[Successive ruptures of patellar and Achilles tendons. Anabolic steroids in competitive sports]

Testosterone Replacement Therapy and Associated Rates of Trigger Finger, de Quervain Tenosynovitis, and Their Subsequent Management

PURPOSE

Anabolic steroid therapy has been associated with tendon injury, but there is a paucity of evidence associating physiologic testosterone replacement therapy (TRT) with tenosynovitis of the hand, specifically trigger finger and de Quervain tenosynovitis. The purpose of this study was to evaluate the relationship between TRT and tenosynovitis of the hand.

METHODS

This was a one-to-one exact matched retrospective cohort study using a large nationwide claims database. Records were queried between 2010 and 2019 for adult patients who filled a prescription for TRT for 3 consecutive months. Rates of new onset trigger finger and de Quervain tenosynovitis and subsequent steroid injection or surgery were identified using ICD-9, ICD-10, and Current Procedural Terminology billing codes. Single-variable chi-square analyses and multivariable logistic regression were used to compare rates in the TRT and control cohorts while controlling for potential confounding variables. Both unadjusted and adjusted odds ratios (OR) are reported for each comparison.

RESULTS

In the adjusted analysis, patients undergoing TRT were more than twice as likely to develop trigger finger compared to their matched controls. TRT was also associated with an increased likelihood of experiencing de Quervain tenosynovitis. Of the patients diagnosed with either trigger finger or de Quervain tenosynovitis over the 2-year period, patients with prior TRT were roughly twice as likely to undergo steroid injections or surgical release for both trigger finger and de Quervain tenosynovitis compared to the controls.

CONCLUSIONS

TRT is associated with an increased likelihood of both trigger finger and de Quervain tenosynovitis, and an increased likelihood of requiring surgical release for both conditions.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Spontaneous rupture of the extensor pollicis longus tendon in systemic lupus erythematosus: A case report and literature review

Spontaneous tendon rupture is a rare entity. Herein, we report a case of spontaneous rupture of the extensor pollicis longus (EPL) tendon in a 61-year-old woman with systemic lupus erythematosus (SLE). The patient worked as an aesthetician and had a 42-year history of SLE that was well controlled using oral steroids. She presented with an inability to extend her left thumb, with no prior history of trauma or symptoms. On imaging, there was no evidence of degenerative changes or osteophyte formation in the gliding area of the EPL tendon. Intraoperatively, there was evidence of tendon rupture around Lister's tubercle. We performed a tendon transfer of the extensor indicis proprius for repair. The patient recovered active thumb extension and returned to work 4 months after surgery without any complications. We suspected that spontaneous EPL tendon rupture was caused by a combination of disease-related factors, including long-term steroid use, chronic inflammation, and continuous mechanical stress from her work and daily activity. This case report demonstrates the multifactorial aetiology of spontaneous tendon rupture in patients with SLE and the importance of monitoring for this complication during routine follow-up.

Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study

BACKGROUND

Accumulating case reports have described tendon rupture in men who use anabolic-androgenic steroids (AAS). However, no controlled study has assessed the history of tendon rupture in a large cohort of AAS users and comparison nonusers.

HYPOTHESIS

Men reporting long-term AAS abuse would report an elevated lifetime incidence of tendon rupture compared with non-AAS-using bodybuilders.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Medical histories were obtained from 142 experienced male bodybuilders aged 35 to 55 years recruited in the course of 2 studies. Of these men, 88 reported at least 2 years of cumulative lifetime AAS use, and 54 reported no history of AAS use. In men reporting a history of tendon rupture, the circumstances of the injury, prodromal symptoms, concomitant drug or alcohol use, and details of current and lifetime AAS use (if applicable) were recorded. Surgical records were obtained for most participants.

RESULTS

Nineteen (22%) of the AAS users, but only 3 (6%) of the nonusers, reported at least 1 lifetime tendon rupture. The hazard ratio for a first ruptured tendon in AAS users versus nonusers was 9.0 (95% CI, 2.5-32.3; P < .001). Several men reported 2 or more independent lifetime tendon ruptures. Interestingly, upper-body tendon ruptures occurred exclusively in the AAS group (15 [17%] AAS users vs 0 nonusers; risk difference, 0.17 [95% CI, 0.09-0.25]; P < .001 [hazard ratio not estimable]), whereas there was no significant difference between users and nonusers in risk for lower-body ruptures (6 [7%] AAS users, 3 [6%] nonusers; hazard ratio, 3.1 [95% CI, 0.7-13.8]; P = .13). Of 31 individual tendon ruptures assessed, only 6 (19%) occurred while weightlifting, with the majority occurring during other sports activities. Eight (26%) ruptures followed prodromal symptoms of nonspecific pain in the region. Virtually all ruptures were treated surgically, with complete or near-complete ultimate restoration of function.

CONCLUSION

AAS abusers, compared with otherwise similar bodybuilders, showed a markedly increased risk of tendon ruptures, particularly upper-body tendon rupture.

Spontaneous patellar tendon rupture in a case followed up for diagnosis of systemic lupus erythematosus

Spontaneous patellar tendon rupture is a rare condition that usually occurs secondary to conditions, such as rheumatoid arthritis, systemic lupus erythematosus (SLE), and use of steroids and fluoroquinolones. This paper presents a full-thickness patellar tendon rupture detected with magnetic resonance imaging, which was performed due to pain and swelling that started spontaneously on the front side of the left knee without a history of any trauma, of a 35-year-old male patient who had been followed up for a diagnosis of SLE for approximately 4 months and who had started taking methylprednisolone 4 mg/day 4 months prior, used it for 1 month, and then stopped using it. In patients who are followed up for a diagnosis of SLE, it should be kept in mind that there is a risk of developing a spontaneous tendon rupture secondary to chronic inflammation and use of corticosteroids.

Anabolic androgenic steroids reverse the beneficial effect of exercise on tendon biomechanics: an experimental study

BACKGROUND

The effect of anabolic androgenic steroids on tendons has not yet been fully elucidated. Aim of the present study was the evaluation of the impact of anabolic androgenic steroids on the biomechanical and histological characteristics of Achilles tendons.

METHODS

Twenty-four male Wistar rats were randomized into four groups with exercise and anabolic steroids (nandrolone decanoate) serving as variables. Protocol duration was 12 weeks. Following euthanasia, tendons' biomechanical properties were tested with the use of a modified clamping configuration. Histological examination with light and electron microscopy were also performed.

RESULTS

In the group of anabolic steroids and exercise the lowest fracture stress values were observed, while in the exercise group the highest ones. Histological examination by light and electron microscopy revealed areas of collagen dysplasia and an increased epitendon in the groups receiving anabolic steroids and exercise.

CONCLUSIONS

These findings suggest that anabolic androgenic steroids reverse the beneficial effect of exercise, thus resulting in inferior maximal stress values.

The effect of local use of nandrolone decanoate on rotator cuff repair in rabbits

OBJECTIVE

There is still controversy about the effect of anabolic steroid on connective tissue. This study examines the hypothesis that the local use of nandrolone decanoate, an anabolic steroid on rotator cuff, facilitates the healing process when used in combination with surgical repair.

METHODS

Forty-eight male rabbits were divided in four groups with anabolic steroids (Nandrolone Decanoate 10 mg/kg) and immobilization as variables. The groups were the following: first group, nonsteroid use-immobilization (NSI); second group, nonsteroid use-nonimmobilization (NSNI); third group, steroid use-immobilization (SI); fourth group steroid use-nonimmobilization (SNI). Every rabbit underwent a rotator cuff incision and reconstruction. Fifteen days later the tendons were sent for biomechanical and histological evaluation.

RESULTS

Groups that did not receive anabolic steroids showed better healing and more tendon strength in comparison to groups that received anabolic steroids. Microscopic examination of specimens from the groups without the use of anabolic steroid showed extensive fibroblastic activity whereas the specimens from those groups with anabolic steroid use showed focal fibroblastic reaction and inflammation. Immobilization provided better results in the groups with anabolic steroid use but it did not influence healing in groups without steroids.

CONCLUSIONS

The effect of local nandrolone decanoate use on a rotator cuff tear is detrimental, acting as a healing inhibitor.