiffness of the left ventricle mouse cardiomyocytes and skeletal muscle fibers after a 30-day space flight on board "BION-M1" biosatellite].

PubMed

Ogneva, I V; Maximova, M V; Larina, I M

2014-01-01

The aim of this study was to determine the transversal stiffness of the cortical cytoskeleton and the cytoskeletal protein desmin content in the left ventricle cardiomyocytes, fibers of the mouse soleus and tibialis anterior muscle after a 30-day space flight on board the "BION-M1" biosatellite (Russia, 2013). The dissection was made after 13-16.5 h after landing. The transversal stiffness was measured in relaxed and calcium activated state by, atomic force microscopy. The desmin content was estimated by western blotting, and the expression level of desmin-coding gene was detected using real-time PCR. The results indicate that, the transversal stiffness of the left ventricle cardiomyocytes and fibers of the soleus muscle in relaxed and activated states did not differ from the control. The transversal stiffness of the tibialis muscle fibers in relaxed and activated state was increased in the mice group after space flight. At the same time, in all types of studied tissues the desmin content and the expression level of desmin-coding gene did not differ from the control level.

Examination of a biodegradable magnesium screw for the reconstruction of the anterior cruciate ligament: A pilot in vivo study in rabbits.

PubMed

Diekmann, Julia; Bauer, Sylvie; Weizbauer, Andreas; Willbold, Elmar; Windhagen, Henning; Helmecke, Patrick; Lucas, Arne; Reifenrath, Janin; Nolte, Ingo; Ezechieli, Marco

2016-02-01

The reconstruction of the anterior cruciate ligament is, for the most part, currently performed with interference screws made of titanium or degradable polymers. The aim of this study was to investigate the use of biodegradable magnesium interference screws for such a procedure because of their known biocompatibility and reported osteoconductive effects. The left tibiae of each of 18 rabbits were implanted with a magnesium-based (MgYREZr-alloy) screw, and another 18 with a titanium-based control. Each group was divided into observation periods of 4, 12 and 24weeks. After sacrifice, μCT scans were acquired to assess the amount of the gas liberated and the degradation rate of the implant. Histological evaluations were performed to investigate the local tissue response adjacent to the implant and to assess the status of the attachment between the tendon and the bone tissue. The μCT scans showed that liberation of gas was most prominent 4weeks after implantation and was significantly decreased by 24weeks. All screws remained in situ and formed a sufficient connection with the tendon and sufficient osseous integration at 24weeks. Histological evaluations showed neither inflammatory reactions nor necrosis of the tendon. The results of this pilot study in rabbits indicate that this magnesium-based interference screw should be considered as an alternative to conventional implant materials. Copyright © 2015 Elsevier B.V. All rights reserved.

Associations between abnormal ultrasound color Doppler measures and tendon pain symptoms in badminton players during a season: a prospective cohort study.

PubMed

Boesen, Anders Ploug; Boesen, Morten Ilum; Torp-Pedersen, Soren; Christensen, Robin; Boesen, Lars; Hölmich, Per; Nielsen, Michael Bachmann; Koenig, Merete Juhl; Hartkopp, Andreas; Ellegaard, Karen; Bliddal, Henning; Langberg, Henning

2012-03-01

Color Doppler ultrasound is widely used to examine intratendinous flow in individuals with overuse tendon problems, but the association between color Doppler and pain is still unclear. Intratendinous flow is present and associated with pain in badminton players, and intratendinous flow and pain increase during a badminton season. Cohort study (prognosis); Level of evidence, 2. Ninety-five semiprofessional badminton players were included in the study at a tournament at the start of the badminton season. All players were interviewed regarding pain. The anterior knee tendons and Achilles tendons were studied. Each tendon was scored using a quantitative grading system (grades 0-5) and a qualitative scoring system (color fraction) using color Doppler ultrasound. Eight months later, 86 of the players (91%) were retested by the same investigators during an equivalent badminton tournament (including 1032 tendon regions; 86 players with 4 tendons each with 3 regions), thus forming the study group. At the start of the season, 24 players (28%) experienced pain in 37 tendons (11%), and at the end of the season, 31 players (36%) experienced pain in 51 tendons (15%), which was a statistically significant increase (P = .0002). Abnormal flow was found in 230 tendon regions in 71 players (83%) at the start of the season compared with 78 tendon regions in 41 players (48%) at the follow-up. The decrease in abnormal flow was statistically significant (P < .0001). Of the 37 painful tendons at the start of the season, 25 had abnormal flow (68%). In contrast, 131 tendons (85%) with abnormal flow at the start of the season were pain free. At the end of the season, 18 of the 51 painful tendons (35%) had abnormal flow. Ninety-six of the 131 pain-free tendons (73%) with abnormal flow at the start of the season were normalized (no pain and normal flow) at the end of the season. It was not possible to verify any association between intratendinous flow and pain at the start of the season or at the follow-up (end of the season). Intratendinous flow at the start of the season could not predict symptomatic outcome at the end of the season. The decrease in Doppler flow during the season might suggest that intratendinous flow could be part of a physiological adaptive response to loading and that intratendinous flow as previously believed is not always a sign of pathological changes.

Anatomic findings and complications after surgical treatment of chronic, partial distal biceps tendon tears: a case cohort comparison study.

PubMed

Ruch, David S; Watters, Tyler Steven; Wartinbee, Daniel A; Richard, Marc J; Leversedge, Fraser J; Mithani, Suhail K

2014-08-01

To describe pertinent anatomic findings during repair of chronic, partial distal biceps tendon tears and to compare the complications of surgery with a similar cohort of acute, complete tears. Group 1 included 14 patients (15 elbows) with partial tears managed operatively an average of 10 months from onset of injury or symptoms. Group 2 included a matched cohort of 16 patients (17 elbows) treated for complete, acute tears an average of 19 days from injury. A retrospective review of all 30 patients focused on demographic data, intraoperative findings, and postoperative complications. A single, anterior incision was used in all cases with multiple suture anchors or a bicortical toggling button for fixation of the repair. We evaluated 27 men and 3 women with an average age of 55 years (group 1) and 48 years (group 2). Intratendinous ganglion formation at the site of rupture of the degenerative tendon was observed in 5 cases of partial tears and none of the complete tears. Partial tears involved the lateral aspect or short head of the biceps tendon insertion in all cases. Postoperative complications included lateral antebrachial cutaneous nerve neuritis in 8 group 1 patients and 6 group 2 patients and transient posterior interosseus nerve palsy in 3 group 1 patients. Partial distal biceps tendon ruptures showed a consistent pattern of pathology involving disruption of the lateral side of the tendon insertion involving the small head of the biceps. Degenerative intratendinous ganglion formation was present in one third of cases. Repair of chronic, partial distal biceps tendon injuries may have a higher incidence of posterior interosseous and lateral antebrachial cutaneous nerve palsies. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Evaluation of peripheral microcirculation improvement of foot after tarsal tunnel release in diabetic patients by transcutaneous oximetry.

PubMed

Trignano, Emilio; Fallico, Nefer; Chen, Hung-Chi; Faenza, Mario; Bolognini, Alfonso; Armenti, Andrea; Santanelli Di Pompeo, Fabio; Rubino, Corrado; Campus, Gian Vittorio

2016-01-01

According to recent studies, peripheral nerve decompression in diabetic patients seems to not only improve nerve function, but also to increase microcirculation; thus decreasing the incidence of diabetic foot wounds and amputations. However, while the postoperative improvement of nerve function is demonstrated, the changes in peripheral microcirculation have not been demonstrated yet. The aim of this study is to assess the degree of microcirculation improvement of foot after the tarsal tunnel release in the diabetic patients by using transcutaneous oximetry. Twenty diabetic male patients aged between 43 and 72 years old (mean age 61.2 years old) suffering from diabetic peripheral neuropathy with superimposed nerve compression underwent transcutaneous oximetry (PtcO2) before and after tarsal tunnel release by placing an electrode on the skin at the level of the dorsum of the foot. Eight lower extremities presented diabetic foot wound preoperatively. Thirty-six lower extremities underwent surgical release of the tibialis posterior nerve only, whereas four lower extremities underwent the combined release of common peroneal nerve, anterior tibialis nerve, and posterior tibialis nerve. Preoperative values of transcutaneous oximetry were below the critical threshold, that is, lower than 40 mmHg (29.1 ± 5.4 mmHg). PtcO2 values at one month after surgery (45.8 ± 6.4 mmHg) were significantly higher than the preoperative ones (P = 0.01). The results of postoperative increase in PtcO2 values demonstrate that the release of the tarsal tunnel determines a relevant increase in microcirculation in the feet of diabetic patients. © 2015 Wiley Periodicals, Inc.

Immediate effect of exercise on achilles tendon properties: systematic review.

PubMed

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

2013-08-01

Understanding the mechanical and morphological adaptation of the Achilles tendon (AT) in response to acute exercise could have important implications for athletic performance, injury prevention, and rehabilitation. The purpose of this study was to conduct a systematic review and critical evaluation of the literature to determine the immediate effect of a single bout of exercise on the mechanical and morphological properties of the AT in vivo. Five electronic research databases were systematically searched for intervention-based studies reporting mechanical and morphological properties of the AT after a single bout of exercise. Searches revealed 3292 possible articles; 21 met the inclusion criteria. There is evidence that maximal isometric contractions and prolonged static stretching (>5 min) of the triceps surae complex cause an immediate decrease in AT stiffness, whereas prolonged running and hopping have minimal effect. Limited but consistent evidence exists, indicating that AT hysteresis is reduced after prolonged static stretching. Consistent evidence supports a reduction in free AT diameter (anterior-posterior) after dynamic ankle exercise, and this change appears most pronounced in the healthy tendon and after eccentric exercise. The mechanical and morphological properties of the AT in vivo are affected by acute exercise in a mode- and dose-dependent manner. Transient changes in AT stiffness, hysteresis, and diameter after unaccustomed exercise modes and doses may expose the tendon to increased risk of strain injury and impact on the mechanical function of the triceps surae muscle-tendon unit.

Pain in donor site after BTB-ACL reconstruction with PRGF: a randomized trial.

PubMed

Seijas, Roberto; Cuscó, Xavier; Sallent, Andrea; Serra, Iván; Ares, Oscar; Cugat, Ramón

2016-06-01

Anterior cruciate ligament (ACL) tears are highly incident injuries in young athletes within our work area. The use of the patellar graft, despite being the treatment of choice, presents post-operative problems such as anterior knee pain, which limits its use and leads to preference being taken for alternative grafts. Our aim was to evaluate if the application of PRGF reduces anterior knee pain in donor site in BTB-ACL reconstruction. 43 patients were included in the double-blinded and randomized clinical trial comparing two patient groups who underwent ACL reconstruction using patellar tendon graft, comparing anterior knee pain with and without the application of PRGF at the donor site after harvesting the graft. The PRGF group showed decreased donor site pain in comparison to the control group, with significant differences in the first two months of follow-up. The application of PRGF decreased donor site pain compared to the control group.

Problems in analysis of data from muscles of rats flown in space

NASA Technical Reports Server (NTRS)

Tischler, M. E.; Henriksen, E.; Jacob, S.; Satarug, S.; Cook, P.

1988-01-01

Comparison of hindlimb muscles of rats flown on Spacelab-3 or tail-traction-suspended showed that 11-17 h reloading post-flight might have altered the results. Soleus atrophied, plantaris, gastrocnemius and extensor digitorum longus grew slower, and tibialis anterior grew normally. In both flight and simulated soleus and plantaris, higher tyrosine and greater glutamine/glutamate ratio indicated negative protein balance and increased glutamine production, respectively, relative to controls. Aspartate was lower in these muscles. Reloading generally decreased tyrosine, but increased aspartate and glutamine/glutamate. These data showed that at 12 h of reloading after flight is characterized by reversal to varying extents of effects of unloading.

Experiment K-7-33: Functional Neuromuscular Adaptation to Spaceflight

NASA Technical Reports Server (NTRS)

Edgerton, V. R.; Bodine-Fowler, S.; Hodgson, J. A.; Roy, R. R.; Kozlovskaya, I. B.

1994-01-01

The following data were collected from two Rhesus monkeys (782 and 2483) that were flown aboard a 14-day biosatellite mission (COSMOS 2044). The proposed study was designed to determine the effects of the absence of weight support on flexor and extensor muscles of the hindlimb. These effects were assessed morphologically and biochemically from muscle biopsies taken from a slow extensor, the soleus; a fast extensor, the medial gastrocnemius; and a fast flexor, the tibialis anterior. A second objective of this study was to determine the relative importance of activity (as determined by intramuscular electromyography, and force (as determined by joint torque) on the adaptation of muscle.

Magnetic resonance imaging of glenohumeral joint instability.

PubMed

Steinbach, Lynne S

2005-03-01

Shoulder instability is common, especially anterior subluxation and dislocation. The sequelae are well seen on magnetic resonance imaging and include tears of the labrum, glenohumeral ligaments, capsule, tendons, and muscles. This article seeks to discuss and illustrate common pitfalls and lesions associated with instability. Anatomic and technical considerations, including the use of magnetic resonance arthrography, are also addressed.

Technical Innovation Case Report: Ultrasound-Guided Prolotherapy Injection for Insertional Achilles Calcific Tendinosis

PubMed Central

DeLuca, Jesse P.; Lammlein, Kyle P.

2016-01-01

We describe the use of ultrasound guidance for hyperosmolar dextrose (prolotherapy) injection of the distal calcaneal tendon specifically just anterior to identified enthesophytes in patients with insertional Achilles calcific tendinosis refractory to conservative treatment. This specific technique has not to our knowledge been described or used in literature previously. PMID:27974984

Arthroscopic single-bundle anterior cruciate ligament reconstruction with six-strand hamstring tendon allograft versus bone-patellar tendon-bone allograft.

PubMed

Dai, Chengliang; Wang, Fei; Wang, Xiaomeng; Wang, Ruipeng; Wang, Shengjie; Tang, Shiyu

2016-09-01

The aim of this study was to compare the clinical outcomes of arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction with six-strand hamstring tendon (HT) allograft versus bone-patellar tendon-bone (BPTB) allograft. The prospective randomized controlled trial was included 129 patients. Sixty-nine patients received reconstruction with six-strand HT allografts (HT group), whereas 60 patients with BPTB allografts (BPTB group). Outcome assessment included re-rupture findings, International Knee Documentation Committee (IKDC) scores, Lysholm scores, KT-1000 arthrometer, Lachman test, pivot-shift test, range of motion (ROM) and single-leg hop test. At a mean follow-up of 52 months, 113 patients (HT group, 61 patients; BPTB group, 52 patients) completed a minimum 4-year follow-up. Four patients in HT group and six in BPTB group experienced ACL re-rupture (6.2 vs. 10.3 %) and received revision surgery. Significant between-group differences were observed in KT-1000 outcomes and pivot-shift test 1 (1.2 ± 1.5 vs. 1.8 ± 1.3, p = 0.025; positive rate 6.5 vs. 18.9 %, p = 0.036), 2 (1.1 ± 1.4 vs. 1.6 ± 1.2, p = 0.044; 8.1 vs. 20.7 %, p = 0.039), 4 (1.1 ± 1.5 vs. 1.7 ± 1.4, p = 0.031; 9.7 vs. 25 %, p = 0.012) years postoperatively. The outcomes between the two groups were comparable in terms of IKDC scores, Lysholm scores, Lachman test, ROM and single-leg hop test. Six-strand HT allograft achieved superior anteroposterior and rotational stability after single-bundle ACL reconstruction. It is a reasonable graft substitute for ACL reconstruction. II.

Anatomic single-bundle anterior cruciate ligament reconstruction improves walking economy: hamstrings tendon versus patellar tendon grafts.

PubMed

Iliopoulos, Efthymios; Galanis, Nikiforos; Zafeiridis, Andreas; Iosifidis, Michael; Papadopoulos, Pericles; Potoupnis, Michael; Geladas, Nikolaos; Vrabas, Ioannis S; Kirkos, John

2017-10-01

Anterior cruciate ligament (ACL) injury is associated with a pathologic gait pattern and increased energy cost during locomotion. ACL reconstruction could improve the gait pattern. Hamstrings tendon (HAM) and bone-patellar tendon-bone (BPTB) grafts are usually used for reconstruction. The aim of this study was to compare the efficacy of anatomic ACL reconstruction with HAM and BPTB grafts on improving and normalizing the energy cost and physiologic reserves during flat, uphill, and downhill walking. Twenty male subjects with unilateral ACL injuries were randomly assigned to ACL reconstruction with a HAM (n = 10) or BPTB (n = 10) graft. Ten matched controls were also enrolled. All participants performed three 8-min walking tasks at 0, +10, and -10 % gradients before and 9 months after surgery. Energy cost (oxygen consumption, VO 2 ), heart rate (HR), and ventilation (VE) were measured. Lysholm/IKDC scores were recorded. Pre-operatively, VO 2 , HR, and VE were higher in the HAM and BPTB groups than in controls during walking at 0, +10, and -10 % gradients (p < 0.001-0.01). Post-operatively, both HAM and BPTB groups showed reduced VO 2 , HR, and VE during the three walking tasks (p < 0.001-0.01). Although the post-operative VO 2 in both surgical groups reached 90-95 % of the normative (control) value during walking, it remained elevated against the value observed in controls (p < 0.001-0.01). The HAM and BPTB groups showed no differences in post-surgical VO 2 or HR during walking at all three gradients. Anatomic ACL reconstruction with either HAM or BPTB graft resulted in similar short-term improvements in energy cost and nearly normalized locomotion economy and cardiorespiratory reserves during flat, uphill, and downhill walking. The improved locomotion economy is an additional benefit of anatomic ACL reconstruction, irrespective of the type of graft used, that the orthopaedic surgeons should consider. II.

A Rare Case of Massive Rotator Cuff Tear and Biceps Tendon Rupture with Posterior Shoulder Dislocation in a Young Adult - Surgical Decision-making and Outcome

PubMed Central

Soon, En Loong; Razak, Hamid Rahmatullah Bin Abd; Tan, Andrew Hwee Chye

2017-01-01

Introduction: Massive rotator cuff tears (RCTs) in the context of shoulder dislocations are relatively uncommon in the young adult (<40 years) and if reported are more commonly described in association with acute traumatic anterior glenohumeral dislocations. They have rarely been described with posterior dislocations, regardless of patient age. This is the 1st case reported in the context of posterior dislocations, where a triad of biceps tendon rupture, posterior dislocation, and RCTs was observed during surgery. It provides an important reminder to readers about certain injuries commonly overlooked during the assessment of an acute traumatic shoulder. Case Report: We report an atypical case of a massive RCT involving a 34-year-old Asian male who landed on his outstretched hand after falling off a bicycle. A tear involving the supraspinatus and subscapularis was visualized during surgery, along with long head of biceps (LHB) tendon rupture. This was after an initial failure to achieve closed reduction of the posteriorly dislocated left shoulder. Conclusion: It is easy to miss the posterior instability, the associated RCTs or the biceps tendon injuries. Biceps tendon rupture should be a consideration when one is unable to reduce a posteriorly dislocated shoulder. The interposed torn LHB tendon trapped within the glenohumeral joint was the likely physical block in the initial failure to achieve closed reduction. With timely diagnosis, prudent physical examination, early imaging and surgery, and excellent results can potentially be achieved to return a young patient to full functionality. PMID:28819610

Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable.

PubMed

Cho, Nam Su; Moon, Seong Cheol; Hong, Se Jung; Bae, Seong Hae; Rhee, Yong Girl

2017-09-01

The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. Cohort study; Level of evidence, 3. One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively. There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P < .001, respectively). At final follow-up, the mean visual analog scale (VAS) for pain score during motion was 1.31 ± 0.98 and 1.24 ± 0.90 in groups A and B, respectively ( P = .587). The mean Constant score was 77.5 ± 11.2 and 78.0 ± 11.9 points in groups A and B, respectively ( P = .875). The mean University of California, Los Angeles score was 30.5 ± 4.1 and 31.0 ± 3.0 points in groups A and B, respectively ( P = .652). In assessing the repair integrity on postoperative MRI, the retear rate was 23.9% and 14.7% in groups A and B, respectively ( P = .029). Irrespective of involvement in the anterior attachment of the rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.

Higher anterior knee laxity influences the landing biomechanics displayed by pubescent girls.

PubMed

Wild, Catherine Y; Munro, Bridget J; Steele, Julie R

2017-01-01

Despite an increase in anterior knee laxity (AKL) during the adolescent growth spurt in girls, it is unknown whether landing biomechanics are affected by this change. This study investigated whether pubescent girls with higher AKL displayed differences in their lower limb strength or landing biomechanics when performing a horizontal leap movement compared to girls with lower AKL. Forty-six pubescent girls (10-13 years) were tested at the time of their peak height velocity (PHV). Passive AKL was quantified and used to classify participants into higher (HAKL; peak displacement > 4 mm) and lower (LAKL; peak displacement < 3 mm) AKL groups (n = 15/group). Three-dimensional kinematics, ground reaction forces (GRF) and muscle activation patterns were assessed during a horizontal leap landing. HAKL participants displayed significantly (P < 0.05) reduced hip abduction, increased hip abduction moments, as well as earlier hamstring muscle and later tibialis anterior activation compared to LAKL participants. Girls with HAKL displayed compensatory landing biomechanics, which are suggested to assist the functional stability of their knees during this dynamic task. Further research is warranted, however, to confirm or refute this notion.

Intraarticular arthrofibrosis of the knee alters patellofemoral contact biomechanics.

PubMed

Mikula, Jacob D; Slette, Erik L; Dahl, Kimi D; Montgomery, Scott R; Dornan, Grant J; O'Brien, Luke; Turnbull, Travis Lee; Hackett, Thomas R

2017-12-19

Arthrofibrosis in the suprapatellar pouch and anterior interval can develop after knee injury or surgery, resulting in anterior knee pain. These adhesions have not been biomechanically characterized. The biomechanical effects of adhesions in the suprapatellar pouch and anterior interval during simulated quadriceps muscle contraction from 0 to 90° of knee flexion were assessed. Adhesions of the suprapatellar pouch and anterior interval were hypothesized to alter the patellofemoral contact biomechanics and increase the patellofemoral contact force compared to no adhesions. Across all flexion angles, suprapatellar adhesions increased the patellofemoral contact force compared to no adhesions by a mean of 80 N. Similarly, anterior interval adhesions increased the contact force by a mean of 36 N. Combined suprapatellar and anterior interval adhesions increased the mean patellofemoral contact force by 120 N. Suprapatellar adhesions resulted in a proximally translated patella from 0 to 60°, and anterior interval adhesions resulted in a distally translated patella at all flexion angles other than 15° (p < 0.05). The most important finding in this study was that patellofemoral contact forces were significantly increased by simulated adhesions in the suprapatellar pouch and anterior interval. Anterior knee pain and osteoarthritis may result from an increase in patellofemoral contact force due to patellar and quadriceps tendon adhesions. For these patients, arthroscopic lysis of adhesions may be beneficial.

Effect of Immediate and Delayed High-Strain Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction

PubMed Central

Packer, Jonathan D.; Bedi, Asheesh; Fox, Alice J.; Gasinu, Selom; Imhauser, Carl W.; Stasiak, Mark; Deng, Xiang-Hua; Rodeo, Scott A.

2014-01-01

Background: We previously demonstrated, in a rat anterior cruciate ligament (ACL) graft reconstruction model, that the delayed application of low-magnitude-strain loading resulted in improved tendon-to-bone healing compared with that observed after immediate loading and after prolonged immobilization. The purpose of this study was to determine the effect of higher levels of strain loading on tendon-to-bone healing. Methods: ACL reconstruction was carried out in a rat model in three randomly assigned groups: high-strain daily loading beginning on either (1) postoperative day one (immediate-loading group; n = 7) or (2) postoperative day four (delayed-loading group; n = 11) or (3) after prolonged immobilization (immobilized group; n = 8). Animals were killed two weeks after surgery and micro-computed tomography (micro-CT) and biomechanical testing of the bone-tendon-bone complex were carried out. Results: The delayed-loading group had greater tissue mineral density than either the immediate-loading or immobilized group (mean [and standard deviation], 813.0 ± 24.9 mg/mL compared with 778.4 ± 32.6 mg/mL and 784.9 ± 26.4 mg/mL, respectively; p < 0.05). There was a trend toward greater bone volume per total volume fraction in both the immobilized and the delayed-loading group compared with the immediate-loading group (0.24 ± 0.03 and 0.23 ± 0.06 compared with 0.20 ± 0.05; p = 0.06). Trabecular thickness was greater in the immobilized group compared with the immediate-loading group (106.5 ± 23.0 μm compared with 72.6 ± 10.6 μm; p < 0.01). There were no significant differences in failure load or stiffness between the immobilized group and either high-strain cyclic-loading group. Conclusions: Immediate application of high-strain loading appears to have a detrimental effect on healing in this rat model. Any beneficial effects of delayed loading on the healing tendon-bone interface (after a brief period of immobilization) may be offset by the detrimental effects of excessive strain levels or by the detrimental effects of stress deprivation on the graft. Clinical Relevance: The timing and magnitude of mechanical load on a healing rat ACL reconstruction graft may have important implications for postoperative rehabilitation. Avoidance of exercises that cause high graft strain in the early postoperative period may lead to improved tendon-to-bone healing in humans. PMID:24806014

Improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus.

PubMed

Wang, Hong-De; Li, Tong; Gao, Shi-Jun

2017-10-30

Discoid medial meniscus is an extremely rare abnormality of the knee. During arthroscopic meniscectomy for symptomatic discoid medial meniscus, it is difficult to remove the posterior portion of the meniscus because of the confined working space within the compartment and the obstruction caused by the anterior cruciate ligament and the tibial intercondylar eminence. To overcome these problems, we describe an improved arthroscopic technique for one-piece excision of symptomatic discoid medial meniscus through three unique portals. Three improved portals were made in the injured knee: a standard anteromedial portal, a central transpatellar tendon portal, and a high anterolateral portal. The anterior side of the discoid medial meniscus was cut 7 mm from the periphery of the meniscus. Next, the anterior portion of the free discoid meniscus fragment was pulled in the anterolateral direction with tension. A curve-shaped cut was made along the longitudinal tear to the posterior horn using basket forceps through the standard anteromedial portal. Then, the anterior portion of the free discoid meniscus was pulled in the anteromedial direction. Pulling the fragment under tension made it easier to cut the posterior side of the discoid meniscus. The posterior side of the discoid meniscus was cut 7 mm from the periphery of the meniscus with straight scissors or basket forceps through the central transpatellar tendon portal. This technique resulted in satisfactory results. Excellent visualization of the posterior part of the discoid medial meniscus was gained during the procedure, and it was easy to cut the posterior part of the discoid medial meniscus. No recurrent symptoms were found. This improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus enables the posterior part of the meniscus to be cut satisfactorily. Moreover, compared with previous techniques, this novel technique causes less formation of foreign bodies and less damage to the anterior cruciate ligament, medial collateral ligament, and cartilage and requires a shorter procedural time.

Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons☆

PubMed Central

de Souza Leao, Marcos George; Pampolha, Abelardo Gautama Moreira; Orlando Junior, Nilton

2015-01-01

Objectives To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL) using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G), by means of the Knee Society Score (KSS) and the Lysholm scale. Methods This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. Results From the statistical analysis, it could be seen that the patients’ functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results (p = >0.05), in all the comparisons. Conclusions The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery. PMID:27218084

Knotless single-row rotator cuff repair: a comparative biomechanical study of 2 knotless suture anchors.

PubMed

Efird, Chad; Traub, Shaun; Baldini, Todd; Rioux-Forker, Dana; Spalazzi, Jeffrey P; Davisson, Twana; Hawkins, Monica; McCarty, Eric

2013-08-01

The purpose of this study was to compare the gap formation during cyclic loading, maximum repair strength, and failure mode of single-row full-thickness supraspinatus repairs performed using 2 knotless suture anchors with differing internal suture-retention mechanisms in a human cadaver model. Nine matched pairs of cadaver shoulders were used. Full-thickness tears were induced by detaching the supraspinatus tendon from the greater tuberosity. Single-row repairs were performed with either type I (Opus Magnum PI; ArthroCare, Austin, Texas) or type II (ReelX STT; Stryker, Mahwah, New Jersey) knotless suture anchors. The repaired tendon was cycled from 10 to 90 N for 500 cycles, followed by load to failure. Gap formation was measured at 5, 100, 200, 300, 400, and 500 cycles with a video digitizing system. Anchor type or location (anterior or posterior) had no effect on gap formation during cyclic loading regardless of position (anterior, P=.385; posterior, P=.389). Maximum load to failure was significantly greater (P=.018) for repairs performed with type II anchors (288±62 N) compared with type I anchors (179±39 N). Primary failure modes were anchor pullout and tendon tearing for type II anchors and suture slippage through the anchor for type I anchors. The internal ratcheting suture-retention mechanism of type II anchors may have helped this anchor outperform the suture-cinching mechanism of type I anchors by supporting significantly higher loads before failure and minimizing suture slippage, potentially leading to stronger repairs clinically. Copyright 2013, SLACK Incorporated.

Has platelet-rich plasma any role in anterior cruciate ligament allograft healing?

PubMed

Nin, Juan Ramón Valentí; Gasque, Gonzalo Mora; Azcárate, Andrés Valentí; Beola, Jesús Dámaso Aquerreta; Gonzalez, Milagros Hernandez

2009-11-01

The aim of this study was to evaluate and compare the clinical and inflammatory parameters with the addition of platelet-derived growth factor (PDGF) in primary anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone allograft. We prospectively randomized 100 patients undergoing arthroscopic patellar tendon allograft ACL reconstruction to a group in whom platelet-enriched gel was used (n = 50) and a non-gel group (n = 50). The platelet concentration was 837 x 10(3)/mm(3), and the gel was introduced inside the graft and the tibial tunnel. Demographic data were comparable between groups. The mean follow-up was 24 months for both groups and included a history, clinical evaluation with the International Knee Documentation Committee score, radiographs, and magnetic resonance imaging. There were no differences in the number of associated injuries. The results did not show any statistically significant differences between the groups for inflammatory parameters (perimeters of the knee and C-reactive protein level), magnetic resonance imaging appearance of the graft, and clinical evaluation scores (visual analog scale, International Knee Documentation Committee, and KT-1000 arthrometer [MEDmetric, San Diego, CA]). At this time, the therapeutic role of PDGF in ACL reconstruction remains unclear. The use of PDGF, on the graft and inside the tibial tunnel, in patients treated with bone-patellar tendon-bone allografts has no discernable clinical or biomechanical effect at 2 years' follow-up. More clinical studies will be needed to show the efficacy and use of these factors in daily practice in ACL reconstruction. Level I, prospective, randomized, double-blind study.

Musculoaponeurotic Area of the Hip and Clinicophotographic Scaling System

PubMed Central

Mena-Chávez, J. Alejandro

2015-01-01

Background: With the evolution of body contouring, few innovative alternatives have been developed for cosmetic treatment in the hip area. Methods: A multicenter controlled study was conducted, including a prior review of the literature regarding the hip area. Dissections were performed on 4 male cadavers, outlining the “musculoaponeurotic area of the hip.” The area was subdivided into anterior and posterior surfaces. A clinical study was conducted in 79 patients, obtaining a scale by using the most prominent points on the sides of both thighs as the main reference. With the lines marked on photographs and the measurements, a “clinicophotographic scaling system” was designed. Results: The anterior surface corresponds to the tensor fasciae latae and its tendon as well as to the aponeurosis of the gluteus medius. The posterior surface corresponds with the iliotibial tract and the tendon insertions of the gluteus maximus. The average dimensions of the cadaver “musculoaponeurotic area of the hip” are as follows: length, 17.5 cm, and width, 11.5 cm. Using the “clinicophotographic scaling system,” the dimensions are as follows: length, 14.9 cm, and width, 10.3 cm. Conclusions: The “musculoaponeurotic area of the hip” was defined involving muscles, tendons, aponeurosis, fascia, subcutaneous cellular tissue, and skin. The borders were established using important anatomical points that determine the length and width of the area. The “clinicophotographic scaling system” was used to clinically calculate the length and width of the area. By examination and palpation, the borders and dimensions of this area could be determined. PMID:26180724

Change in muscle fascicle length influences the recruitment and discharge rate of motor units during isometric contractions.

PubMed

Pasquet, Benjamin; Carpentier, Alain; Duchateau, Jacques

2005-11-01

This study examines the effect of fascicle length change on motor-unit recruitment and discharge rate in the human tibialis anterior (TA) during isometric contractions of various intensities. The torque produced during dorsiflexion and the surface and intramuscular electromyograms (EMGs) from the TA were recorded in eight subjects. The behavior of the same motor unit (n = 59) was compared at two ankle joint angles (+10 and -10 degrees around the ankle neutral position). Muscle fascicle length of the TA was measured noninvasively using ultrasonography recordings. When the ankle angle was moved from 10 degrees plantarflexion to 10 degrees dorsiflexion, the torque produced during maximal voluntary contraction (MVC) was significantly reduced [35.2 +/- 3.3 vs. 44.3 +/- 4.2 (SD) Nm; P < 0.001] and the average surface EMG increased (0.47 +/- 0.08 vs. 0.43 +/- 0.06 mV; P < 0.05). At reduced ankle joint angle, muscle fascicle length declined by 12.7% (P < 0.01) at rest and by 18.9% (P < 0.001) during MVC. Motor units were activated at a lower recruitment threshold for short compared with long muscle fascicle length, either when expressed in absolute values (2.1 +/- 2.5 vs. 3.6 +/- 3.7 Nm; P < 0.001) or relative to their respective MVC (5.2 +/- 6.1 vs. 8.8 +/- 9.0%). Higher discharge rate and additional motor-unit recruitment were observed at a given absolute or relative torque when muscle fascicles were shortened. However, the data indicate that increased rate coding was mainly present at low torque level (<10% MVC), when the muscle-tendon complex was compliant, whereas recruitment of additional motor units played a dominant role at higher torque level and decreased compliance (10-35% MVC). Taken together, the results suggest that the central command is modulated by the afferent proprioceptive information during submaximal contractions performed at different muscle fascicle lengths.

Intramuscular pressure and torque during isometric, concentric and eccentric muscular activity

NASA Technical Reports Server (NTRS)

Styf, J.; Ballard, R.; Aratow, M.; Crenshaw, A.; Watenpaugh, D.; Hargens, A. R.

1995-01-01

Intramuscular pressures, electromyography (EMG) and torque generation during isometric, concentric and eccentric maximal isokinetic muscle activity were recorded in 10 healthy volunteers. Pressure and EMG activity were continuously and simultaneously measured side by side in the tibialis anterior and soleus muscles. Ankle joint torque and position were monitored continuously by an isokinetic dynamometer during plantar flexion and dorsiflexion of the foot. The increased force generation during eccentric muscular activity, compared with other muscular activity, was not accompanied by higher intramuscular pressure. Thus, this study demonstrated that eccentric muscular activity generated higher torque values for each increment of intramuscular pressure. Intramuscular pressures during antagonistic co-activation were significantly higher in the tibilis anterior muscle (42-46% of maximal agonistic activity) compared with the soleus muscle (12-29% of maximal agonistic activity) and was largely due to active recruitment of muscle fibers. In summary, eccentric muscular activity creates higher torque values with no additional increase of the intramuscular pressure compared with concentric and isometric muscular activity.

Muscular activity of lower limb muscles associated with working on inclined surfaces

PubMed Central

Lu, Ming-Lun; Kincl, Laurel; Lowe, Brian; Succop, Paul; Bhattacharya, Amit

2015-01-01

This study investigated effects of visual cues, muscular fatigue, task performance and experience of working on inclined surfaces on activity of postural muscles in the lower limbs associated with maintaining balance on three inclined surfaces—0°, 14° and 26°. Normalized electromyographic (NEMG) data were collected on 44 professional roofers bilaterally from the rectus femoris, biceps femoris, tibialii anterior, and gastrocnemii medial muscle groups. The 50th and 95th percentile normalized EMG amplitudes were used as EMG variables. Results showed that inclination angle and task performance caused a significant increase in the NEMG amplitudes of all postural muscles. Visual cues were significantly associated with a decrease in the 95th percentile EMG amplitude for the right gastrocnemius medial and tibialis anterior. Fatigue was related to a significant decrease in the NEMG amplitude for the rectus femoris. Experience of working on inclined surfaces did not have a significant effect on the NEMG amplitude. PMID:25331562

At similar angles, slope walking has a greater fall risk than stair walking.

PubMed

Sheehan, Riley C; Gottschall, Jinger S

2012-05-01

According to the CDC, falls are the leading cause of injury for all age groups with over half of the falls occurring during slope and stair walking. Consequently, the purpose of this study was to compare and contrast the different factors related to fall risk as they apply to these walking tasks. More specifically, we hypothesized that compared to level walking, slope and stair walking would have greater speed standard deviation, greater ankle dorsiflexion, and earlier peak activity of the tibialis anterior. Twelve healthy, young male participants completed level, slope, and stair trials on a 25-m walkway. Overall, during slope and stair walking, medial-lateral stability was less, anterior-posterior stability was less, and toe clearance was greater in comparison to level walking. In addition, there were fewer differences between level and stair walking than there were between level and slope walking, suggesting that at similar angles, slope walking has a greater fall risk than stair walking. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments

PubMed Central

Crevoisier, Xavier; Assal, Mathieu; Stanekova, Katarina

2016-01-01

The pathogenesis of hallux valgus deformity is multifactorial. Conservative treatment can alleviate pain but is unable to correct the deformity. Surgical treatment must be adapted to the type and severity of the deformity. Success of surgical treatment ranges from 80% to 95%, and complication rates range from 10% to 30%. Ankle osteoarthrosis most commonly occurs as a consequence of trauma. Ankle arthrodesis and total ankle replacement are the most common surgical treatments of end stage ankle osteoarthrosis. Both types of surgery result in similar clinical improvement at midterm; however, gait analysis has demonstrated the superiority of total ankle replacement over arthrodesis. More recently, conservative surgery (extraarticular alignment osteotomies) around the ankle has gained popularity in treating early- to mid-stage ankle osteoarthrosis. Adult acquired flatfoot deformity is a consequence of posterior tibial tendon dysfunction in 80% of cases. Classification is based upon the function of the tibialis posterior tendon, the reducibility of the deformity, and the condition of the ankle joint. Conservative treatment includes orthotics and eccentric muscle training. Functional surgery is indicated for treatment in the early stages. In case of fixed deformity, corrective and stabilising surgery is performed. Cite this article: Crevoisier X, Assal M, Stanekova K. Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments. EFORT Open Rev 2016;1:58–64. DOI: 10.1302/2058-5241.1.000015. PMID:28461929

EVALUATION OF THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING FLEXOR TENDONS AND RIGID GUIDE TRANSVERSE SCREW

PubMed Central

de Castro, Renato Luiz Bevilacqua; Acras, Sandor Dosa

2015-01-01

Objective: The aim of this study was to analyze the results of ACL (anterior cruciate ligament) reconstruction using quadruple flexor tendons as grafts, with ligament fixation in the femur using a rigid guide transverse screw and in the tibia, using a cancellous screw with a fixing washer. Methods: 173 knees (166 from males and seven from females) that had undergone surgery with ACL reconstruction using this technique between December 2002 and February 2007 were evaluated. The mean age was 30 years (from 13 to 56 years), and the mean follow-up time was 30 months (6-55 months). We divided the knees into three groups, which were assessed using the Lysholm scale: Group A with six months of follow-up; Group B with 12 months of follow-up; and Group C with 24 months of follow-up. Results: We evaluated the results, and groups A, B and C received 94, 95 and 95 points respectively on the Lysholm scale. Conclusions: The surgical technique proved to be safe and easy to perform, with good results and a low complication rate. Also, its results were maintained throughout the study period of 24 months. PMID:27027002

Allogeneic versus autologous derived cell sources for use in engineered bone-ligament-bone grafts in sheep anterior cruciate ligament repair.

PubMed

Mahalingam, Vasudevan D; Behbahani-Nejad, Nilofar; Horine, Storm V; Olsen, Tyler J; Smietana, Michael J; Wojtys, Edward M; Wellik, Deneen M; Arruda, Ellen M; Larkin, Lisa M

2015-03-01

The use of autografts versus allografts for anterior cruciate ligament (ACL) reconstruction is controversial. The current popular options for ACL reconstruction are patellar tendon or hamstring autografts, yet advances in allograft technologies have made allogeneic grafts a favorable option for repair tissue. Despite this, the mismatched biomechanical properties and risk of osteoarthritis resulting from the current graft technologies have prompted the investigation of new tissue sources for ACL reconstruction. Previous work by our lab has demonstrated that tissue-engineered bone-ligament-bone (BLB) constructs generated from an allogeneic cell source develop structural and functional properties similar to those of native ACL and vascular and neural structures that exceed those of autologous patellar tendon grafts. In this study, we investigated the effectiveness of our tissue-engineered ligament constructs fabricated from autologous versus allogeneic cell sources. Our preliminary results demonstrate that 6 months postimplantation, our tissue-engineered auto- and allogeneic BLB grafts show similar histological and mechanical outcomes indicating that the autologous grafts are a viable option for ACL reconstruction. These data indicate that our tissue-engineered autologous ligament graft could be used in clinical situations where immune rejection and disease transmission may preclude allograft use.

Musculoskeletal injuries in the ultramarathon: the 1990 Westfield Sydney to Melbourne run.

PubMed Central

Fallon, K E

1996-01-01

OBJECTIVE: To document the injuries sustained by participants in a 1005 km ultramarathon. METHODS: Clinical notes were reviewed on entrants in the 1005 km Sydney to Melbourne ultramarathon. An injury was recorded following self referral by a participant or if the history obtained from the runner or his support crew indicated the likelihood of a significant injury which could have an impact upon performance. RESULTS: 64 injuries were found in 32 runners. The knee (31.3%) and ankle (28.1%) regions were most commonly injured. The most common single diagnosis was retropatellar pain syndrome, and Achilles tendinitis and medial tibial stress syndrome were the next most common injuries. Peritendinitis/tendinitis of the tendons passing under the extensor retinaculum at the ankle, an injury infrequently reported in other sports, was common (19% of all injuries). CONCLUSIONS: The injuries were typically associated with running but 12 (19% of the total) involved the tendons of the muscles of the anterior compartment of the lower leg, and in almost every case the major site of inflammation was at the extensor retinaculum at the anterior aspect of the ankle. This injury appears to be relatively specific to the ultramarathon-"ultramarathoner's ankle". Images p321-a PMID:9015594

Patellar Sleeve Fracture With Ossification of the Patellar Tendon.

PubMed

Damrow, Derek S; Van Valin, Scott E

2017-03-01

Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.]. Copyright 2016, SLACK Incorporated.

Proteomic differences between native and tissue‐engineered tendon and ligament

PubMed Central

Tew, Simon R.; Peffers, Mandy; Canty‐Laird, Elizabeth G.; Comerford, Eithne

2016-01-01

Tendons and ligaments (T/Ls) play key roles in the musculoskeletal system, but they are susceptible to traumatic or age‐related rupture, leading to severe morbidity as well as increased susceptibility to degenerative joint diseases such as osteoarthritis. Tissue engineering represents an attractive therapeutic approach to treating T/L injury but it is hampered by our poor understanding of the defining characteristics of the two tissues. The present study aimed to determine differences in the proteomic profile between native T/Ls and tissue engineered (TE) T/L constructs. The canine long digital extensor tendon and anterior cruciate ligament were analyzed along with 3D TE fibrin‐based constructs created from their cells. Native tendon and ligament differed in their content of key structural proteins, with the ligament being more abundant in fibrocartilaginous proteins. 3D T/L TE constructs contained less extracellular matrix (ECM) proteins and had a greater proportion of cellular‐associated proteins than native tissue, corresponding to their low collagen and high DNA content. Constructs were able to recapitulate native T/L tissue characteristics particularly with regard to ECM proteins. However, 3D T/L TE constructs had similar ECM and cellular protein compositions indicating that cell source may not be an important factor for T/L tissue engineering. PMID:27080496

The Effect of Cartilage Fragments on Femoral Tunnel Widening After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Study.

PubMed

Zhang, Chi; Pan, Jun; Chen, Jian-De; Zhang, Yi-Jun; Gu, Peng-Cheng; Lin, Xiang-Jin; Cai, You-Zhi

2018-05-03

To analyze the effect of cartilage fragments on tunnel widening and tendon-bone integration at 2 years' follow-up after anterior cruciate ligament reconstruction (ACLR). A prospective randomized controlled study was performed in 116 patients who underwent ACLR with autologous hamstring tendons augmented with cartilage fragments (study group, n = 56) or without any augmentation (control group, n = 60). All patients were followed up for 25.6 months (range, 24-28 months), and the International Knee Documentation Committee score, Lysholm score, and visual analog scale score were determined. Computed tomography scans of all patients were obtained 2 years after surgery to evaluate the diameter of the femoral tunnel and thereby assess the amount of tunnel widening. Magnetic resonance imaging evaluation was performed 2 years postoperatively to evaluate the status of the graft in the femoral tunnel. In addition, 5 patients underwent biopsy of the tendon-bone interface at 24 months postoperatively with histologic assessment and transmission electron microscopy. A total of 107 patients completed the follow-up. There were no significant differences between the 2 groups in terms of International Knee Documentation Committee score (P = .07), Lysholm score (P = .10), and visual analog scale score (P = .57) at 24 months' follow-up. The femoral tunnel diameter and the tunnel widening percentage in the study group were significantly smaller than those in the control group (P < .001). The signal-noise quotient value of the graft in the femoral tunnel was 10.4 ± 7.0 in the study group, which was significantly lower than that in the control group (19.5 ± 9.2, P < .001). Histologic studies of the tendon-bone interface showed that there were more bone formations containing chondroid cells with aligned connective tissue in the study group compared with the control group; in addition, the diameter of the collagen fibrils in the study group was considerably thicker than that in the control group (P < .05). The use of cartilage fragments was effective in preventing femoral tunnel widening and seemed to promote the tendon-bone integration process after ACLR. Level II, prospective randomized controlled study. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Is Quadriceps Tendon Autograft a Better Choice Than Hamstring Autograft for Anterior Cruciate Ligament Reconstruction? A Comparative Study With a Mean Follow-up of 3.6 Years.

PubMed

Cavaignac, Etienne; Coulin, Benoit; Tscholl, Philippe; Nik Mohd Fatmy, Nik; Duthon, Victoria; Menetrey, Jacques

2017-05-01

The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft. The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity. Cohort study; Level of evidence, 3. Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. Descriptive statistics are presented for these variables using the Student t test. Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) ( P > .05). The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005). There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group (90% vs 64%, P = .052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength. The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity.

Biomechanical analysis of articular-sided partial-thickness rotator cuff tear and repair.

PubMed

Mihata, Teruhisa; McGarry, Michelle H; Ishihara, Yoko; Bui, Christopher N H; Alavekios, Damon; Neo, Masashi; Lee, Thay Q

2015-02-01

Articular-sided partial-thickness rotator cuff tears are common injuries in throwing athletes. The superior shoulder capsule beneath the supraspinatus and infraspinatus tendons works as a stabilizer of the glenohumeral joint. To assess the effect of articular-sided partial-thickness rotator cuff tear and repair on shoulder biomechanics. The hypothesis was that shoulder laxity might be changed because of superior capsular plication in transtendon repair of articular-sided partial-thickness rotator cuff tears. Controlled laboratory study. Nine fresh-frozen cadaveric shoulders were tested by using a custom shoulder-testing system at the simulated late-cocking phase and acceleration phase of throwing motion. Maximum glenohumeral external rotation angle, anterior translation, position of the humeral head apex with respect to the glenoid, internal impingement area, and glenohumeral and subacromial contact pressures were measured. Each specimen underwent 3 stages of testing: stage 1, with the intact shoulder; stage 2, after creation of articular-sided partial-thickness tears of the supraspinatus and infraspinatus tendons; and stage 3, after transtendon repair of the torn tendons by using 2 suture anchors. Articular-sided partial-thickness tears did not significantly change any of the shoulder biomechanical measurements. In the simulated late-cocking phase, transtendon rotator cuff repair resulted in decreased maximum external rotation angle by 4.2° (P = .03), posterior shift of the humeral head (1.1-mm shift; P = .02), decreased glenohumeral contact pressure by 1.7 MPa (56%; P = .004), and decreased internal impingement area by 26.4 mm(2) (65%; P < .001) compared with values in the torn shoulder. In the acceleration phase, the humeral head shifted inferiorly (1.2-mm shift; P = .03 vs torn shoulder), and glenohumeral anterior translation (1.5-mm decrease; P = .03 vs torn shoulder) and subacromial contact pressure (32% decrease; P = .004 vs intact shoulder) decreased significantly after transtendon repair. Transtendon repair of articular-sided partial-thickness supraspinatus and infraspinatus tears decreased glenohumeral and subacromial contact pressures at time zero; these changes might lead to reduced secondary subacromial and internal impingements and consequently progression to full-thickness rotator cuff tear. However, repair of the tendons decreased anterior translation and external rotation and changed the positional relationship between the humeral head and the glenoid. Careful attention should be paid to shoulder laxity and range of motion when transtendon repair is chosen to treat articular-sided partial-thickness rotator cuff tears, specifically in throwing athletes. © 2014 The Author(s).

Posterolateral complex knee injuries: magnetic resonance imaging with surgical correlation.

PubMed

Theodorou, D J; Theodorou, S J; Fithian, D C; Paxton, L; Garelick, D H; Resnick, D

2005-05-01

To describe the magnetic resonance imaging (MRI) findings of injuries of the posterolateral aspect of the knee and to evaluate the diagnostic capabilities of MRI in the assessment of these injuries. The MRI studies of 14 patients (mean age 33 years) with trauma to the posterolateral aspect of the knee were retrospectively reviewed, and the imaging findings were correlated with those of surgery. In all patients, MRI showed an intact iliotibial (ITB) band. MRI showed injury to the biceps tendon in 11 (79%), the gastrocnemius tendon in 1 (7%)), the popliteus tendon in 5 (36%), and the lateral collateral ligament (LCL) in 14 (100%) patients. Tear of the anterior cruciate ligament (ACL) was seen in 11 (79%) patients and tear of the posterior cruciate ligament (PCL) in 4 (29%) patients. With routine MRI, visualization of the popliteofibular or fabellofibular ligaments was incomplete. On MRI, the lateral meniscus and the medial meniscus were torn with equal frequency (n = 4; 29%). Osteochondral defects were seen in 5 (36%) cases and joint effusion in all 14 (100%) cases on MRI. Using surgical findings as the standard for diagnosis, MRI proved 86% accurate in the detection of injury to the ITB band, the biceps tendon (93%), the gastrocnemius tendon (100%), the popliteus tendon (86%), the LCL (100%), the ACL (79%), the PCL (86%), the lateral meniscus (90%), the medial meniscus (82%), and the osteochondral structures (79%). Surgical correlation confirmed the MRI findings of joint effusion in all cases. MRI is well suited for demonstrating the presence and extent of injuries of the major structures of the posterolateral complex of the knee, allowing characterization of the severity of injury.

Muscle contributions to medial tibiofemoral compartment contact loading following ACL reconstruction using semitendinosus and gracilis tendon grafts.

PubMed

Konrath, Jason M; Saxby, David J; Killen, Bryce A; Pizzolato, Claudio; Vertullo, Christopher J; Barrett, Rod S; Lloyd, David G

2017-01-01

The muscle-tendon properties of the semitendinosus (ST) and gracilis (GR) are substantially altered following tendon harvest for the purpose of anterior cruciate ligament reconstruction (ACLR). This study adopted a musculoskeletal modelling approach to determine how the changes to the ST and GR muscle-tendon properties alter their contribution to medial compartment contact loading within the tibiofemoral joint in post ACLR patients, and the extent to which other muscles compensate under the same external loading conditions during walking, running and sidestep cutting. Motion capture and electromyography (EMG) data from 16 lower extremity muscles were acquired during walking, running and cutting in 25 participants that had undergone an ACLR using a quadruple (ST+GR) hamstring auto-graft. An EMG-driven musculoskeletal model was used to estimate the medial compartment contact loads during the stance phase of each gait task. An adjusted model was then created by altering muscle-tendon properties for the ST and GR to reflect their reported changes following ACLR. Parameters for the other muscles in the model were calibrated to match the experimental joint moments. The medial compartment contact loads for the standard and adjusted models were similar. The combined contributions of ST and GR to medial compartment contact load in the adjusted model were reduced by 26%, 17% and 17% during walking, running and cutting, respectively. These deficits were balanced by increases in the contribution made by the semimembranosus muscle of 33% and 22% during running and cutting, respectively. Alterations to the ST and GR muscle-tendon properties in ACLR patients resulted in reduced contribution to medial compartment contact loads during gait tasks, for which the semimembranosus muscle can compensate.

The anatomical and imaging study of pes anserinus and its clinical application

PubMed Central

Zhong, Sheng; Wu, Bo; Wang, Miao; Wang, Xiaohong; Yan, Qi; Fan, Xingyu; Hu, Yanmei; Han, Yingying; Li, Youqiong

2018-01-01

Abstract Background: The pes anserinus was an important graft choice for anterior cruciate ligament (ACL) reconstruction. The infrapatellar branch of the saphenous nerve (IPBSN) might be damaged in this surgery. This study aimed to provide anatomic and ultrasonic measurement data of pes anserinus and superficial nerves. Methods: Eighty lower limb specimens of forty adult cadavers were dissected. The length, width, thickness, and the position of the tibial attachment of pes anserinus tendons were anthropometric measured, as well as the distance between the infrapatellar branch of the saphenous nerve and the pes anserinus. Sixty healthy adult participants were enrolled for ultrasonic research. The length, width, thickness of pes anserinus was also measured and the saphenous nerve was also assessed. Results: Anatomic results showed that there were 3 types of pes anserinus, the infrapatellar branch of the saphenous nerve (IPBSN) was almost paralleled to the upper edge of the pes anserinus tendon, and the average of distance between them was about 0.95 cm. The length of semitendinosus and gracilis tendons were 146.49 ± 12.83 mm and 124.62 ± 8.86 mm, the width of sartorius tendon was 25.58 ± 4.65 mm, wider than other tendons. The classification of pes anserinus tendons and the saphenous nerves could be identified in ultrasonic image. The length of semitendinosus and gracilis tendons were 151.35 ± 9.65 mm and 120.86 ± 8.99 mm, the width of sartorius tendon was 22.84 ± 3.83 mm. And there was no significance difference between anatomic and ultrasonic measurement (P > .05). Conclusion: The morphology of pes anserinus and its peripheral structures could be identified and measured precisely by ultrasound device, a presurgical ultrasonic examination was recommended. The arrangement of pes anserinus tendons was classified into 3 types according to our results. The incision should be performed medial to tibial eminence 1.5 cm and under the tibial tubercle level 2 to 3 cm, an oblique incision formed an angle of 50° with tibial transection was recommend, which was parallel to the direction of pes anserinus tendon. PMID:29642176

Biomechanical comparison between the rectangular-tunnel and the round-tunnel anterior cruciate ligament reconstruction procedures with a bone-patellar tendon-bone graft.

PubMed

Suzuki, Tomoyuki; Shino, Konsei; Otsubo, Hidenori; Suzuki, Daisuke; Mae, Tatsuo; Fujimiya, Mineko; Yamashita, Toshihiko; Fujie, Hiromichi

2014-10-01

The purpose of this study was to evaluate the effectiveness of 2 anterior cruciate ligament (ACL) reconstruction techniques using a bone-patellar tendon-bone (BPTB) graft with femoral tunnel, either a rectangular tunnel (RET) or a round tunnel (ROT). For experiment 1, nine fresh-frozen human cadaveric knees were tested with a robotic/universal force-moment sensor system to determine the initial optimal tension: the amount of graft tension at 15° of flexion most closely resembling the anterior laxity of a normal knee. The value was estimated by repeatedly measuring anterior laxity when 100 N of anteroposterior drawer load was applied to the knees at 30° of flexion after RET ACL or ROT ACL reconstruction. For experiment 2, six fresh-frozen human cadaveric knees were selected. On the basis of the initial tension determined in experiment 1, RET ACL reconstruction was conducted with the graft tensioned to 10 N, followed by ROT ACL reconstruction on the same knee at 40 N of initial tension, and the biomechanical efficacy of the 2 methods was compared. For experiment 1, the mean laxity match tension at 15° of flexion was 8.6 ± 4.8 N and 34.8 ± 9.2 N for RET- and ROT-reconstructed knees, respectively. For experiment 2, both RET and ROT ACL reconstructions were successful in controlling anterior tibial translation under anterior tibial loads, with the graft initially tensioned to 10 N in the former and to 40 N in the latter. However, the greater tensioning in ROT reconstruction led to proximal, posterior, and lateral displacement of the tibia along with its external and valgus rotation. The RET ACL-reconstructed knee more closely resembled the normal knee in biomechanical behavior. Although ROT reconstruction successfully controlled anterior translation with greater initial tensioning to the graft, the normal positional relation between the tibia and femur was impaired. Rectangular femoral ACL fixation constructs and grafts may prove more efficacious at restoring in vivo ACL kinematics than round femoral tunnels. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Comparative evaluation of the results of three techniques in the reconstruction of the anterior cruciate ligament, with a minimum follow-up of two years.

PubMed

Cury, Ricardo de Paula Leite; Sprey, Jan Willem Cerf; Bragatto, André Luiz Lima; Mansano, Marcelo Valentim; Moscovici, Herman Fabian; Guglielmetti, Luiz Gabriel Betoni

2017-01-01

To compare the clinical results of the reconstruction of the anterior cruciate ligament by transtibial, transportal, and outside-in techniques. This was a retrospective study on 90 patients (ACL reconstruction with autologous flexor tendons) operated between August 2009 and June 2012, by the medial transportal (30), transtibial (30), and "outside-in" (30) techniques. The following parameters were assessed: objective and subjective IKDC, Lysholm, KT1000, Lachman test, Pivot-Shift and anterior drawer test. On physical examination, the Lachman test and Pivot-Shift indicated a slight superiority of the outside-in technique, but without statistical significance ( p  = 0.132 and p  = 0.186 respectively). The anterior drawer, KT1000, subjective IKDC, Lysholm, and objective IKDC tests showed similar results in the groups studied. A higher number of complications were observed in the medial transportal technique ( p  = 0.033). There were no statistically significant differences in the clinical results of patients undergoing reconstruction of the anterior cruciate ligament by transtibial, medial transportal, and outside-in techniques.

Bilateral spinal anterior horn lesions in acute motor axonal neuropathy.

PubMed

Sawada, Daisuke; Fujii, Katsunori; Misawa, Sonoko; Shiohama, Tadashi; Fukuhara, Tomoyuki; Fujita, Mayuko; Kuwabara, Satoshi; Shimojo, Naoki

2018-05-28

Guillain-Barré syndrome is an acute immune-mediated peripheral polyneuropathy. Neuroimaging findings from patients with this syndrome have revealed gadolinium enhancement in the cauda equina and in the anterior and posterior nerve roots, but intra-spinal lesions have never been described. Herein, we report, for the first time, bilateral spinal anterior horn lesions in a patient with an acute motor axonal neuropathy form of Guillain-Barré syndrome. The patient was a previously healthy 13-year-old Japanese girl, who exhibited acute-onset flaccid tetraplegia and loss of tendon reflexes. Nerve conduction studies revealed motor axonal damage, leading to the diagnosis of acute motor axonal neuropathy. Notably, spinal magnetic resonance imaging revealed bilateral anterior horn lesions on T2-weighted imaging at the Th11-12 levels, as well as gadolinium enhancement of the cauda equina and anterior and posterior nerve roots. The anterior horn lesions were most prominent on day 18, and their signal intensity declined thereafter. Although intravenous treatment with immunoglobulins was immediately administered, the motor function was not completely regained. We propose that anterior spinal lesions might be responsible for the prolonged neurological disability of patients with Guillain-Barré syndrome, possibly produced by retrograde progression from the affected anterior nerve roots to the intramedullary roots, and the anterior horn motor neurons. Copyright © 2018 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Eden-Hybinette and Pectoralis Major Transfer for Recurrent Shoulder Instability Due to Failed Latarjet and Chronic Subscapularis Rupture.

PubMed

Li, Xinning; Cusano, Antonio; Eichinger, Josef

2017-01-01

Shoulder dislocations are a common injury, with anterior shoulder dislocation among male patients being the most common presentation. A patient with recurrent shoulder instability, anterior-superior escape, and chronic subscapularis tendon rupture following multiple shoulder stabilization surgeries presents the surgeon with a complex and challenging case. This report describes a 40-year-old man with an extensive left shoulder history that included a failed Latarjet procedure, an irreparable, chronic subscapularis tear with grade 4 Goutallier fatty infiltration, and associated anterior-superior escape. Given his marked dysfunction, weakness, pain, and recurrent instability in the absence of glenohumeral arthritis, he underwent an open Eden-Hybinette procedure (iliac crest autograft), a pectoralis major transfer, and an anterior capsule repair. The patient returned to his previous work activities without limitations. To the authors' knowledge, this is the first report describing a combination of anterior glenoid bone grafting with a full pectoralis major muscle transfer for a patient with chronic subscapularis rupture and anterior-superior escape after a failed Latarjet procedure with minimum glenoid bone loss. Furthermore, the authors provide a biomechanical rationale for the reconstruction used for this problem. [Orthopedics. 2017; 40(1):e182-e187.]. Copyright 2016, SLACK Incorporated.

Clinical results of hamstring autografts in anterior cruciate ligament reconstruction: a comparison of femoral knot/press-fit fixation and interference screw fixation.

PubMed

Ho, Wei-Pin; Lee, Chian-Her; Huang, Chang-Hung; Chen, Chih-Hwa; Chuang, Tai-Yuan

2014-07-01

To compare the clinical outcomes of femoral knot/press-fit anterior cruciate ligament (ACL) reconstruction with conventional techniques using femoral interference screws. Among patients who underwent arthroscopic ACL reconstruction with hamstring autografts, 73 were treated with either a femoral knot/press-fit technique (40 patients, group A) or femoral interference screw fixation (33 patients, group B). The clinical results of the 2 groups were retrospectively compared. The inclusion criteria were primary ACL reconstruction in active patients. The exclusion criteria were fractures, multiligamentous injuries, patients undergoing revision, or patients with contralateral ACL-deficient knees. In the femoral knot/press-fit technique, semitendinosus and gracilis tendons were prepared as 2 loops with knots. After passage through a bottleneck femoral tunnel, the grafts were fixed with a press-fit method (grafts' knots were stuck in the bottleneck of the femoral tunnel). A tie with Mersilene tape (Ethicon, Somerville, NJ) over a bone bridge for each tendon loop and an additional bioabsorbable interference screw were used for tibial fixation. The mean follow-up period was 38 months (range, 24 to 61 months). A significant improvement in knee function and symptoms was reported in most patients, as shown by improved Tegner scores, Lysholm knee scores, and International Knee Documentation Committee assessments (P < .01). The results of instrumented laxity testing, thigh muscle assessment, and radiologic assessment were clearly improved when compared with the preoperative status (P < .01). No statistically significant difference in outcomes could be observed between group A and group B (P = not significant). In this nonrandomized study, femoral knot/press-fit ACL reconstruction did not appear to provide increased anterior instability compared with that of conventional femoral interference screw ACL reconstruction. Favorable outcomes with regard to knee stability and patient satisfaction were achieved in most of our ACL-reconstructed patients using femoral knot/press-fit fixation with hamstring tendon autograft. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Enhancement of Tendon–Bone Healing for Anterior Cruciate Ligament (ACL) Reconstruction Using Bone Marrow-Derived Mesenchymal Stem Cells Infected with BMP-2

PubMed Central

Dong, Yu; Zhang, Qingguo; Li, Yunxia; Jiang, Jia; Chen, Shiyi

2012-01-01

At present, due to the growing attention focused on the issue of tendon–bone healing, we carried out an animal study of the use of genetic intervention combined with cell transplantation for the promotion of this process. Here, the efficacy of bone marrow stromal cells infected with bone morphogenetic protein-2 (BMP-2) on tendon–bone healing was determined. A eukaryotic expression vector containing the BMP-2 gene was constructed and bone marrow-derived mesenchymal stem cells (bMSCs) were infected with a lentivirus. Next, we examined the viability of the infected cells and the mRNA and protein levels of BMP-2-infected bMSCs. Gastrocnemius tendons, gastrocnemius tendons wrapped by bMSCs infected with the control virus (bMSCs+Lv-Control), and gastrocnemius tendons wrapped by bMSCs infected with the recombinant BMP-2 virus (bMSCs+Lv-BMP-2) were used to reconstruct the anterior cruciate ligament (ACL) in New Zealand white rabbits. Specimens from each group were harvested four and eight weeks postoperatively and evaluated using biomechanical and histological methods. The bMSCs were infected with the lentivirus at an efficiency close to 100%. The BMP-2 mRNA and protein levels in bMSCs were significantly increased after lentiviral infection. The bMSCs and BMP-2-infected bMSCs on the gastrocnemius tendon improved the biomechanical properties of the graft in the bone tunnel; specifically, bMSCs infected with BMP-2 had a positive effect on tendon–bone healing. In the four-week and eight-week groups, bMSCs+Lv-BMP-2 group exhibited significantly higher maximum loads of 29.3 ± 7.4 N and 45.5 ± 11.9 N, respectively, compared with the control group (19.9 ± 6.4 N and 21.9 ± 4.9 N) (P = 0.041 and P = 0.001, respectively). In the eight-week groups, the stiffness of the bMSCs+Lv-BMP-2 group (32.5 ± 7.3) was significantly higher than that of the bMSCs+Lv-Control group (22.8 ± 7.4) or control groups (12.4 ± 6.0) (p = 0.036 and 0.001, respectively). Based on the histological findings, there was an increased amount of perpendicular collagen fibers formed between the tendon and bone in the bMSCs+Lv-Control and bMSCs+Lv-BMP-2 group, compared with the gastrocnemius tendons. The proliferation of cartilage-like cells and the formation of fibrocartilage-like tissue were highest within the bone tunnels in the bMSCs+Lv-BMP-2 group. These results suggest that this lentivirus can be used to efficiently infect bMSCs with BMP-2. Furthermore, tendons wrapped by bMSCs+Lv-BMP-2 improved tendon–bone healing. PMID:23202970

Glenohumeral instability and rotator cuff tear.

PubMed

Porcellini, Giuseppe; Caranzano, Francesco; Campi, Fabrizio; Pellegrini, Andrea; Paladini, Paolo

2011-12-01

The prevalence of rotator cuff tears after traumatic dislocation increases with advancing age, a likely consequence of the age-associated deterioration of the structure and mechanical properties of the tendons of the rotator cuff. These are the effective stabilizers of the glenohumeral joint, compressing the humeral head in the 3-dimensional concavity of the glenohumeral joint. It is impossible to establish whether a lesion of the capsular-labrum complex or of the rotator cuff causes or follows a dislocation, regardless of whether it is anterior or posterior. A peripheral nerve or a brachial plexus injury can be associated with tendon lesion and instability, developing the "terrible triad" of the shoulder. Both conservative and surgical management are possible, and surgeons must choose the most appropriate management modality according to the biologic age, functional demands, and type of lesion.

A tricalcium phosphate/polyether ether ketone anchor bionic fixation device for anterior cruciate ligament reconstruction: Safety and efficacy in a beagle model.

PubMed

Mao, Genwen; Qin, Zili; Li, Zheng; Li, Xiang; Qiu, Yusheng; Bian, Weiguo

2018-05-02

The goal of this study was to develop a bionic fixation device based on the use of a tricalcium phosphate/polyether ether ketone anchor and harvesting of the ulnar carpal flexor muscle tendon for application as a ligament graft in a beagle anterior cruciate ligament (ACL) reconstruction model, with the goal of accelerating the ligament graft-to-bone tunnel healing and providing a robust stability through exploration of this new kind of autologous ligament graft. The safety and efficacy of this fixation device were explored 3 and 6 months after surgery in a beagle ACL reconstruction model using biomechanical tests and comprehensive histological observation. The data were compared using a two-tailed Student's t test and a paired t test. A p value <0.05 was defined as statistically significant. All the models were successfully established. This fixation device possessed the excellent mechanical properties for ACL reconstruction. A comprehensive histological observation revealed that a cartilage layer was visible in the transition zone between the tendon and bone interface at both 3 and 6 months postoperation. The trabecular of the new bone was observed six months after surgery and was found to be similar to a direct connection. This fixation technique provided not only a robust primary mechanical fixation but also a bionic fixation for long-term knee joint stability by accelerating the healing of the tendon to the bone tunnel, showing a high potential for use in clinical practice. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc.

Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

PubMed

Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

2014-12-01

Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p < 0.02) and used less narcotic use (average 1.7 tablets, p < 0.02) for the first 36 hours compared with group 1. No statistically significant differences were identified between the two groups with regard to demographics, hours of postoperative cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Excessive glenohumeral horizontal abduction as occurs during the late cocking phase of the throwing motion can be critical for internal impingement.

PubMed

Mihata, Teruhisa; McGarry, Michelle H; Kinoshita, Mitsuo; Lee, Thay Q

2010-02-01

The objective of this study was to determine the effects of increased horizontal abduction with maximum external rotation, as occurs during the late cocking phase of throwing motion, on shoulder internal impingement. An increase in glenohumeral horizontal abduction will cause overlap of the rotator cuff insertion with respect to the glenoid and increase pressure between the supraspinatus and infraspinatus tendon insertions on the greater tuberosity and the glenoid. Controlled laboratory study. Eight cadaveric shoulders were tested with a custom shoulder testing system with the specimens in 60 degrees of glenohumeral abduction and maximum external rotation. The amount of internal impingement was evaluated by assessing the location of the supraspinatus and infraspinatus articular insertions on the greater tuberosity relative to the glenoid using a MicroScribe 3DLX. Pressure in the posterior-superior quadrant of the glenoid was measured using Fuji prescale film. Data were obtained with the humerus in the scapular plane and 15 degrees , 30 degrees , and 45 degrees of horizontal abduction from the scapular plane. At 30 degrees and 45 degrees of horizontal abduction, the articular margin of the supraspinatus and infraspinatus tendons was anterior to the posterior edge of the glenoid and less than 2 mm from the glenoid rim in the lateral direction; the contact pressure was also greater than that found in the scapular plane and 15 degrees of horizontal abduction. Conclusion Horizontal abduction beyond the coronal plane increased the amount of overlap and contact pressure between the supraspinatus and infraspinatus tendons and glenoid. Excessive glenohumeral horizontal abduction beyond the coronal plane may cause internal impingement, which may lead to rotator cuff tears and superior labral anterior to posterior (SLAP) lesions.

Noninvasive Intracranial Pressure and Tissue Oxygen Measurements for Space and Earth

NASA Technical Reports Server (NTRS)

Hargens, A. R.; Ballard, R. E.; Murthy, G.; Watenpaugh, D. E.

1994-01-01

The paper discusses the following: Increasing intracranial pressure in humans during simulated microgravity. and near-infrared monitoring of model chronic compartment syndrome in exercising skeletal muscle. Compared to upright-seated posture, 0 deg. supine, 6 deg. HDT, and 15 deg. HDT produced TMD changes of 317 +/- 112, 403 +/- 114, and 474 +/- 112 n1 (means +/- S.E.), respectively. Furthermore, postural transitions from 0 deg. supine to 6 deg. HDT and from 6 deg. to 15 deg. HDT generated significant TMD changes (p less than 0.05). There was no hysteresis when postural transitions to HDT were compared to reciprocal transitions toward upright seated posture. Currently, diagnosis of chronic compartment syndrome (CCS) depends on measurement of intramuscular pressure by invasive catheterization. We hypothesized that this syndrome can be detected noninvasively by near-infrared (NIR) spectroscopy, which tracks variations in muscle hemoglobin/myoglobin oxygen saturation. CCS was simulated in the tibialis anterior muscle of 7 male and 3 female subjects by gradual inflation of a cuff placed around the leg to 40 mmHg during 14 minutes of cyclic isokinetic dorsiflexion exercise. On a separate day, subjects underwent the identical exercise protocol with no external compression. In both cases, tissue oxygenation (T(sub O2) was measured in the tibialis anterior by NIR spectroscopy and normalized to a percentage scale between baseline and a T(sub O2) nadir reached during exercise to ischemic exhaustion. Over the course of exercise, T(sub O2) declined at a rate of 1.4 +/- 0.3% per minute with model CCS, yet did not decrease during control exercise. Post-exercise recovery of T(sub O2) was slower with model CCS (2.5 +/- 0.6 min) than in control (1.3 +/- 0.2 min). These results demonstrate that NIR spectroscopy can detect muscle deoxygenation caused by pathologically elevated intramuscular pressure in exercising skeletal muscle. Consequently, this technique shows promise as a noninvasive diagnostic tool for CCS.

Gait bradykinesia in Parkinson's disease: a change in the motor program which controls the synergy of gait.

PubMed

Warabi, Tateo; Furuyama, Hiroyasu; Sugai, Eri; Kato, Masamichi; Yanagisawa, Nobuo

2018-01-01

This study examined how gait bradykinesia is changed by the motor programming in Parkinson's disease. Thirty-five idiopathic Parkinson's disease patients and nine age-matched healthy subjects participated in this study. After the patients fixated on a visual-fixation target (conditioning-stimulus), the voluntary-gait was triggered by a visual on-stimulus. While the subject walked on a level floor, soleus, tibialis anterior EMG latencies, and the y-axis-vector of the sole-floor reaction force were examined. Three paradigms were used to distinguish between the off-/on-latencies. The gap-task: the visual-fixation target was turned off; 200 ms before the on-stimulus was engaged (resulting in a 200 ms-gap). EMG latency was not influenced by the visual-fixation target. The overlap-task: the on-stimulus was turned on during the visual-fixation target presentation (200 ms-overlap). The no-gap-task: the fixation target was turned off and the on-stimulus was turned on simultaneously. The onset of EMG pause following the tonic soleus EMG was defined as the off-latency of posture (termination). The onset of the tibialis anterior EMG burst was defined as the on-latency of gait (initiation). In the gap-task, the on-latency was unchanged in all of the subjects. In Parkinson's disease, the visual-fixation target prolonged both the off-/on-latencies in the overlap-task. In all tasks, the off-latency was prolonged and the off-/on-latencies were unsynchronized, which changed the synergic movement to a slow, short-step-gait. The synergy of gait was regulated by two independent sensory-motor programs of the off- and on-latency levels. In Parkinson's disease, the delayed gait initiation was due to the difficulty in terminating the sensory-motor program which controls the subject's fixation. The dynamic gait bradykinesia was involved in the difficulty (long off-latency) in terminating the motor program of the prior posture/movement.

Motor unit number estimates and neuromuscular transmission in the tibialis anterior of master athletes: evidence that athletic older people are not spared from age-related motor unit remodeling.

PubMed

Piasecki, Mathew; Ireland, Alex; Coulson, Jessica; Stashuk, Dan W; Hamilton-Wright, Andrew; Swiecicka, Agnieszka; Rutter, Martin K; McPhee, Jamie S; Jones, David A

2016-10-01

Muscle motor unit numbers decrease markedly in old age, while remaining motor units are enlarged and can have reduced neuromuscular junction transmission stability. However, it is possible that regular intense physical activity throughout life can attenuate this remodeling. The aim of this study was to compare the number, size, and neuromuscular junction transmission stability of tibialis anterior (TA) motor units in healthy young and older men with those of exceptionally active master runners. The distribution of motor unit potential (MUP) size was determined from intramuscular electromyographic signals recorded in healthy male Young (mean ± SD, 26 ± 5 years), Old (71 ± 4 years) and Master Athletes (69 ± 3 years). Relative differences between groups in numbers of motor units was assessed using two methods, one comparing MUP size and muscle cross-sectional area (CSA) determined with MRI, the other comparing surface recorded MUPs with maximal compound muscle action potentials and commonly known as a "motor unit number estimate (MUNE)". Near fiber (NF) jiggle was measured to assess neuromuscular junction transmission stability. TA CSA did not differ between groups. MUNE values for the Old and Master Athletes were 45% and 40%, respectively, of the Young. Intramuscular MUPs of Old and Master Athletes were 43% and 56% larger than Young. NF jiggle was slightly higher in the Master Athletes, with no difference between Young and Old. These results show substantial and similar motor unit loss and remodeling in Master Athletes and Old individuals compared with Young, which suggests that lifelong training does not attenuate the age-related loss of motor units. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Lower limb muscle activity during forefoot and rearfoot strike running techniques.

PubMed

Landreneau, Lindsey L; Watts, Kayla; Heitzman, Jill E; Childers, W Lee

2014-12-01

Distance running offers a method to improve fitness but also has a risk of lower limb overuse injuries. Foot strike technique has been suggested as a method to alter loading of the lower limb and possibly minimize injury risk. However, there is a dearth of information regarding neuromuscular response to variations in running techniques. The purpose of this investigation was to compare the EMG activity that occurs during FFS running and RFS running, focusing on the biceps femoris, semitendenosis, rectus femoris, vastus medialis oblique, tibialis anterior (TA), medial head of gastrocnemeus (MGas), lateral head of gastrocnemius (LGas), and soleus. healthy adults (6 male, 8 female; age, 24.2 ± 0.8 years, height 170.1 ± 7.8 cm; mass 69.8 ±10.9 kg; Body Mass Index 24.1 ± 3.0 kg·m2) participated in the study. All participants performed a RFS and FFS running trial at 8.85 kph. A 3D motion capture system was used to collect kinematic data and electromyography was used to define muscle activity. Two-tailed paired t-tests were used to examine differences in outcomes between RFS and FFS conditions. The ankle was significantly more plantarflexed during FFS running (p = .0001) but there were no significant differences in knee and hip angles (p = .618 & .200, respectively). There was significantly less activity in tibialis anterior (TA) (p < .0001) and greater activity in the MGas (p= .020) during FFS running. The LGas and soleus did not change activity (p = .437 & .490, respectively). FFS running demonstrated lower muscular activity in the TA and increased activation in the MGas. FFS and RFS running have the potential to off-load injury prone tissues by changing between techniques. However, future studies will be necessary to establish more direct mechanistic connections between running technique and injury.

Non-invasive measurement of tibialis anterior muscle temperature during rest, cycling exercise and post-exercise recovery.

PubMed

Flouris, Andreas D; Dinas, Petros C; Tsitoglou, Kiriakos; Patramani, Ioanna; Koutedakis, Yiannis; Kenny, Glen P

2015-07-01

We introduce a non-invasive and accurate method to assess tibialis anterior muscle temperature (Tm) during rest, cycling exercise, and post-exercise recovery using the insulation disk (INDISK) technique. Twenty-six healthy males (23.6  ±  6.2 years; 24.1  ±  3.1 body mass index) were randomly allocated into the 'model' (n = 16) and the 'validation' (n = 10) groups. Participants underwent 20 min supine rest, 20 min cycling exercise at 60% of age-predicted maximum heart rate, and 20 min supine post-exercise recovery. In the model group, Tm (34.55  ±  1.02 °C) was greater than INDISK temperature (Tid; 32.44  ±  1.23 °C; p < 0.001) and skin surface temperature (Tsk; 29.84  ±  1.47 °C; p < 0.001) throughout the experimental protocol. The strongest prediction model (R(2) = 0.646) incorporated Tid and the difference between the current Tid temperature and that recorded four minutes before. No mean difference (p > 0.05) and a strong correlation (r = 0.804; p < 0.001) were observed between Tm and predicted Tm (predTm) in the model group. Cross-validation analyses in the validation group demonstrated no mean difference (p > 0.05), a strong correlation (r = 0.644; p < 0.001), narrow 95% limits of agreement (-0.06  ±  1.51), and low percent coefficient of variation (2.24%) between Tm (34.39  ±  1.00 °C) and predTm (34.45  ±  0.73 °C). We conclude that the novel technique accurately predicts Tm during rest, cycling exercise, and post-exercise recovery, providing a valid and cost-efficient alternative when direct Tm measurement is not feasible.

Intra and inter-session reliability of rapid Transcranial Magnetic Stimulation stimulus-response curves of tibialis anterior muscle in healthy older adults.

PubMed

Peri, Elisabetta; Ambrosini, Emilia; Colombo, Vera Maria; van de Ruit, Mark; Grey, Michael J; Monticone, Marco; Ferriero, Giorgio; Pedrocchi, Alessandra; Ferrigno, Giancarlo; Ferrante, Simona

2017-01-01

The clinical use of Transcranial Magnetic Stimulation (TMS) as a technique to assess corticospinal excitability is limited by the time for data acquisition and the measurement variability. This study aimed at evaluating the reliability of Stimulus-Response (SR) curves acquired with a recently proposed rapid protocol on tibialis anterior muscle of healthy older adults. Twenty-four neurologically-intact adults (age:55-75 years) were recruited for this test-retest study. During each session, six SR curves, 3 at rest and 3 during isometric muscle contractions at 5% of maximum voluntary contraction (MVC), were acquired. Motor Evoked Potentials (MEPs) were normalized to the maximum peripherally evoked response; the coil position and orientation were monitored with an optical tracking system. Intra- and inter-session reliability of motor threshold (MT), area under the curve (AURC), MEPmax, stimulation intensity at which the MEP is mid-way between MEPmax and MEPmin (I50), slope in I50, MEP latency, and silent period (SP) were assessed in terms of Standard Error of Measurement (SEM), relative SEM, Minimum Detectable Change (MDC), and Intraclass Correlation Coefficient (ICC). The relative SEM was ≤10% for MT, I50, latency and SP both at rest and 5%MVC, while it ranged between 11% and 37% for AURC, MEPmax, and slope. MDC values were overall quite large; e.g., MT required a change of 12%MSO at rest and 10%MSO at 5%MVC to be considered a real change. Inter-sessions ICC were >0.6 for all measures but slope at rest and MEPmax and latency at 5%MVC. Measures derived from SR curves acquired in <4 minutes are affected by similar measurement errors to those found with long-lasting protocols, suggesting that the rapid method is at least as reliable as the traditional methods. As specifically designed to include older adults, this study provides normative data for future studies involving older neurological patients (e.g. stroke survivors).

Reciprocal inhibition between motor neurons of the tibialis anterior and triceps surae in humans.

PubMed

Yavuz, Utku Ş; Negro, Francesco; Diedrichs, Robin; Farina, Dario

2018-05-01

Motor neurons innervating antagonist muscles receive reciprocal inhibitory afferent inputs to facilitate the joint movement in the two directions. The present study investigates the mutual transmission of reciprocal inhibitory afferent inputs between the tibialis anterior (TA) and triceps surae (soleus and medial gastrocnemius) motor units. We assessed this mutual mechanism in large populations of motor units for building a statistical distribution of the inhibition amplitudes during standardized input to the motor neuron pools to minimize the effect of modulatory pathways. Single motor unit activities were identified using high-density surface electromyography (HDsEMG) recorded from the TA, soleus (Sol), and medial gastrocnemius (GM) muscles during isometric dorsi- and plantarflexion. Reciprocal inhibition on the antagonist muscle was elicited by electrical stimulation of the tibial (TN) or common peroneal nerves (CPN). The probability density distributions of reflex strength for each muscle were estimated to examine the strength of mutual transmission of reciprocal inhibitory input. The results showed that the strength of reciprocal inhibition in the TA motor units was fourfold greater than for the GM and the Sol motor units. This suggests an asymmetric transmission of reciprocal inhibition between ankle extensor and flexor muscles. This asymmetry cannot be explained by differences in motor unit type composition between the investigated muscles since we sampled low-threshold motor units in all cases. Therefore, the differences observed for the strength of inhibition are presumably due to a differential reciprocal spindle afferent input and the relative contribution of nonreciprocal inhibitory pathways. NEW & NOTEWORTHY We investigated the mutual transmission of reciprocal inhibition in large samples of motor units using a standardized input (electrical stimulation) to the motor neurons. The results demonstrated that the disynaptic reciprocal inhibition exerted between ankle flexor and extensor muscles is asymmetric. The functional implication of asymmetric transmission may be associated with the neural strategies of postural control.

Are automatic postural responses in patients with Parkinson's disease abnormal due to their stooped posture?

PubMed

Bloem, B R; Beckley, D J; van Dijk, J G

1999-02-01

Abnormal automatic postural responses are thought to contribute to balance impairment in Parkinson's disease. However, because postural responses are modifiable by stance, we have speculated that some postural abnormalities in patients with Parkinson's disease are secondary to their stooped stance. We have studied this assumption by assessing automatic postural responses in 30 healthy subjects who were instructed either to stand upright or to assume a typical parkinsonian posture. During both conditions, subjects received 20 serial 4 degrees 'toe-up' rotational perturbations from a supporting forceplate. We recorded short-latency (SL) and medium-latency (ML) responses from stretched gastrocnemius muscles and long-latency (LL) responses from shortened tibialis anterior muscles. We also assessed changes in the center of foot pressure (CFP) and the center of gravity (COG). The results were qualitatively compared to a previously described group of patients with Parkinson's disease who, under these circumstances, typically have large ML responses, small LL responses and insufficient voluntary postural corrections, accompanied by a slow rate of backward CFP displacement and an increased posterior COG displacement. The stooped posture resulted in unloading of medial gastrocnemius muscles and loading of tibialis anterior muscles. Onset latencies of stretch responses in gastrocnemius muscles were delayed in stooped subjects, but the onset of LL responses was markedly reduced. Amplitudes of both ML and LL responses were reduced in stooped subjects. Prestimulus COG and, to a lesser extent, CFP were shifted forwards in stooped subjects. Posterior COG displacement and the rate of backward CFP displacement were diminished in stooped subjects. Voluntary postural corrections were unchanged while standing stooped. These results indicate that some postural abnormalities of patients with Parkinson's disease (most notably the reduced LL responses) can be reproduced in healthy subjects mimicking a stooped parkinsonian posture. Other postural abnormalities (most notably the increased ML responses and insufficient voluntary responses) did not appear in stooped controls and may contribute to balance impairment in Parkinson's disease.

Natural disease history of mouse models for limb girdle muscular dystrophy types 2D and 2F

PubMed Central

Putker, K.; Tanganyika-de Winter, C. L.; Boertje-van der Meulen, J. W.; van Vliet, L.; Overzier, M.; Plomp, J. J.; Aartsma-Rus, A.; van Putten, M.

2017-01-01

Limb-girdle muscular dystrophy types 2D and 2F (LGMD 2D and 2F) are autosomal recessive disorders caused by mutations in the alpha- and delta sarcoglycan genes, respectively, leading to severe muscle weakness and degeneration. The cause of the disease has been well characterized and a number of animal models are available for pre-clinical studies to test potential therapeutic interventions. To facilitate transition from drug discovery to clinical trials, standardized procedures and natural disease history data were collected for these mouse models. Implementing the TREAD-NMD standardized operating procedures, we here subjected LGMD2D (SGCA-null), LGMD2F (SGCD-null) and wild type (C57BL/6J) mice to five functional tests from the age of 4 to 32 weeks. To assess whether the functional test regime interfered with disease pathology, sedentary groups were taken along. Muscle physiology testing of tibialis anterior muscle was performed at the age of 34 weeks. Muscle histopathology and gene expression was analysed in skeletal muscles and heart. Muscle histopathology and gene expression was analysed in skeletal muscles and heart. Mice successfully accomplished the functional tests, which did not interfere with disease pathology. Muscle function of SGCA- and SGCD-null mice was impaired and declined over time. Interestingly, female SGCD-null mice outperformed males in the two and four limb hanging tests, which proved the most suitable non-invasive tests to assess muscle function. Muscle physiology testing of tibialis anterior muscle revealed lower specific force and higher susceptibility to eccentric-induced damage in LGMD mice. Analyzing muscle histopathology and gene expression, we identified the diaphragm as the most affected muscle in LGMD strains. Cardiac fibrosis was found in SGCD-null mice, being more severe in males than in females. Our study offers a comprehensive natural history dataset which will be useful to design standardized tests and future pre-clinical studies in LGMD2D and 2F mice. PMID:28797108

[Relationship between muscle activity and kinematics of the lower extremity in slow motions of squats in humans].

PubMed

Khorievin, V I; Horkovenko, A V; Vereshchaka, I V

2013-01-01

Squatting can be performed on ankle strategy when ankle joint is flexed more than a hip joint and on hip strategy when large changes occur at the hip joint. The relationships between changes ofjoint angles and electromyogram (EMG) of the leg muscles were studied in five healthy men during squatting that was performed at the ankle and hip strategies with a slow changes in the knee angle of 40 and 60 degrees. It is established that at ankle strategy the ankle muscles were activated ahead of joint angle changes and shifting the center of pressure (CT) on stabilographic platform, whereas activation of the thigh muscles began simultaneously with the change of the joint angles, showing the clear adaptation in successive trials and a linear relationships between the static EMG component and the angle changes of the ankle joint. In the case of hip strategy of squatting the thigh muscles were activated simultaneously with the change in the joint angles and the displacement of CT, whereas the ankle muscles were activated later than the thigh muscles, especially the muscle tibialis anterior, showing some adaptations in consecutive attempts. At the ankle strategy the EMG amplitude was greatest in thigh muscles, reproducing contour of changes in joint angles, whereas the ankle muscles were activated only slightly during changes of joint angles. In the case of hip strategy dominated the EMG amplitude of the muscle tibialis anterior, which was activated when driving down the trunk and fixation of the joint angles that was accompanied by a slight coactivation of the calf muscles with the step-like increase in the amplitude of the EMG of the thigh muscles. Choice of leg muscles to start the squatting on both strategies occurred without a definite pattern, which may indicate the existence of a wide range of options for muscle activity in a single strategy.

Convergence of flexor reflex and corticospinal inputs on tibialis anterior network in humans.

PubMed

Mackey, Ann S; Uttaro, Denise; McDonough, Maureen P; Krivis, Lisa I; Knikou, Maria

2016-01-01

Integration between descending and ascending inputs at supraspinal and spinal levels is a key characteristic of neural control of movement. In this study, we characterized convergence of the flexor reflex and corticospinal inputs on the tibialis anterior (TA) network in healthy human subjects. Specifically, we characterized the modulation profiles of the spinal TA flexor reflex following subthreshold and suprathreshold transcranial magnetic stimulation (TMS). We also characterized the modulation profiles of the TA motor evoked potentials (MEPs) following medial arch foot stimulation at sensory and above reflex threshold. TA flexor reflexes were evoked following stimulation of the medial arch of the foot with a 30 ms pulse train at innocuous intensities. TA MEPs were evoked following TMS of the leg motor cortex area. TMS at 0.7 and at 1.2 MEP resting threshold increased the TA flexor reflex when TMS was delivered 40-100 ms after foot stimulation, and decreased the TA flexor reflex when TMS was delivered 25-110 ms before foot stimulation. Foot stimulation at sensory and above flexor reflex threshold induced a similar time-dependent modulation in resting TA MEPs, that were facilitated when foot stimulation was delivered 40-100 ms before TMS. The flexor reflex and MEPs recorded from the medial hamstring muscle were modulated in a similar manner to that observed for the TA flexor reflex and MEP. Cutaneomuscular afferents from the distal foot can increase the output of the leg motor cortex area. Descending motor volleys that directly or indirectly depolarize flexor motoneurons increase the output of the spinal FRA interneuronal network. The parallel facilitation of flexor MEPs and flexor reflexes is likely cortical in origin. Afferent mediated facilitation of corticospinal excitability can be utilized to strengthen motor cortex output in neurological disorders. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Paraspinal Muscle Passive Stiffness Remodels in Direct Response to Spine Stiffness: A Study Using the ENT1-Deficient Mouse.

PubMed

Gsell, Kelsey Y; Zwambag, Derek P; Fournier, Dale E; Séguin, Cheryle A; Brown, Stephen H M

2017-10-01

Basic science study of the relationship between the structural properties of the spine and its surrounding musculature. To determine whether an increase in spine stiffness causes an inverse compensatory change in the passive stiffness of the adjacent paraspinal muscles. Intervertebral disc degeneration causes an increase in multifidus passive stiffness; this was hypothesized to compensate for a decrease in spine stiffness associated with disc degeneration. Mice lacking equilibrative nucleoside transporter 1 (ENT1) develop progressive ectopic calcification of the fibrous connective tissues of the spine, which affects the lumbar spine by 6 months of age and likely creates a mechanically stiffer spine. Experiments were conducted on four groups of mice (n = 8 mice/group): wild-type (WT) and ENT1 knockout (KO) at 2 or 8 months of age. Lumbar spines were removed and tested in cyclic axial compression to determine neutral zone length and stiffness. Single muscle fibers and bundles of fibers were isolated from lumbar multifidus and erector spinae, as well as tibialis anterior (a non-spine-related control) and tested to determine elastic modulus (passive stiffness). At 2 months of age, neither spine nor muscle stiffness was different between KO and WT. At 8 months of age, compared with WT the lumbar spines of ENT1 KO mice had a stiffer and shorter neutral zone, and the paraspinal muscle fibers were less stiff; however, fiber bundles were not different. In addition, tibialis anterior was not different between KO and WT. This work has confirmed that calcification of spinal connective tissues in the ENT1 KO mouse results in a stiffened spine, whereas the concurrent decrease in muscle fiber elastic modulus in the adjacent paraspinal muscles suggests a direct compensatory relationship between the stiffness of the spine and the muscles that are attached to it. N/A.

Systemic Microgravity Response: Utilizing GeneLab to Develop Hypotheses for Spaceflight Risks

NASA Technical Reports Server (NTRS)

Beheshti, Afshin; Fogle, Homer; Galazka, Jonathan; Kidane, Yared; Chakravarty, Kaushik; Berrios, Daniel C.; Costes, Sylvain V.

2017-01-01

Biological risks associated with microgravity is a major concern for space travel. Although determination of risk has been a focus for NASA research, data examining systemic (i.e., multi- or pan-tissue) responses to space flight are sparse. The overall goal of our work is to identify potential master regulators responsible for such responses to microgravity conditions. To do this we utilized the NASA GeneLab database which contains a wide array of omics experiments, including data from: 1) different flight conditions (space shuttle (STS) missions vs. International Space Station (ISS); 2) different tissues; and 3) different types of assays that measure epigenetic, transcriptional, and protein expression changes. We have performed meta-analysis identifying potential master regulators involved with systemic responses to microgravity. The analysis used 7 different murine and rat data sets, examining the following tissues: liver, kidney, adrenal gland, thymus, mammary gland, skin, and skeletal muscle (soleus, extensor digitorum longus, tibialis anterior, quadriceps, and gastrocnemius). Using a systems biology approach, we were able to determine that p53 and immune related pathways appear central to pan-tissue microgravity responses. Evidence for a universal response in the form of consistency of change across tissues in regulatory pathways was observed in both STS and ISS experiments with varying durations; while degree of change in expression of these master regulators varied across species and strain, some change in these master regulators was universally observed. Interestingly, certain skeletal muscle (gastrocnemius and soleus) show an overall down-regulation in these genes, while in other types (extensor digitorum longus, tibialis anterior and quadriceps) they are up-regulated, suggesting certain muscle tissues may be compensating for atrophy responses caused by microgravity. Studying these organtissue-specific perturbations in molecular signaling networks, we demonstrate the value of GeneLab in characterizing potential master regulators associated with biological risks for spaceflight.

Intramuscular Pressure of Tibialis Anterior Reflects Ankle Torque but Does Not Follow Joint Angle-Torque Relationship.

PubMed

Ateş, Filiz; Davies, Brenda L; Chopra, Swati; Coleman-Wood, Krista; Litchy, William J; Kaufman, Kenton R

2018-01-01

Intramuscular pressure (IMP) is the hydrostatic fluid pressure that is directly related to muscle force production. Electromechanical delay (EMD) provides a link between mechanical and electrophysiological quantities and IMP has potential to detect local electromechanical changes. The goal of this study was to assess the relationship of IMP with the mechanical and electrical characteristics of the tibialis anterior muscle (TA) activity at different ankle positions. We hypothesized that (1) the TA IMP and the surface EMG (sEMG) and fine-wire EMG (fwEMG) correlate to ankle joint torque, (2) the isometric force of TA increases at increased muscle lengths, which were imposed by a change in ankle angle and IMP follows the length-tension relationship characteristics, and (3) the electromechanical delay (EMD) is greater than the EMD of IMP during isometric contractions. Fourteen healthy adults [7 female; mean ( SD ) age = 26.9 (4.2) years old with 25.9 (5.5) kg/m 2 body mass index] performed (i) three isometric dorsiflexion (DF) maximum voluntary contraction (MVC) and (ii) three isometric DF ramp contractions from 0 to 80% MVC at rate of 15% MVC/second at DF, Neutral, and plantarflexion (PF) positions. Ankle torque, IMP, TA fwEMG, and TA sEMG were measured simultaneously. The IMP, fwEMG, and sEMG were significantly correlated to the ankle torque during ramp contractions at each ankle position tested. This suggests that IMP captures in vivo mechanical properties of active muscles. The ankle torque changed significantly at different ankle positions however, the IMP did not reflect the change. This is explained with the opposing effects of higher compartmental pressure at DF in contrast to the increased force at PF position. Additionally, the onset of IMP activity is found to be significantly earlier than the onset of force which indicates that IMP can be designed to detect muscular changes in the course of neuromuscular diseases impairing electromechanical transmission.

Do Subjects with Whiplash-Associated Disorders Respond Differently in the Short-Term to Manual Therapy and Exercise than Those with Mechanical Neck Pain?

PubMed

Castaldo, Matteo; Catena, Antonella; Chiarotto, Alessandro; Fernández-de-Las-Peñas, César; Arendt-Nielsen, Lars

2017-04-01

To compare the short-term effects of manual therapy and exercise on pain, related disability, range of motion, and pressure pain thresholds between subjects with mechanical neck pain and whiplash-associated disorders. Twenty-two subjects with mechanical neck pain and 28 with whiplash-associated disorders participated. Clinical and physical outcomes including neck pain intensity, neck-related disability, and pain area, as well as cervical range of motion and pressure pain thresholds over the upper trapezius and tibialis anterior muscles, were obtained at baseline and after the intervention by a blinded assessor. Each subject received six sessions of manual therapy and specific neck exercises. Mixed-model repeated measures analyses of covariance (ANCOVAs) were used for the analyses. Subjects with whiplash-associated disorders exhibited higher neck-related disability ( P  = 0.021), larger pain area ( P  = 0.003), and lower pressure pain thresholds in the tibialis anterior muscle ( P  = 0.009) than those with mechanical neck pain. The adjusted ANCOVA revealed no between-group differences for any outcome (all P  > 0.15). A significant main effect of time was demonstrated for clinical outcomes and cervical range of motion with both groups experiencing similar improvements (all P  < 0.01). No changes in pressure pain thresholds were observed in either group after treatment ( P  > 0.222). The current clinical trial found that subjects with mechanical neck pain and whiplash-associated disorders exhibited similar clinical and neurophysiological responses after a multimodal physical therapy intervention, suggesting that although greater signs of central sensitization are present in subjects with whiplash-associated disorders, this does not alter the response in the short term to manual therapy and exercises. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

EMG analysis of peroneal and tibialis anterior muscle activity prior to foot contact during functional activities.

PubMed

McLoda, T A; Hansen, A J; Birrer, D A

2004-06-01

The purpose of this investigation was to determine the pre-activity of the tibialis anterior (TA), peroneus longus (PL), and peroneus brevis (PB) prior to foot contact during three conditions. Twenty-six subjects (age 22 +/- 2 yrs; 15 male, 11 female) with no lower extremity injuries reported for data collection. Data were collected from each subject's dominant leg using surface electromyography (EMG). EMG electrodes were applied over the test muscles using a standard protocol. A heel-toe strike transducer was affixed to the bottom of the subject's shoe. The subject completed two randomized trials of walking on a treadmill (5.6 kph), jogging on a treadmill (9.3 kph) and drop landing from a 38 cm box. Isometric reference positions (IRPs) were recorded for the TA, PL, and PB. Muscle data were normalized to IRPs and the average processed EMG for the 200 ms prior to heel strike during walking and jogging and prior to toe strike when dropping from the box was used for analysis. A one-way repeated measures MANOVA was used to detect differences in pre-activity of the muscles between the three conditions. Univariate tests were used to determine differences for each muscle and Tukey's was applied post hoc to determine individual effect differences. The MANOVA revealed significant differences among the three conditions (F2.50 = 10.770; P < .0005). Average TA activity was significantly higher during jogging (Tukey's; P < .0005). Significant differences existed between each condition for the TA. Average PL and PB activity was significantly higher when drop landing (Tukey's; P < .0005). There was no significant difference between walking and jogging for the PL and PB. The amount of muscle pre-activity occurring before heel or toe strike provides useful information for the examination of reaction times to unexpected inversion during dynamic activities.

Dependence of the paired motor unit analysis on motor unit discharge characteristics in the human tibialis anterior muscle

PubMed Central

Stephenson, Jennifer L.; Maluf, Katrina S.

2011-01-01

The paired motor unit analysis provides in vivo estimates of the magnitude of persistent inward currents (PIC) in human motoneurons by quantifying changes in the firing rate (ΔF) of an earlier recruited (reference) motor unit at the time of recruitment and derecruitment of a later recruited (test) motor unit. This study assessed the variability of ΔF estimates, and quantified the dependence of ΔF on the discharge characteristics of the motor units selected for analysis. ΔF was calculated for 158 pairs of motor units recorded from nine healthy individuals during repeated submaximal contractions of the tibialis anterior muscle. The mean (SD) ΔF was 3.7 (2.5) pps (range −4.2 to 8.9 pps). The median absolute difference in ΔF for the same motor unit pair across trials was 1.8 pps, and the minimal detectable change in ΔF required to exceed measurement error was 4.8 pps. ΔF was positively related to the amount of discharge rate modulation in the reference motor unit (r2=0.335; P<0.001), and inversely related to the rate of increase in discharge rate (r2=0.125; P<0.001). A quadratic function provided the best fit for relations between ΔF and the time between recruitment of the reference and test motor units (r2=0.229, P<0.001), the duration of test motor unit activity (r2=0.110, P<0.001), and the recruitment threshold of the test motor unit (r2=0.237, P<0.001). Physiological and methodological contributions to the variability in ΔF estimates of PIC magnitude are discussed, and selection criteria to reduce these sources of variability are suggested for the paired motor unit analysis. PMID:21459110

Homologies of the transversospinalis muscles in the anterior presacral region of Sauria (crown Diapsida).

PubMed

Tsuihiji, Takanobu

2005-02-01

Homologies of muscles of the m. transversospinalis group in the dorsal and cervical regions in Sauria are established based on detailed dissections and published accounts of lepidosaurs, crocodylians, and birds. Attachments and directions of tendons comprising this muscle group are fairly conserved among the saurian clades, enabling rather robust inferences on muscle homologies. The innervation pattern indicates that mm. ascendentes are the most lateral muscles of the m. transversospinalis group in Aves, and are inferred to be homologous with the crocodylian m. tendinoarticularis based on their topological similarities. It is suggested here that the lepidosaurian articulo-parietalis part of m. longissimus cervico-capitis actually belongs to the m. transversospinalis group because its tendons of origin are shared with those of m. semispinalis. The avian m. complexus and the lateral part of the crocodylian m. transversospinalis capitis have origins and insertions similar to this lepidosaurian muscle, and are proposed to be homologous with the latter. In some birds, m. longus colli dorsalis, pars profunda continues directly into the anterior cervical region as m. splenius accessorius, suggesting a serially homologous relationship. Similarly, m. splenius anticus continues anteriorly from m. longus colli dorsalis, pars cranialis, and both of these muscles lie dorsal to m. splenius accessorius. Therefore, the currently used nomenclature that regards m. splenius accessorius as a part of m. longus colli dorsalis, pars cranialis and that regards m. splenius anticus as a part of the former muscle does not accurately reflect the serial homologies among these muscles and may not be justified. Copyright 2004 Wiley-Liss, Inc.

INTEGRITY OF THE SUBSCAPULARIS TENDON AFTER OPEN SURGERY FOR THE TREATMENT OF ANTERIOR SHOULDER INSTABILITY: A CLINICAL AND RADIOLOGICAL EVALUATION.

PubMed

Lech, Osvandré; Piluski, Paulo; Tambani, Renato; Castro, Nero; Pimentel, Gilnei

2009-01-01

To evaluate the integrity of the subscapularis tendon by strength, function and magnetic resonance imaging after deltopectoralis access for anterior shoulder instability. 20 patients with anterior shoulder instability have been evaluated. Minimum follow-up was 12 months, with a mean of 40 months. Only male patients were included, with a mean of age of 29 years (20 - 42 years). The patients have been submitted to physical examinations of mobility, muscular strength, Belly Test and Gerber Test. The isokinetic strength in internal and external rotation, in angular speeds of 60(0)/s and 180(0)/s, for both shoulders was measured using a dynamometer. In 15 patients magnetic resonance imaging (MRI) was carried out on both shoulders for evaluating the thickness, cross-sectional area and atrophy of the subscapularis muscle. A significant difference was found between torque peaks at the speed of 60(0)/s for internal (p=0.036) and external (p=0.008) rotation. However, at 180(0)/s the opposite happens (internal rotation: p=0.133; external rotation: p=0.393). Subscapularis muscle thickness and area are significantly smaller than the normal side, with a deficit of 19% and 23%, respectively. According to Rowe and UCLA scores, we find excellent and good results for the majority of patients, with a mean of 88 and 31.6 points, respectively. Despite of the good functional results, open surgery can limit strength and reduce the thickness and the cross-sectional area of subscapularis muscle. However, the best results were found in the patients who had the dominant side operated.

Tibial plateau fracture after anterior cruciate ligament reconstruction: Role of the interference screw resorption in the stress riser effect.

PubMed

Thaunat, Mathieu; Nourissat, Geoffroy; Gaudin, Pascal; Beaufils, Philippe

2006-06-01

We report a case of tibial plateau fracture after previous anterior cruciate ligament (ACL) reconstruction using patellar tendon autograft and bioabsorbable screws 4 years previously. The fracture occurred through the tibial tunnel. The interference screw had undergone complete resorption and the tunnel widening had increased. The resorption of the interference screw did not simultaneously promote and foster the growth of surrounding bone tissue. Therefore, the area of reactive tissue left by the screw resorption in an enlarged bone tunnel may lead to vulnerability of the tibial plateau. Stress risers would occur following ACL reconstruction if either resorption is not complete or bony integration is not complete.

A rare variation of the digastric muscle

PubMed Central

KALNIEV, MANOL; KRASTEV, DIMO; KRASTEV, NIKOLAY; VIDINOV, KALIN; VELTCHEV, LUDMIL; APOSTOLOV, ALEXANDER; MILEVA, MILKA

2013-01-01

The digastric muscle is composed by two muscle bellies: an anterior and a posterior, joined by an intermediate tendon. This muscle is situated in the anterior region of the neck. The region between the hyoid bone and the mandible is divided by an anterior belly into two triangles: the submandibular situated laterally and the submental triangle which is located medially. We found that the anatomical variations described in the literature relate mainly to the anterior belly and consist of differences in shape and attachment of the muscle. During routine dissection in February 2013 in the section hall of the Department of Anatomy and Histology in Medical University – Sofia we came across a very interesting variation of the digastric muscle. The digastric muscles that presented anatomical variations were photographed using a Sony Cyber-shot DSC-T1 camera, with a Carl Zeiss Vario-Tessar lens. We found out bilateral variation of the digastric muscle in one cadaver. The anterior bellies were very thin and insert to the hyoid bone. Two anterior bellies connect each other and thus they formed a loop. The anatomical variations observed of our study related only to the anterior belly, as previously described by other authors. It is very important to consider the occurrence of the above mentioned variations in the digastric muscle when surgical procedures are performed on the anterior region of the neck. PMID:26527971

Three-dimensional evaluation of cyclic displacement in single-row and double-row rotator cuff reconstructions under static external rotation.

PubMed

Lorbach, Olaf; Kieb, Matthias; Raber, Florian; Busch, Lüder C; Kohn, Dieter M; Pape, Dietrich

2013-01-01

The double-row suture bridge repair was recently introduced and has demonstrated superior biomechanical results and higher yield load compared with the traditional double-row technique. It therefore seemed reasonable to compare this second generation of double-row constructs to the modified single-row double mattress reconstruction. The repair technique, initial tear size, and tendon subregion will have a significant effect on 3-dimensional (3D) cyclic displacement under additional static external rotation of a modified single-row compared with a double-row rotator cuff repair. Controlled laboratory study. Rotator cuff tears (small to medium: 25 mm; medium to large: 35 mm) were created in 24 human cadaveric shoulders. Rotator cuff repairs were performed as modified single-row or double-row repairs, and cyclic loading (10-60 N, 10-100 N) was applied under 20° of external rotation. Radiostereometric analysis was used to calculate cyclic displacement in the anteroposterior (x), craniocaudal (y), and mediolateral (z) planes with a focus on the repair constructs and the initial tear size. Moreover, differences in cyclic displacement of the anterior compared with the posterior tendon subregions were calculated. Significantly lower cyclic displacement was seen in small to medium tears for the single-row compared with double-row repair at 60 and 100 N in the x plane (P = .001) and y plane (P = .001). The results were similar in medium to large tears at 100 N in the x plane (P = .004). Comparison of 25-mm versus 35-mm tears did not show any statistically significant differences for the single-row repairs. In the double-row repairs, lower gap formation was found for the 35-mm tears (P ≤ .05). Comparison of the anterior versus posterior tendon subregions revealed a trend toward higher anterior gap formation, although this was statistically not significant. The tested single-row reconstruction achieved superior results in 3D cyclic displacement to the tested double-row repair. Extension of the initial rupture size did not have a negative effect on the biomechanical results of the tested constructs. Single-row repairs with modified suture configurations provide comparable biomechanical strength to double-row repairs. Furthermore, as increased gap formation in the early postoperative period might lead to failure of the construct, a strong anterior fixation and restricted external rotation protocol might be considered in rotator cuff repairs to avoid this problem.

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

PubMed Central

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

2009-01-01

Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis. The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL) can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL) tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20–25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons. With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to appropriate methodologies used to obtain their biomechanical properties. Specifically, we hope the reader will pay attention to how the properties of these tissues can be altered due to various experimental and biologic factors. Following this background material, we will present how biomechanics can be applied to gain an understanding of the mechanisms as well as clinical management of various ligament and tendon ailments. To conclude, new technology, including imaging and robotics as well as functional tissue engineering, that could form novel treatment strategies to enhance healing of ligament and tendon are presented. PMID:19457264

Predictors and effects of patellofemoral pain following hamstring-tendon ACL reconstruction.

PubMed

Culvenor, Adam G; Collins, Natalie J; Vicenzino, Bill; Cook, Jill L; Whitehead, Timothy S; Morris, Hayden G; Crossley, Kay M

2016-07-01

Patellofemoral pain is a frequent and troublesome complication following anterior cruciate ligament reconstruction (ACLR), irrespective of graft source. Yet, little is known about the factors associated with patellofemoral pain following hamstring-tendon ACLR. Retrospective analysis of potential patellofemoral pain predictors, and cross-sectional analysis of possible patellofemoral pain consequences. Potential predictors (pre-injury patellofemoral pain and activity level, concomitant patellofemoral cartilage damage and meniscectomy, age, sex, and surgical delay) and consequences (hopping performance, quality of life, kinesiophobia, and return to sport rates and attitudes) of patellofemoral pain 12 months following hamstring-tendon ACLR were assessed in 110 participants using univariate and multivariate analyses. Thirty-three participants (30%) had patellofemoral pain at 12 months post-ACLR. Older age at the time of ACLR was the only predictor of post-operative patellofemoral pain. Following ACLR, those with patellofemoral pain had a higher body mass index, and worse physical performance, quality of life, kinesiophobia and return to sport attitudes. Patellofemoral pain has a significant burden on individuals 12 months following hamstring-tendon ACLR. Clinicians need to be cognisant of patellofemoral pain, particularly in older individuals and those with a higher body mass index. The importance of considering psychological factors that are not typically addressed during ACLR rehabilitation, such as kinesiophobia, quality of life and return to sport attitudes is emphasised. Copyright © 2016. Published by Elsevier Ltd.

Proteomic differences between native and tissue-engineered tendon and ligament.

PubMed

Kharaz, Yalda A; Tew, Simon R; Peffers, Mandy; Canty-Laird, Elizabeth G; Comerford, Eithne

2016-05-01

Tendons and ligaments (T/Ls) play key roles in the musculoskeletal system, but they are susceptible to traumatic or age-related rupture, leading to severe morbidity as well as increased susceptibility to degenerative joint diseases such as osteoarthritis. Tissue engineering represents an attractive therapeutic approach to treating T/L injury but it is hampered by our poor understanding of the defining characteristics of the two tissues. The present study aimed to determine differences in the proteomic profile between native T/Ls and tissue engineered (TE) T/L constructs. The canine long digital extensor tendon and anterior cruciate ligament were analyzed along with 3D TE fibrin-based constructs created from their cells. Native tendon and ligament differed in their content of key structural proteins, with the ligament being more abundant in fibrocartilaginous proteins. 3D T/L TE constructs contained less extracellular matrix (ECM) proteins and had a greater proportion of cellular-associated proteins than native tissue, corresponding to their low collagen and high DNA content. Constructs were able to recapitulate native T/L tissue characteristics particularly with regard to ECM proteins. However, 3D T/L TE constructs had similar ECM and cellular protein compositions indicating that cell source may not be an important factor for T/L tissue engineering. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Interactions between COL5A1 Gene and Risk of the Anterior Cruciate Ligament Rupture.

PubMed

Lulińska-Kuklik, Ewelina; Rahim, Masouda; Domańska-Senderowska, Daria; Ficek, Krzysztof; Michałowska-Sawczyn, Monika; Moska, Waldemar; Kaczmarczyk, Mariusz; Brzeziański, Michał; Brzeziańska-Lasota, Ewa; Cięszczyk, Paweł; September, Alison V

2018-06-01

Collagen alpha-1(V) chain, encoded by the COL5A1 gene, plays a crucial role in abundant fibrillar collagens supporting many tissues in the body containing type I collagen and appears to regulate the association between heterotypic fibers composed of both type I and type V collagen occurring among others in muscles, tendons and ligaments. Taking this fact into consideration we decided to examine the association between COL5A1 rs12722 and rs13946 polymorphisms, individually and as inferred haplotypes, with anterior cruciate ligament rupture risk (ACLR) in professional soccer players. A total of 134 male professional soccer players with surgically diagnosed primary anterior cruciate ligament ruptures and 211 apparently healthy male professional soccer players, who were without any self-reported history of ligament or tendon injury, were included in the study. Both the cases and the healthy controls were recruited from the same soccer teams, of a similar age category, and had a comparable level of exposure to anterior cruciate ligament injury. Genomic DNA was extracted from oral epithelial cells using GenElute Mammalian Genomic DNA MiniprepKit. All samples were genotyped for the rs12722 and rs13946 polymorphisms using a Rotor-Gene realtime polymerase chain reaction. Statistically significant differences in the genotype frequencies for the COL5A1 rs13946 polymorphisms in dominant modes of inheritance occurred (p = 0.039). Statistically significant differences were documented only in the dominant model under the representation tendency of the C-C haplotype in the ACLR group compared to controls (p = 0.038). Our results suggest that variation in the COL5A1 gene may be one of the non-modifiable factors associated with the ACL injury in professional soccer players. The C-C rs12722-rs13946 haplotype provides a protective effect against the ACL tear.

Double-layer versus single-layer bone-patellar tendon-bone anterior cruciate ligament reconstruction: a prospective randomized study with 3-year follow-up.

PubMed

Mei, Xiaoliang; Zhang, Zhenxiang; Yang, Jingwen

2016-12-01

To evaluate the clinical results of a randomized controlled trial of single-layer versus double-layer bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. Fifty-eight subjects who underwent primary ACL reconstruction with a BPTB allograft were prospectively randomized into two groups: single-layer reconstruction (n = 31) and double-layer reconstruction (n = 27). The following evaluation methods were used: clinical examination, KT-1000 arthrometer measurement, muscle strength, Tegner activity score, Lysholm score, subjective rating scale regarding patient satisfaction and sports performance level, graft retear, contralateral ACL tear, and additional meniscus surgery. Forty-eight subjects (24 in single-layer group and 24 in double-layer group) who were followed up for 3 years were evaluated. Preoperatively, there were no differences between the groups. At 3-year follow-up, the Lachman and pivot-shift test results were better in the double-layer group (P = 0.019 and P < 0.0001, respectively). KT measurements were better in the double-layer group (mean 2.9 versus 1.5 mm; P = 0.0025). The Tegner score was also better in the double-layer group (P = 0.024). There were no significant differences in range of motion, muscle strength, Lysholm score, subjective rating scale, graft retear, and secondary meniscal tear. In ACL reconstruction, double-layer BPTB reconstruction was significantly better than single-layer reconstruction regarding anterior and rotational stability at 3-year follow-up. The results of KT measurements and the Lachman and pivot-shift tests were significantly better in the double-layer group, whereas there was no difference in the anterior drawer test results. The Tegner score was also better in the double-layer group; however, there were no differences in the other subjective findings.

Myoneural necrosis following high-frequency electrical stimulation of the cast-immobilized rabbit hindlimb

NASA Technical Reports Server (NTRS)

Friden, J.; Lieber, R. L.; Myers, R. R.; Powell, H. C.; Hargens, A. R.

1989-01-01

The morphological and physiological effects of 4 weeks of high-frequency electrical stimulation (1 h/day, 5 days/week) on cast-immobilized rabbit hindlimbs were investigated in the tibialis anterior muscle and peroneal nerve. In 2 out of 6 animals, high-frequency stimulation with immobilization caused muscle fiber death, internalization of muscle fiber nuclei, connective tissue proliferation, inflammatory response, altered fiber size distribution and variable staining intensities. The fast-twitch fibers were predominantly affected. Two of six peripheral nerves subjected to immobilization and stimulation showed severe damage. Tetanic forces were significantly reduced in the affected muscles. Therefore, the immobilization and high-frequency stimulation may be detrimental to myoneural structure and function and, thus, this combination of therapies should be applied conservatively.

Adaptive response of slow and fast skeletal muscle in the monkey to spaceflight

NASA Technical Reports Server (NTRS)

Bodine-Fowler, Sue

1996-01-01

Experiments were designed to determine the effects of the absence of weight support on hindlimb muscles of the monkey: an ankle flexor (tibialis anterior, TA), two ankle extensors (medical gastrocnemius, MG and soleus, SOL), and a knee extensor (vastus lateralis, VL). These experiments will be performed as part of the BION mission. The original project proposed to assess the effects of weightlessness in adult Rhesus monkeys which were to be flown on the Space Shuttle as part of SLS-3. Feasibility studies were carried out and a series of experiments were performed at NASA/Ames Research Center to assess the effects of a 21-day restraint period in the ESOP on muscle properties. The results of these studies are summarized.

Lower Extremity Muscle Thickness During 30-Day 6 degrees Head-Down Bed Rest with Isotonic and Isokinetic Exercise Training

NASA Technical Reports Server (NTRS)

Ellis, S.; Kirby, L. C.; Greenleaf, J. E.

1993-01-01

Muscle thickness was measured in 19 Bed-Rested (BR) men (32-42 year) subjected to IsoTonic (ITE, cycle orgometer) and IsoKi- netic (IKE, torque orgometer) lower extremity exercise training, and NO Exercise (NOE) training. Thickness was measured with ultrasonography in anterior thigh-Rectus Femoris (RF) and Vastus Intermadius (VI), and combined posterior log-soleus, flexor ballucis longus, and tibialis posterior (S + FHL +TP) - muscles. Compared with ambulatory control values, thickness of the (S + FHL + TP) decreased by 90%-12% (p less than 0.05) In all three test groups. The (RF) thickness was unchanged in the two exercise groups, but decreased by 10% (p less than 0.05) in the NOE. The (VI) thickness was unchanged In the ITE group, but decreased by 12%-l6% (p less than 0.05) in the IKE and NOE groups. Thus, intensive, alternating, isotonic cycle ergometer exercise training is as effective as intensive, intermittent, isokinetic exercise training for maintaining thicknesses of rectus femoris and vastus lntermedius anterior thigh muscles, but not posterior log muscles, during prolonged BR deconditioning.

Decellularized Versus Fresh-Frozen Allografts in Anterior Cruciate Ligament Reconstruction: An In Vitro Study in a Rabbit Model.

PubMed

Dong, Shikui; Huangfu, Xiaoqiao; Xie, Guoming; Zhang, Yang; Shen, Peng; Li, Xiaoxi; Qi, Jin; Zhao, Jinzhong

2015-08-01

The common fresh-frozen allografts that are used for anterior cruciate ligament (ACL) reconstructions behave slower during the remodeling process and produce weaker tendon-bone integrations than do autografts. Decellularization of allogenic tendons results in a clean and porous collagen scaffold with low antigenicity and high compatibility, which may be more suitable for ACL reconstructions. Allograft decellularization will result in a tissue structure with suitable mechanical characteristics for ACL reconstruction, thereby promoting graft remodeling and enhancing tendon-bone healing. Controlled laboratory study. Decellularized allograft tissues were prepared with a pH-modified decellularization process and evaluated for their biocompatibility and biomechanical character in vitro. Eighty New Zealand White rabbits were divided into 2 groups, with 40 in each group, to receive ACL reconstruction with either fresh-frozen (common) allografts or decellularized allografts on both knees. At 2, 4, 8, and 12 weeks postoperatively, the rabbits were euthanized for biomechanical testing, micro-computed tomography analysis, and histologic analysis. The pH-modified decellularized allograft tissues kept excellent biocompatibility and biomechanical character during the in vitro study. Biomechanical testing indicated that the decellularized allograft had significantly higher ultimate load (P = .02) and stiffness (P = .01) levels than the common allograft at 12 weeks, and there was no significant difference between the 2 groups at any other time point. The micro-CT evaluation determined significantly higher bone mineral density (P < .01) in the decellularized allograft group than that in the common allograft group at 12 weeks, but no difference between the 2 groups was observed at any other time point. Regarding bone volume/total volume, there was no difference between the 2 groups at any time point. Fibroblast ingrowths, vascular formation, and connective tissue formation in the tendon-bone interface were better in the decellularized group within 8 weeks. New bone formation was more common in the decellularized allograft group. The collagen birefringence was restored more quickly in the decellularized allograft group than in the common allograft group at all time points. The use of pH-modified decellularized allografts compared with the common allografts resulted in better cellularity, vascularity, collagen matrix remolding, new bone formation around the graft, enhanced tendon-bone healing, and higher ultimate failure load and stiffness of the graft after ACL reconstruction in the rabbit model. The pH-modified decellularized allograft may be a better graft option than the common fresh-frozen allograft for knee ligament reconstructions. © 2015 The Author(s).