1
|
Ivankovic I, Lin HA, Özbek A, Orive A, Deán‐Ben XL, Razansky D. Multispectral Optoacoustic Tomography Enables In Vivo Anatomical and Functional Assessment of Human Tendons. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308336. [PMID: 38445972 PMCID: PMC11095142 DOI: 10.1002/advs.202308336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/11/2023] [Indexed: 03/07/2024]
Abstract
Tendon injuries resulting from accidents and aging are increasing globally. However, key tendon functional parameters such as microvascularity and oxygen perfusion remain inaccessible via the currently available clinical diagnostic tools, resulting in disagreements on optimal treatment options. Here, a new noninvasive method for anatomical and functional characterization of human tendons based on multispectral optoacoustic tomography (MSOT) is reported. Healthy subjects are investigated using a hand-held scanner delivering real-time volumetric images. Tendons in the wrist, ankle, and lower leg are imaged in the near-infrared optical spectrum to utilize endogenous contrast from Type I collagen. Morphology of the flexor carpi ulnaris, carpi radialis, palmaris longus, and Achilles tendons are reconstructed in full. The functional roles of the flexor digitorium longus, hallicus longus, and the tibialis posterior tendons have been visualized by dynamic tracking during toe extension-flexion motion. Furthermore, major vessels and microvasculature near the Achilles tendon are localized, and the global increase in oxygen saturation in response to targeted exercise is confirmed by perfusion studies. MSOT is shown to be a versatile tool capable of anatomical and functional tendon assessments. Future studies including abnormal subjects can validate the method as a viable noninvasive clinical tool for tendinopathy management and healing monitoring.
Collapse
Affiliation(s)
- Ivana Ivankovic
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| | - Hsiao‐Chun Amy Lin
- Department of Biomedical Engineering and Environmental SciencesNational Tsing Hua UniversityNo.101, Sec.2, Kuang‐Fu RdHsinchu300044Taiwan
| | - Ali Özbek
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| | - Ana Orive
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| | - Xosé Luís Deán‐Ben
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| | - Daniel Razansky
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| |
Collapse
|
2
|
Thomsen RS, Nilsen TIL, Haugeberg G, Sitter B, Kavanaugh A, Pedersen SJ, Hoff M. Changes of inflammation in patients with psoriatic arthritis after high intensity interval training assessed by ultrasound and MRI, a randomized controlled trial. BMC Musculoskelet Disord 2023; 24:743. [PMID: 37726677 PMCID: PMC10508016 DOI: 10.1186/s12891-023-06871-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND In psoriatic arthritis (PsA) there is a theoretical risk of increased disease activity related to strenuous physical activity, including exercise. We evaluated the effect of high intensity interval training (HIIT) on objective measures of inflammation in PsA assessed by ultrasound (US) of peripheral joints and entheses, and by bone marrow edema (BME) on MRI of the sacroiliac joints (SIJ) and spine. METHODS We randomly assigned 67 PsA patients to an intervention group that performed structured HIIT for 11 weeks, or to a control group instructed not to change their physical exercise habits. Outcome measures included US evaluation of the total cohort and MRI in a subgroup of 41; both assessed at 3 months. We calculated the proportions with an increased US B-mode and power-doppler (PD) signal of joints and entheses and Spondyloarthritis-Research-Consortium-of-Canada (SPARCC)-BME score of the SIJ and spine for both groups. RESULTS Proportions with an increased US B-mode score of the joints were 32% and 28% in HIIT and control groups, respectively. Corresponding proportions of PD scores of the joints were 7% and 10% and PD scores of entheses were 32% and 31%. The proportions with increased MRI BME of the SIJ were 6% in the HIIT group and 10% in the control group. Corresponding proportions were 6% and 5% for the MRI BME of the spine. CONCLUSION In PsA patients with a low to moderate disease activity, there was no clear evidence of objectively measured increased inflammation after HIIT, as evaluated by US and MRI. TRIAL REGISTRATION ClinicalTrials.gov NCT02995460 (16/12/2016).
Collapse
Affiliation(s)
- Ruth Stoklund Thomsen
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway.
- Department of Circulation and Medical Imaging, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Anaesthesia and Intensive Care, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Glenn Haugeberg
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway
- Division of Rheumatology, Department of Internal Medicine, Hospital of Southern Norway Trust, Kristiansand, Norway
| | - Beathe Sitter
- Department of Circulation and Medical Imaging, NTNU, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, School of Medicine, University of California, San Diego, USA
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Disease, Rigshospitalet, Denmark
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, NTNU, Faculty of Medicine, Norwegian University of Science and Technology, Post Box 8905, N-7491, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| |
Collapse
|
3
|
Malliaras P, Connell D, Boesen AP, Kearney RS, Menz HB, Morrissey D, Munteanu SE, Silbernagel KG, Underwood M, Haines TP. Efficacy of high-volume injections with and without corticosteroid compared with sham for Achilles tendinopathy: a protocol for a randomised controlled trial. BMJ Open Sport Exerc Med 2021; 7:e001136. [PMID: 34765229 PMCID: PMC8543648 DOI: 10.1136/bmjsem-2021-001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 11/03/2022] Open
Abstract
Introduction Achilles tendinopathy (AT) is a common and disabling musculoskeletal condition. First-line management involving Achilles tendon loading exercise with, or without, other modalities may not resolve the problem in up to 44% of cases. Many people receive injections. Yet there are no injection treatments with demonstrated long-term efficacy. The aim of the trial is to examine the 12-month efficacy of high-volume injection (HVI) with corticosteroid and HVI without corticosteroid versus sham injection among individuals with AT. Methods and analysis The trial is a three-arm, parallel group, double-blind, superiority randomised controlled trial that will assess the efficacy of HVI with and without corticosteroid versus sham up to 12 months. We will block-randomise 192 participants to one of the three groups with a 1:1:1 ratio, and both participants and outcome assessors will be blinded to treatment allocation. All participants will receive an identical evidence-based education and exercise intervention. The primary outcome measure will be the Victorian Institute of Sport Assessment - Achilles (VISA-A) at 12 months post-randomisation, a validated, reliable and disease-specific measure of pain and function. Choice of secondary outcomes was informed by core outcome domains for tendinopathy. Data will be analysed using the intention-to-treat principle. Ethics and dissemination Ethics approval was obtained via the Monash University Human Ethics Committee (no: 13138). The study is expected to be completed in 2024 and disseminated via peer review publication and conference presentations. Trial registration number Australia and New Zealand Clinical trials registry (ACTRN12619001455156).
Collapse
Affiliation(s)
- Peter Malliaras
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - David Connell
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia.,Imaging @ Olympic Park, Melbourne, Victoria, Australia
| | | | - Rebecca S Kearney
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK.,University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK.,Physiotherapy Department, Barts Health NHS Trust, London, UK
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | | | - Martin Underwood
- Warwick Medical School, University of Warwick, Coventry, West Midlands, UK
| | - Terry P Haines
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| |
Collapse
|
4
|
Risch L, Stoll J, Schomöller A, Engel T, Mayer F, Cassel M. Intraindividual Doppler Flow Response to Exercise Differs Between Symptomatic and Asymptomatic Achilles Tendons. Front Physiol 2021; 12:617497. [PMID: 34295255 PMCID: PMC8290144 DOI: 10.3389/fphys.2021.617497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objective This study investigated intraindividual differences of intratendinous blood flow (IBF) in response to running exercise in participants with Achilles tendinopathy. Design This is a cross-sectional study. Setting The study was conducted at the University Outpatient Clinic. Participants Sonographic detectable intratendinous blood flow was examined in symptomatic and contralateral asymptomatic Achilles tendons of 19 participants (42 ± 13 years, 178 ± 10 cm, 76 ± 12 kg, VISA-A 75 ± 16) with clinically diagnosed unilateral Achilles tendinopathy and sonographic evident tendinosis. Intervention IBF was assessed using Doppler ultrasound “Advanced Dynamic Flow” before (Upre) and 5, 30, 60, and 120 min (U5–U120) after a standardized submaximal constant load run. Main Outcome Measure IBF was quantified by counting the number (n) of vessels in each tendon. Results At Upre, IBF was higher in symptomatic compared with asymptomatic tendons [mean 6.3 (95% CI: 2.8–9.9) and 1.7 (0.4–2.9), p < 0.01]. Overall, 63% of symptomatic and 47% of asymptomatic Achilles tendons responded to exercise, whereas 16 and 11% showed persisting IBF and 21 and 42% remained avascular throughout the investigation. At U5, IBF increased in both symptomatic and asymptomatic tendons [difference to baseline: 2.4 (0.3–4.5) and 0.9 (0.5–1.4), p = 0.05]. At U30 to U120, IBF was still increased in symptomatic but not in asymptomatic tendons [mean difference to baseline: 1.9 (0.8–2.9) and 0.1 (-0.9 to 1.2), p < 0.01]. Conclusion Irrespective of pathology, 47–63% of Achilles tendons responded to exercise with an immediate acute physiological IBF increase by an average of one to two vessels (“responders”). A higher amount of baseline IBF (approximately five vessels) and a prolonged exercise-induced IBF response found in symptomatic ATs indicate a pain-associated altered intratendinous “neovascularization.”
Collapse
Affiliation(s)
- Lucie Risch
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany
| | - Josefine Stoll
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany
| | - Anne Schomöller
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany.,Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany.,Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| |
Collapse
|
5
|
Risch L, Mayer F, Cassel M. Doppler Flow Response Following Running Exercise Differs Between Healthy and Tendinopathic Achilles Tendons. Front Physiol 2021; 12:650507. [PMID: 33833692 PMCID: PMC8021791 DOI: 10.3389/fphys.2021.650507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background The relationship between exercise-induced intratendinous blood flow (IBF) and tendon pathology or training exposure is unclear. Objective This study investigates the acute effect of running exercise on sonographic detectable IBF in healthy and tendinopathic Achilles tendons (ATs) of runners and recreational participants. Methods 48 participants (43 ± 13 years, 176 ± 9 cm, 75 ± 11 kg) performed a standardized submaximal 30-min constant load treadmill run with Doppler ultrasound “Advanced dynamic flow” examinations before (Upre) and 5, 30, 60, and 120 min (U5-U120) afterward. Included were runners (>30 km/week) and recreational participants (<10 km/week) with healthy (Hrun, n = 10; Hrec, n = 15) or tendinopathic (Trun, n = 13; Trec, n = 10) ATs. IBF was assessed by counting number [n] of intratendinous vessels. IBF data are presented descriptively (%, median [minimum to maximum range] for baseline-IBF and IBF-difference post-exercise). Statistical differences for group and time point IBF and IBF changes were analyzed with Friedman and Kruskal-Wallis ANOVA (α = 0.05). Results At baseline, IBF was detected in 40% (3 [1–6]) of Hrun, in 53% (4 [1–5]) of Hrec, in 85% (3 [1–25]) of Trun, and 70% (10 [2–30]) of Trec. At U5 IBF responded to exercise in 30% (3 [−1–9]) of Hrun, in 53% (4 [−2–6]) of Hrec, in 70% (4 [−10–10]) of Trun, and in 80% (5 [1–10]) of Trec. While IBF in 80% of healthy responding ATs returned to baseline at U30, IBF remained elevated until U120 in 60% of tendinopathic ATs. Within groups, IBF changes from Upre-U120 were significant for Hrec (p < 0.01), Trun (p = 0.05), and Trec (p < 0.01). Between groups, IBF changes in consecutive examinations were not significantly different (p > 0.05) but IBF-level was significantly higher at all measurement time points in tendinopathic versus healthy ATs (p < 0.05). Conclusion Irrespective of training status and tendon pathology, running leads to an immediate increase of IBF in responding tendons. This increase occurs shortly in healthy and prolonged in tendinopathic ATs. Training exposure does not alter IBF occurrence, but IBF level is elevated in tendon pathology. While an immediate exercise-induced IBF increase is a physiological response, prolonged IBF is considered a pathological finding associated with Achilles tendinopathy.
Collapse
Affiliation(s)
- Lucie Risch
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany.,Faculty of Health Sciences, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine and Orthopedics, University of Potsdam, Potsdam, Germany.,Faculty of Health Sciences, University of Potsdam, Potsdam, Germany
| |
Collapse
|
6
|
Costantino F, Carmona L, Boers M, Backhaus M, Balint PV, Bruyn GA, Christensen R, Conaghan PG, Ferreira RJO, Garrido-Castro JL, Guillemin F, Hammer HB, van der Heijde D, Iagnocco A, Kortekaas MC, Landewé RB, Mandl P, Naredo E, Schmidt WA, Terslev L, Terwee CB, Thiele R, D'Agostino MA. EULAR recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2021; 80:840-847. [PMID: 33483318 DOI: 10.1136/annrheumdis-2020-219816] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To produce European League Against Rheumatism (EULAR) recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). METHODS Based on the literature reviews and expert opinion (through Delphi surveys), a taskforce of 23 members (12 experts in ultrasound in RMDs, 9 in methodology and biostatistics together with a patient research partner and a health professional in rheumatology) developed a checklist of items to be reported in every RMD study using ultrasound. This checklist was further refined by involving a panel of 79 external experts (musculoskeletal imaging experts, methodologists, journal editors), who evaluated its comprehensibility, feasibility and comprehensiveness. Agreement on each proposed item was assessed with an 11-point Likert scale, grading from 0 (total disagreement) to 10 (full agreement). RESULTS Two face-to-face meetings, as well as two Delphi rounds of voting, resulted in a final checklist of 23 items, including a glossary of terminology. Twenty-one of these were considered 'mandatory' items to be reported in every study (such as blinding, development of scoring systems, definition of target pathologies) and 2 'optional' to be reported only if applicable, such as possible confounding factors (ie, ambient conditions) or experience of the sonographers. CONCLUSION An EULAR taskforce developed a checklist to ensure transparent and comprehensive reporting of aspects concerning research and procedures that need to be presented in studies using ultrasound in RMDs. This checklist, if widely adopted by authors and editors, will greatly improve the interpretability of study development and results, including the assessment of validity, generalisability and applicability.
Collapse
Affiliation(s)
- Félicie Costantino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Rheumatology Department, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, Île-de-France, France
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Madrid, Spain
| | - Maarten Boers
- Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Marina Backhaus
- Department of Internal Medicine-Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Berlin, Berlin, Germany
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George A Bruyn
- Rheumatology Department, MC Group Hospitals, Lelystad, The Netherlands.,Rheumatology Department, Reumakliniek Flevoland, Lelystad, The Netherlands
| | - Robin Christensen
- Department of Clinical Research, Odense University Hospital, Odense, Denmark
| | | | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | | | | | | | | | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | | | - Robert Bm Landewé
- Rheumatology Department, Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Peter Mandl
- Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Wolfgang A Schmidt
- Rheumatology Department, Medical Centre for Rheumatology Berlin Buch, Berlin, Germany
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Caroline B Terwee
- Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Ralf Thiele
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Maria-Antonietta D'Agostino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France .,Rheumatology Department, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| |
Collapse
|
7
|
Murphy SL, Krause D, Roll SC, Gandikota G, Barber M, Khanna D. Development of a Musculoskeletal Ultrasound Protocol to Examine Upper Extremity Rehabilitation Outcomes in Systemic Sclerosis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021; 37:13-23. [PMID: 33521795 PMCID: PMC7842414 DOI: 10.1177/8756479320965210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis. MATERIALS & METHODS Three MSUS methods (grey scale, Doppler, strain elastography) and two acquisition techniques (long versus short axis; transducer on skin versus floating on gel) were examined in the forearm before and after rehabilitation treatment. For grey-scale, tissue thickness measures, intra- and inter-rater reliability were calculated (ICCs), and paired t-tests examined differences among techniques. RESULTS Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable grey-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intra- and inter-rater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning. CONCLUSION A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.
Collapse
Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health Care System, Ann Arbor, MI, Geriatric Research Education and Clinical Center (GRECC)
| | - Donnamarie Krause
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Mary Barber
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Dinesh Khanna
- Rheumatology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|
8
|
Fallows R, Lumsden G. Pitfalls in the study of neovascularisation in achilles and patellar tendinopathy: a review of important factors for clinicians to consider and the need for greater standardisation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1690216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Richard Fallows
- Telford Musculoskeletal Services, Shropshire Community Health NHS Trust, Shropshire, UK
| | - Gordon Lumsden
- Physiotherapy Department, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
| |
Collapse
|
9
|
Freedman BR, Mooney DJ. Biomaterials to Mimic and Heal Connective Tissues. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1806695. [PMID: 30908806 PMCID: PMC6504615 DOI: 10.1002/adma.201806695] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/27/2019] [Indexed: 05/11/2023]
Abstract
Connective tissue is one of the four major types of animal tissue and plays essential roles throughout the human body. Genetic factors, aging, and trauma all contribute to connective tissue dysfunction and motivate the need for strategies to promote healing and regeneration. The goal here is to link a fundamental understanding of connective tissues and their multiscale properties to better inform the design and translation of novel biomaterials to promote their regeneration. Major clinical problems in adipose tissue, cartilage, dermis, and tendon are discussed that inspire the need to replace native connective tissue with biomaterials. Then, multiscale structure-function relationships in native soft connective tissues that may be used to guide material design are detailed. Several biomaterials strategies to improve healing of these tissues that incorporate biologics and are biologic-free are reviewed. Finally, important guidance documents and standards (ASTM, FDA, and EMA) that are important to consider for translating new biomaterials into clinical practice are highligted.
Collapse
Affiliation(s)
- Benjamin R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| |
Collapse
|
10
|
Roesch HJ, Milanese S, Osborne B, Spurrier DJ, Thoirs KA. The acute effects of exercise on tendon dimensions and vascularity. An exploratory study using diagnostic ultrasound of the male Achilles tendon. J Sci Med Sport 2018; 21:982-987. [DOI: 10.1016/j.jsams.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/06/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
|
11
|
Risch L, Wochatz M, Messerschmidt J, Engel T, Mayer F, Cassel M. Reliability of Evaluating Achilles Tendon Vascularization Assessed With Doppler Ultrasound Advanced Dynamic Flow. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:737-744. [PMID: 28960372 DOI: 10.1002/jum.14414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The reliability of quantifying intratendinous vascularization by high-sensitivity Doppler ultrasound advanced dynamic flow has not been examined yet. Therefore, this study aimed to investigate the intraobserver and interobserver reliability of evaluating Achilles tendon vascularization by advanced dynamic flow using established scoring systems. METHODS Three investigators evaluated vascularization in 67 recordings in a test-retest design, applying the Ohberg score, a modified Ohberg score, and a counting score. Intraobserver and interobserver agreement for the Ohberg score and modified Ohberg score was analyzed by the Cohen κ and Fleiss κ coefficients (absolute), Kendall τ b coefficient, and Kendall coefficient of concordance (W; relative). The reliability of the counting score was analyzed by intraclass correlation coefficients (ICC) 2.1 and 3.1, the standard error of measurement (SEM), and Bland-Altman analysis (bias and limits of agreement [LoA]). RESULTS Intraobserver and interobserver agreement (absolute/relative) ranged from 0.61 to 0.87/0.87 to 0.95 and 0.11 to 0.66/0.76 to 0.89 for the Ohberg score and from 0.81 to 0.87/0.92 to 0.95 and 0.64 to 0.80/0.88 to 0.93 for the modified Ohberg score, respectively. The counting score revealed an intraobserver ICC of 0.94 to 0.97 (SEM, 1.0-1.5; bias, -1; and LoA, 3-4 vessels). The interobserver ICC for the counting score ranged from 0.91 to 0.98 (SEM, 1.0-1.9; bias, 0; and LoA, 3-5 vessels). CONCLUSIONS The modified Ohberg score and counting score showed excellent reliability and seem convenient for research and clinical practice. The Ohberg score revealed decent intraobserver but unexpected low interobserver reliability and therefore cannot be recommended.
Collapse
Affiliation(s)
- Lucie Risch
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - Monique Wochatz
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - Janin Messerschmidt
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - Frank Mayer
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine and Sports Orthopedics, University of Potsdam, Potsdam, Germany
| |
Collapse
|
12
|
Watson J, Barker-Davies RM, Bennett AN, Fong DTP, Wheeler PC, Lewis M, Ranson C. Sport and exercise medicine consultants are reliable in assessing tendon neovascularity using ultrasound Doppler. BMJ Open Sport Exerc Med 2018; 4:e000298. [PMID: 29527321 PMCID: PMC5841524 DOI: 10.1136/bmjsem-2017-000298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Several lower limb tendinopathy treatment modalities involve identification of pathological paratendinous or intratendinous neovascularisation to target proposed co-location of painful neoneuralisation. The ability to reliably locate and assess the degree of neovascularity is therefore clinically important. The Modified Ohberg Score (MOS) is frequently used to determine degree of neovascularity, but reliability has yet to be established among Sport and Exercise Medicine (SEM) consultants. This study aims to determine inter-rater and intra-rater reliability of an SEM consultant cohort when assessing neovascularity using the 5-point MOS. METHOD Eleven participants (7 male and 4 female) provided 16 symptomatic Achilles and patella tendons. These were sequentially examined using power Doppler (PD) enabled ultrasound (US) imaging by 6 SEM consultants who rated neovascular changes seen using the MOS. Representative digital scan images were saved for rescoring 3 weeks later. Inter-rater and intra-rater reliability of the MOS was examined using intraclass correlation coefficient (ICC) and Kappa Agreement scores. RESULTS Neovascular changes were reported in 65.6% of 96 scans undertaken. ICC for inter-rater reliability was 0.86 and Fleiss Kappa 0.52. ICC for intra-rater reliability was 0.95 and Weighted Kappa 0.91. CONCLUSIONS Neovascular changes were present in two-thirds of symptomatic tendons. Excellent SEM consultant inter-rater and intra-rater reliability was demonstrated. These findings support the use of PD-enabled US to assess neovascularity by appropriately experienced SEM consultants. Furthermore, future interventional research using a similarly experienced SEM consultant cohort can be undertaken with assurance that assessment of neovascularity will be reliable.
Collapse
Affiliation(s)
- James Watson
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, London, UK
- Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK
| | - Robert M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, London, UK
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, London, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, London, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, London, UK
| | - Patrick C Wheeler
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, London, UK
| | - Mark Lewis
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, London, UK
| | - Craig Ranson
- Athlete Health Department, English Institute of Sport, Manchester, UK
| |
Collapse
|
13
|
Chan O, Havard B, Morton S, Pritchard M, Maffulli N, Crisp T, Padhiar N, Perry JD, King J, Morrissey D. Outcomes of prolotherapy for intra-tendinous Achilles tears: a case series. Muscles Ligaments Tendons J 2017; 7:78-87. [PMID: 28717615 DOI: 10.11138/mltj/2017.7.1.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The intra-tendinous tear is a new pathology that is defined as a discontinuity of fibres situated entirely within the tendon. Prolotherapy involves injecting an irritant, such as hyperosmolar dextrose, to stimulate a tissue healing response and ultimately reduce pain. METHODS 43 consecutive patients diagnosed with an intra-tendinous tear were included (27 males: 16 females, mean (SD) age 41 (11.3). Patients were injected with 0.4ml-1.5ml (mean 0.8ml) of 50% dextrose and 0.5% marcaine mixed in a 1:1 ratio. A 4-6 week period of walking boot immobilisation was followed by progressive rehabilitation (6-8 weeks). Outcomes were assessed with a VISA-A questionnaire at baseline, 3 months and a mean 12.6 (7.0) months post-treatment. Ultrasound scans were conducted before treatment and 5.2 (2.3) weeks later to assess sonographic changes. RESULTS 30 patients (70%) responded with VISA-A scores increasing by 31 (30.5) points after 3 months (f=0.62, p<0.05) and by 40 (29.3) points after 12.60 (7.0) months (f=0.87, p<0.05). After 5.2 (2.3) weeks, echogenicity was significantly reduced (p<0.05) and 27% of tears were no longer detectable. No significant differences were observed in remaining tears with respect to tear size, tendon thickness or neovascularisation. CONCLUSION Treatment resulted in clinically significant improvements and controlled trials are warranted. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Otto Chan
- BMI London Independent Hospital, Stepney Green, London, UK
| | - Ben Havard
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Sarah Morton
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Mel Pritchard
- BMI London Independent Hospital, Stepney Green, London, UK
| | | | - Tom Crisp
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Nat Padhiar
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Jeremy David Perry
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - John King
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Dylan Morrissey
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK.,Bart's Health NHS Trust, London, UK
| |
Collapse
|
14
|
Risch L, Cassel M, Mayer F. Acute effect of running exercise on physiological Achilles tendon blood flow. Scand J Med Sci Sports 2017; 28:138-143. [PMID: 28294413 DOI: 10.1111/sms.12874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2017] [Indexed: 11/26/2022]
Abstract
Sonographically detectable intratendinous blood flow (IBF) is found in 50%-88% of Achilles tendinopathy patients as well as in up to 35% of asymptomatic Achilles tendons (AT). Although IBF is frequently associated with tendon pathology, it may also represent a physiological regulation, for example, due to increased blood flow in response to exercise. Therefore, this study aimed to investigate the acute effects of a standardized running exercise protocol on IBF assessed with Doppler ultrasound (DU) "Advanced dynamic flow" in healthy ATs. 10 recreationally active adults (5 f, 5 m; 29±3 years, 1.72±0.12 m, 68±16 kg, physical activity 206±145 minute/wk) with no history of AT pain and inconspicious tendon structure performed 3 treadmill running tasks on separate days (M1-3) with DU examinations directly before and 5, 30, 60, and 120 minutes after exercise. At M1, an incremental exercise test was used to determine the individual anaerobic threshold (IAT). At M2 and M3, participants performed 30- minute submaximal constant load tests (CL1 /CL2 ) with an intensity 5% below IAT. IBF in each tendon was quantified by counting the number of vessels. IBF increased in five ATs from no vessels at baseline to one to four vessels solely detectable 5 minutes after CL1 or CL2 . One AT had persisting IBF (three vessels) throughout all examinations. Fourteen ATs revealed no IBF at all. Prolonged running led to a physiological, temporary appearance of IBF in 25% of asymptomatic ATs. To avoid exercise-induced IBF in clinical practice, DU examinations should be performed after 30 minutes of rest.
Collapse
Affiliation(s)
- L Risch
- University Outpatient Clinic, Department Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - M Cassel
- University Outpatient Clinic, Department Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - F Mayer
- University Outpatient Clinic, Department Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| |
Collapse
|
15
|
Lanfranchi MA, Leluc O, Tavano A, Wormser C, Morange S, Chagnaud C, Pradel V, Lafforgue P, Pham T. Are Ultrasound Findings Similar in Patients with Axial Spondyloarthritis and in Athlete Entheses? J Rheumatol 2017; 44:609-612. [PMID: 28250140 DOI: 10.3899/jrheum.160715] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Enthesitis is the spondyloarthritis (SpA) landmark, but can also be seen after entheses overuse, such as during intensive sport. METHODS We aimed to compare entheses ultrasound (US) findings in a prospective cross-sectional study of 30 axial SpA cases, 30 athletes, and 29 controls. RESULTS Mean (SD) MAdrid Sonographic Enthesis Index (MASEI) score was 26.3 (13), 12.2 (7), and 10.4 (6) in patients with SpA, athletes, and non-athlete control groups, respectively (p < 0.0001). CONCLUSION The MASEI score was significantly higher in patients with SpA compared with healthy controls, athletes, and non-athletes, and can be of value to distinguish SpA from healthy subjects, whatever their physical activity.
Collapse
Affiliation(s)
- Marie-Alix Lanfranchi
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Olivier Leluc
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Alice Tavano
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Cécile Wormser
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Sophie Morange
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Christophe Chagnaud
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Vincent Pradel
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Pierre Lafforgue
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Thao Pham
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France. .,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University.
| |
Collapse
|
16
|
Risch L, Cassel M, Messerschmidt J, Intziegianni K, Fröhlich K, Kopinski S, Mayer F. Is Sonographic Assessment of Intratendinous Blood Flow in Achilles Tendinopathy Patients Reliable?: Consistency of Doppler Ultrasound Modes and Intra- and Inter-observer Reliability. Ultrasound Int Open 2016; 2:E13-8. [PMID: 27689161 PMCID: PMC5023215 DOI: 10.1055/s-0035-1569286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the consistency between different Doppler ultrasound (DU) modes as well as the intra- and inter-observer reliability of investigators with different experience level in assessing intratendinous blood flow (IBF) in Achilles tendinopathy patients. MATERIAL AND METHODS 18 participants (36 Achilles tendons, AT) with Achilles tendinopathy (24 AT) were examined with power Doppler ultrasound (PDU), colour Doppler ultrasound (CDU) and "Advanced Dynamic Flow" (ADF) (Toshiba Xario SSA-660 A; 14MHz transducer) by 2 investigators (experienced, EI; inexperienced, II) in a test-retest design (M1/M2). A modified Öhberg score was used to quantify IBF. Data was analysed descriptively (absolute and relative). Consistency of the 3 modes was presented by Kendall's Coefficient of Concordance (Kendall's W). Intra- and inter-observer reliability were calculated by use of Kendall's tau b correlation coefficient. RESULTS IBF was detected in 79-92% of symptomatic AT and in 33-50% of contralateral asymptomatic AT. Comparing the 3 modes, Kendall's W ranged from 0.97-0.98. Analysis of intra-observer reliability resulted in Kendall's tau 0.90-0.92 for EI and 0.84-0.87 for II. Inter-observer reliability resulted in Kendall's tau 0.64-0.69 in M1 and 0.68-0.70 in M2. CONCLUSION The very good consistency between PDU, CDU and ADF indicates a comparable applicability for assessing IBF in ATs. Intra-observer reliability was high for both investigators, independent of experience. The moderate inter-observer reliability reflects the challenge in sonographic detection of intratendinous blood flow (IBF) amount.
Collapse
Affiliation(s)
- L. Risch
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - M. Cassel
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - J. Messerschmidt
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - K. Intziegianni
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - K. Fröhlich
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - S. Kopinski
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - F. Mayer
- University Outpatient Clinic, Sports Medicine and Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| |
Collapse
|
17
|
Freedman BR, Bade ND, Riggin CN, Zhang S, Haines PG, Ong KL, Janmey PA. The (dys)functional extracellular matrix. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2015; 1853:3153-64. [PMID: 25930943 DOI: 10.1016/j.bbamcr.2015.04.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/11/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
The extracellular matrix (ECM) is a major component of the biomechanical environment with which cells interact, and it plays important roles in both normal development and disease progression. Mechanical and biochemical factors alter the biomechanical properties of tissues by driving cellular remodeling of the ECM. This review provides an overview of the structural, compositional, and mechanical properties of the ECM that instruct cell behaviors. Case studies are reviewed that highlight mechanotransduction in the context of two distinct tissues: tendons and the heart. Although these two tissues demonstrate differences in relative cell-ECM composition and mechanical environment, they share similar mechanisms underlying ECM dysfunction and cell mechanotransduction. Together, these topics provide a framework for a fundamental understanding of the ECM and how it may vary across normal and diseased tissues in response to mechanical and biochemical cues. This article is part of a Special Issue entitled: Mechanobiology.
Collapse
Affiliation(s)
- Benjamin R Freedman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Nathan D Bade
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Corinne N Riggin
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip G Haines
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katy L Ong
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Janmey
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA; Department of Physiology, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
18
|
WEARING SCOTTC, LOCKE SIMON, SMEATHERS JAMESE, HOOPER SUEL. Tendinopathy Alters Cumulative Transverse Strain in the Patellar Tendon after Exercise. Med Sci Sports Exerc 2015; 47:264-71. [DOI: 10.1249/mss.0000000000000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
19
|
Affiliation(s)
- Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, United Kingdom
| | | | | | | |
Collapse
|
20
|
Syha R, Springer F, Grözinger G, Würslin C, Ipach I, Ketelsen D, Schabel C, Gebhard H, Hein T, Martirosian P, Schick F, Claussen CD, Grosse U. Short-term exercise-induced changes in hydration state of healthy achilles tendons can be visualized by effects of off-resonant radiofrequency saturation in a three-dimensional ultrashort echo time MRI sequence applied at 3 tesla. J Magn Reson Imaging 2013; 40:1400-7. [DOI: 10.1002/jmri.24488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/25/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Roland Syha
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Fabian Springer
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Gerd Grözinger
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Christian Würslin
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Ingmar Ipach
- Department of Orthopaedic surgery; University hospital of Tübingen; Tübingen Germany
| | - Dominik Ketelsen
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Christoph Schabel
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Harry Gebhard
- Berufsgenossenschaftliche Unfallklinik Tübingen; Tübingen Germany
| | - Tobias Hein
- Department of Sports medicine; University of Tübingen; Tübingen Germany
| | - Petros Martirosian
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Fritz Schick
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Claus D. Claussen
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Ulrich Grosse
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| |
Collapse
|
21
|
De Jonge S, Warnaars JLF, De Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Verhaar JAN, Tol JL. Relationship between neovascularization and clinical severity in Achilles tendinopathy in 556 paired measurements. Scand J Med Sci Sports 2013; 24:773-8. [DOI: 10.1111/sms.12072] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2013] [Indexed: 01/14/2023]
Affiliation(s)
- S. De Jonge
- Sports Medicine Department; The Hague Medical Center; Leidschendam The Netherlands
- Department of Orthopedics; Erasmus Medical Center; Rotterdam The Netherlands
| | - J. L. F. Warnaars
- Sports Medicine Department; The Hague Medical Center; Leidschendam The Netherlands
| | - R. J. De Vos
- Sports Medicine Department; The Hague Medical Center; Leidschendam The Netherlands
| | - A. Weir
- Sports Medicine Department; The Hague Medical Center; Leidschendam The Netherlands
| | - H. T. M. van Schie
- Department of Orthopedics; Erasmus Medical Center; Rotterdam The Netherlands
- Department of Equine Sciences; Faculty of Veterinary Medicine; Utrecht University; Utrecht The Netherlands
| | - S. M. A. Bierma-Zeinstra
- Sports Medicine Department; The Hague Medical Center; Leidschendam The Netherlands
- Department of General Practice; Erasmus University Medical Center; Rotterdam The Netherlands
| | - J. A. N. Verhaar
- Department of Orthopedics; Erasmus Medical Center; Rotterdam The Netherlands
| | - J. L. Tol
- Sports Medicine Department; The Hague Medical Center; Leidschendam The Netherlands
| |
Collapse
|
22
|
Pingel J, Fredberg U, Mikkelsen LR, Schjerling P, Heinemeier KM, Kjaer M, Harisson A, Langberg H. No inflammatory gene-expression response to acute exercise in human Achilles tendinopathy. Eur J Appl Physiol 2013; 113:2101-9. [PMID: 23588255 DOI: 10.1007/s00421-013-2638-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 03/30/2013] [Indexed: 11/30/2022]
Abstract
Although histology data favour the view of a degenerative nature of tendinopathy, indirect support for inflammatory reactions to loading in affected tendons exists. The purpose of the present study was to elucidate whether inflammatory signalling responses after acute mechanical loading were more pronounced in tendinopathic versus healthy regions of human tendon and if treatment with non-steroidal anti-inflammatory medications (NSAID's) reduces this response. Twenty-seven tendinopathy patients (>6 months) were randomly assigned to a placebo (n = 14) or NSAID (Ibumetin NYCOMED GmbH Plant Oranienburg Germany (600 mg) × 3/day/1 week) group (n = 13) in a double-blinded-fashion. Tendon biopsies were taken from the painful and a healthy region of the same tendon 2 h after 1 h running. Gene-expression of several targets was analysed in the sampled Achilles tendon biopsies. The mRNA for TGF-β, collagen-I and collagen-III were significantly higher expressed, and decorin, CTGF, IL-6 and IL-10 were significantly lower expressed in the tendinopathic versus healthy tendon area. Only IL-10 was lower in expression in experiments with NSAID administration, while all other determined parameters were unaffected by NSAID. All ultrasonographic outcomes were unchanged in response to acute exercise and not influenced by NSAID. The signalling for collagen and TGF-beta was upregulated after acute loading in tendinopathic tendon. In contrast to the hypothesis, inflammatory signalling was not exaggerated in tendinopathic tendon 2 h after acute mechanical loading.
Collapse
Affiliation(s)
- Jessica Pingel
- Department of Orthopaedic Surgery M. Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health Sciences, Institute of Sports Medicine Copenhagen, University of Copenhagen, Bispebjerg Bakke 23, Copenhagen NV, Denmark.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Pingel J, Harrison A, Suetta C, Simonsen L, Langberg H, Bülow J. The acute effects of exercise on the microvascular volume of Achilles tendons in healthy young subjects. Clin Physiol Funct Imaging 2013; 33:252-7. [PMID: 23692613 DOI: 10.1111/cpf.12021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 12/19/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Real-time harmonic contrast-enhanced ultrasound (CEU) is used in several diseases to visualize the microvascularization in various tissues, due to its high sensitivity. AIM The aim of the present study was to investigate whether CEU could be used to detect an increase in the microvascular volume (MV) in healthy tendon tissue in response to exercise comprising a 1-h run. METHODS After a bolus injection of the ultrasound contrast SonoVue(®), CEU measurements of (MV) in the Achilles tendon were taken prior to exercise, immediately after a 1-h run, and 24 h after exercise in nine healthy young subjects (seven men and two women) mean age 31 ± 4 years. In addition, the effect of 15 min of arm cycling exercise on the flow within the Achilles tendon was tested in four athletes (mean age 33 ± 6 years) using the CEU method before and after exercise. RESULTS The present data show a significant increase in the (MV) of the Achilles tendon for all subjects following the run compared with before exercise. No significant change in (MV) was seen in the Achilles tendon after 15-min arm cycling exercise (P = 0·96). This indicates that the increase in microvascular blood volume within the Achilles tendon in response to running is a local response. CONCLUSION The present data reveal that real-time harmonic CEU can be used to determine the MV of healthy Achilles tendons both at rest and after 1 h of running exercise.
Collapse
Affiliation(s)
- Jessica Pingel
- Institute of Sports Medicine Copenhagen and Centre for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
| | | | | | | | | | | |
Collapse
|
24
|
Neovascularization in Achilles tendinopathy: have we been chasing a red herring? Knee Surg Sports Traumatol Arthrosc 2012; 20:1891-4. [PMID: 22890896 DOI: 10.1007/s00167-012-2172-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/28/2012] [Indexed: 01/08/2023]
|