Tendon structural adaptations to load exercise are inhibited by anabolic androgenic steroids

Severe Cardiac and Metabolic Pathology Induced by Steroid Abuse in a Young Individual

Androgenic-Anabolic Steroids (AAS) abuse is known to play an important role in causing the systemic inflammatory response and multiple-organ dysfunction in healthy individuals. Although many of the undesirable effects of steroid abuse have been reported, at present, little is known about the effect of anabolic supplements and the correlation between cardiac and metabolic pathology. This paper presents a case of a 25 year old patient with a complex medical history after 6 months of steroid administration. Myocardial infraction, dyslipidemia, obesity, hyperuricemia, secondary diabetes, and chronic renal disease were identified after clinical and para-clinical examinations. The particularities of this case were interpreted in the context of a literature review, highlighting the effect of multi-organ damage as a result of the uncontrolled use of anabolic steroid supplements.

Asynchronous Bilateral Achilles Tendon Rupture with Selective Androgen Receptor Modulators: A Case Report

CASE

A 36-year-old male competitive powerlifter sustained asynchronous bilateral Achilles tendon ruptures after using 2 types of selective androgen receptor modulators (SARMs). Both tendon ruptures occurred near the myotendinous junction and were treated with open surgical repair and an initial period of immobilization followed by progressive weightbearing and rehabilitation; no postoperative complications were observed.

CONCLUSION

Previous studies have reported that anabolic androgenic steroids have a deleterious impact on tendon structure and function. This case suggests that SARM compounds may also predispose users to Achilles tendon rupture.

Bilateral Quadriceps Rupture in an Elite Weight Lifter: A Case Report and Review of Literature

Simultaneous bilateral quadriceps tendon ruptures (QTR) are rare injuries in sportspersons; weightlifting, involving sudden eccentric contraction of the bilateral quadriceps, has the potential to cause this injury. We present a case of an elite weightlifter with bilateral quadriceps tear occurring during the "jerk" part of clean and jerk phase of weightlifting; single stage bilateral end to end repair was done, followed by 3 weeks of cast immobilisation. He then underwent a supervised rehabilitation protocol, leading to graduated strengthening of the muscles. He went back to competitive sport after 2 years and participated in a national championship after 5 years. Detailed questioning revealed a history of anabolic steroid use in the early phase of his career; a literature review showed only seven cases of this injury pattern in weightlifting/bodybuilding sports, and five of these seven had a definitive history of anabolic steroid use. Bilateral QTR may be a pointer to predisposing factors like use of steroids, which should be diligently identified. Good outcomes are possible after early surgical repair and rehabilitation, with high rates of return to sports.

The Effects of Corticosteroid Injection in the Healthy and Damaged Achilles Tendon Model: Histopathological and Biomechanical Experimental Study in Rats

OBJECTIVE

To show the effects of corticosteroids on inflammatory reactions in the injured Achilles tendon in rats.

MATERIAL AND METHOD

Thirty-two adult Wistar Albino rats were used in the study. The rats were divided into 4 groups. In the first group (Intact Saline), saline solution was injected to the intact Achilles tendon. In the second group (Intact Corticosteroid), corticosteroid was injected to the intact tendon. In the third group (Injured Saline), saline solution was injected to the injured Achilles tendon. In the fourth group (Injured Corticosteroid), corticosteroid was injected to the injured tendon. All groups were sacrificed on day 30 and Achilles tendons were taken and prepared for histological and biomechanical evaluation.

RESULTS

According to the biomechanical test; mean load-to-failure of the Intact Saline group was significantly lower than the Intact Corticosteroid (p=0.016), Injured Saline (p=0.001) and Injured Corticosteroid) (p=0.012) groups. According to the histopathological evaluation, tenocyte mean of the Intact Saline group was statistically lower than the Injured Saline and Injured Corticosteroid groups. Tenocyte mean of the Intact Corticosteroid group was statistically significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Saline group was significantly lower than the Injured Saline and Injured Corticosteroid groups. The ground substance mean of the Intact Corticosteroid group was significantly lower than the Injured Saline and Injured Corticosteroid groups. There was no statistically significant difference between the groups in terms of calcification.

CONCLUSION

It has been found that there is biomechanical and histopathological significant benefit of intra-tendon corticosteroid administration in the experimentally generated Achilles tendon injury model.

Detraining and Anabolic-Androgenic Steroid Discontinuation Change Calcaneal Tendon Morphology

Several side effects of anabolic-androgenic steroid (AAS) administration associated with training are reported in the biomechanical properties of the calcaneal tendon (CT) of rats. Thus, the aim of the present study is to evaluate the effects of the detraining and discontinuation of AAS administration on the CT morphology of rats submitted to exercise in water. Animals were divided into two groups (20/group): (1) Immediately after training (IA), and (2) Six weeks of detraining and AAS discontinuation (6W). The IA group included four subgroups: Sedentary (S), Trained (T), Sedentary with AAS administration (SAAS), and trained with AAS administration (TAAS). The 6W group included four subgroups: Sedentary (6W-S), six weeks of detrained (6W-T), six weeks of sedentary with AAS discontinuation (6W-SAAS), and six weeks of detrained with AAS discontinuation (6W-TAAS). Data show significant reduction in adipose cells volume density (Vv%) in the distal CT in 6W-TAAS group, indicating that training can exert a positive effect on the tendon. The 6W-SAAS group exhibited increased adipose cells Vv% in the distal region, compared with the W6-S and W6-T groups. A decrease in tendon proper cells Vv% and in peritendinous sheath cells Vv% of proximal and distal regions was also observed. In 6W-TAAS group showed increase in adipose cells, blood vessels, peritendinous sheath cells, and tendon proper cells Vv% in the distal region of the CT. The vertical jumps in water were not able to protect CT regions from the negative effects of AAS discontinuation for six weeks. However, after detraining and AAS discontinuation, many protective factors of the mechanical load in the long-term could be observed.

Tendon Remodeling in Response to Resistance Training, Anabolic Androgenic Steroids and Aging

Exercise training (ET), anabolic androgenic steroids (AAS), and aging are potential factors that affect tendon homeostasis, particularly extracellular matrix (ECM) remodeling. The goal of this review is to aggregate findings regarding the effects of resistance training (RT), AAS, and aging on tendon homeostasis. Data were gathered from our studies regarding the impact of RT, AAS, and aging on the calcaneal tendon (CT) of rats. We demonstrated a series of detrimental effects of AAS and aging on functional and biomechanical parameters, including the volume density of blood vessel cells, adipose tissue cells, tendon calcification, collagen content, the regulation of the major proteins related to the metabolic/development processes of tendons, and ECM remodeling. Conversely, RT seems to mitigate age-related tendon dysfunction. Our results suggest that AAS combined with high-intensity RT exert harmful effects on ECM remodeling, and also instigate molecular and biomechanical adaptations in the CT. Moreover, we provide further information regarding the harmful effects of AAS on tendons at a transcriptional level, and demonstrate the beneficial effects of RT against the age-induced tendon adaptations of rats. Our studies might contribute in terms of clinical approaches in favor of the benefits of ET against tendinopathy conditions, and provide a warning on the harmful effects of the misuse of AAS on tendon development.

Anabolic steroids and tendons: A review of their mechanical, structural, and biologic effects

One of the suspected deleterious effects of androgenic-anabolic steroids (AAS) is the increased risk for tendon rupture. However, investigations to date have produced inconsistent results and it is still unclear how AAS influence tendons. A systematic review of the literature was conducted to identify studies that have investigated the mechanical, structural, or biologic effects that AAS have on tendons. In total, 18 highly heterogeneous studies were identified. Small animal studies made up the vast majority of published research, and contradictory results were reported frequently. All of the included studies focused on the potential deleterious effects that AAS have on tendon, which is striking given the recent use of AAS in patients following tendon injury. Rather than providing strong evidence for or against the use of AAS, this review highlights the need for additional research. Future studies investigating the use of AAS as a possible treatment for tendon injury/pathology are supported by reports suggesting that AAS may counteract the irreparable structural/functional changes that occur in the musculotendinous unit following rotator cuff tears, as well as studies suggesting that the purported deleterious effects on tendon may be transient. Other possible areas for future research are discussed in the context of key findings that may have implications for the therapeutic application of AAS. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2830-2841, 2018.

Effects of aging and resistance training in rat tendon remodeling

In elderly persons, weak tendons contribute to functional limitations, injuries, and disability, but resistance training can attenuate this age-related decline. We evaluated the effects of resistance training on the extracellular matrix (ECM) of the calcaneal tendon (CT) in young and old rats and its effect on tendon remodeling. Wistar rats aged 3 mo (young, n = 30) and 20 mo (old, n = 30) were divided into 4 groups: young sedentary, young trained, old sedentary (OS), and old trained (OT). The training sessions were conducted over a 12-wk period. Aging in sedentary rats showed down-regulation in key genes that regulated ECM remodeling. Moreover, the OS group showed a calcification focus in the distal region of the CT, with reduced blood vessel volume density. In contrast, resistance training was effective in up-regulating connective tissue growth factor, VEGF, and decorin gene expression in old rats. Resistance training also increased proteoglycan content in young and old rats in special small leucine-rich proteoglycans and blood vessels and prevented calcification in OT rats. These findings confirm that resistance training is a potential mechanism in the prevention of aging-related loss in ECM and that it attenuates the detrimental effects of aging in tendons, such as ruptures and tendinopathies.-Marqueti, R. C., Durigan, J. L. Q., Oliveira, A. J. S., Mekaro, M. S., Guzzoni, V., Aro, A. A., Pimentel, E. R., Selistre-de-Araujo, H. S. Effects of aging and resistance training in rat tendon remodeling.

Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use

Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases.

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.