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Gil-Cantero S, Iorio F, Unalan I, Kurtuldu F, Künig S, Wenhardt C, Pinnaro V, Aigner-Radakovics K, Steinberger P, Boccaccini AR, Stöckl J. Impact of morphological features and chemical composition of tendon biomimetic scaffolds on immune recognition via Toll-like receptors. Biomater Sci 2024; 12:4695-4712. [PMID: 39082440 DOI: 10.1039/d4bm00147h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Tendinopathies are a major worldwide clinical problem. The development of tendon biomimetic scaffolds is considered a promising, therapeutic approach. However, to be clinically effective, scaffolds should avoid immunological recognition. It has been well described that scaffolds composed of aligned fibers lead to a better tenocyte differentiation, vitality, proliferation and motility. However, little has been studied regarding the impact of fiber spatial distribution on the recognition by immune cells. Additionally, it has been suggested that higher hydrophilicity would reduce their immune recognition. Herein, polycaprolactone (PCL)-hyaluronic acid (HA)-based electrospun scaffolds were generated with different fiber diameters (in the nano- and micro-scales) and orientations as well as different grades of wettability and the impact of these properties on immunological recognition has been assessed, by means of Toll-like receptor (TLR) reporter cells. Our results showed that TLR 2/1 and TLR 2/6 were not triggered by the scaffolds. In addition, the TLR 4 signalling pathway seems to be triggered to a greater extent by higher PCL and HA concentrations, but the alignment of the fibers prevents the triggering of this receptor. Taken together, TLR reporter cells were shown to be a useful and effective tool to study the potential of scaffolds to induce immune responses and the results obtained can be used to inform the design of fibrous scaffolds for tendon repair.
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Affiliation(s)
- Sara Gil-Cantero
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria.
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Germany.
| | - Francesco Iorio
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Germany.
| | - Irem Unalan
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Germany.
| | - Fatih Kurtuldu
- FunGlass, Alexander Dubček University of Trenčín, Trenčín, Slovakia
| | - Sarojinidevi Künig
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria.
| | - Claus Wenhardt
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria.
| | - Veronica Pinnaro
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria.
| | - Katharina Aigner-Radakovics
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria.
| | - Peter Steinberger
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria.
| | - Aldo R Boccaccini
- Institute of Biomaterials, Department of Materials Science and Engineering, University of Erlangen-Nuremberg, Germany.
| | - Johannes Stöckl
- Center for Pathophysiology, Infectiology and Immunology, Institute of Immunology, Medical University of Vienna, Vienna, Austria.
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Ghaderi MT, Momenzadeh OR, Jaberi FM, Azarpira N, Bahari M, Mohammadpour M. Effect of a single versus serial platelet-rich plasma injection on the healing of acute patellar tendon defect: an experimental study. BMC Musculoskelet Disord 2024; 25:684. [PMID: 39215319 PMCID: PMC11363653 DOI: 10.1186/s12891-024-07804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND There is no consensus on the frequency and timing of platelet-rich plasma (PRP) injection in tendon healing. We aimed to evaluate the effectiveness of single versus multiple PRP injections in the healing of patellar tendon defects in the experimental model, through histological and biomechanical investigation. METHODS Forty-four male skeletally mature Dutch rabbits were randomly divided into the five study groups ( A, B,C, D,E). After creating a longitudinal acute patellar tendon defect on both knees (One-third the width of the patella tendon), the right legs of the rabbits were used as the intervention group and the left legs as the control groups. Animals in groups A, B, and C were euthanized on days 7, 14, and 28, respectively, after the first PRP injection. Animals in group D received the second PRP injection on day 10 and was euthanized on day 14. Animals in group D received the second and third PRP injections on days 10 and 20, respectively, and were euthanized on day 28. The outcomes were evaluated histologically (modification of Movin's Grading) and biomechanically. RESULTS The inflammatory condition was exaggerated in groups D and E. Load at failure was higher in the non-injected side of groups D and E, while there was no significant difference between the right and left legs of the three groups A, B and C. In other word, groups with a single PRP injection were more resistant to the increasing load compared to the groups with multiple PRP injections. CONCLUSIONS PRP improves tendon healing if injected early after injury, while its injection after the initial phase of injury hampers tendon healing. In addition, a single PRP injection seems to be more effective than multiple PRP injection. Therefore, in cases where PRP injection is indicated for tendon repair, such as acute tendon injury, we recommend using a single PRP injection during tendon repair surgery.
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Affiliation(s)
- Mohammad Taher Ghaderi
- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Shafa Yahyaian Educational and Medical Center, Iran University of Medical Sciences, Shafa Orthopedic Hospital, Baharestan Square, Mojahedin-e-Islam St., Tehran, 1157637131, Iran
| | - Omid Reza Momenzadeh
- Department of Orthopedics, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereidoon Mojtahed Jaberi
- Department of Orthopedics, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Bahari
- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Shafa Yahyaian Educational and Medical Center, Iran University of Medical Sciences, Shafa Orthopedic Hospital, Baharestan Square, Mojahedin-e-Islam St., Tehran, 1157637131, Iran
| | - Mehdi Mohammadpour
- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Shafa Yahyaian Educational and Medical Center, Iran University of Medical Sciences, Shafa Orthopedic Hospital, Baharestan Square, Mojahedin-e-Islam St., Tehran, 1157637131, Iran.
- Clinical Research Development Unit, Taleghani Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran.
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Yeo YH, Jo SK, Kim MH, Lee SJ, Han SY, Park MH, Kim DY, Kim DY, Yoo IH, Kang C, Song JH, Park WH. Fabrication of atelocollagen-coated bioabsorbable suture and the evaluation of its regenerative efficacy in Achilles tendon healing using a rat experimental model. Int J Biol Macromol 2024; 271:132564. [PMID: 38782324 DOI: 10.1016/j.ijbiomac.2024.132564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
Recently, the incidence of Achilles tendon ruptures (ATRs) has become more common, and repair surgery using a bioabsorbable suture is generally preferred, particularly in the case of healthy patients. Sutures composed of poly(lactic-co-glycolic acid) (PLGA) are commonly used in ATR surgeries. Nevertheless, owing to the inherent limitations of PLGA, novel bioabsorbable sutures that can accelerate Achilles tendon healing are sought. Recently, several studies have demonstrated the beneficial effects of atelocollagen on tendon healing. In this study, poly(3,4-dihydroxy-L-phenylalanine) (pDOPA), a hydrophilic biomimetic material, was used to modify the hydrophobic surface of a PLGA suture (Vicryl, VC) for the stable coating of atelocollagen on its surface. The main objective was to fabricate an atelocollagen-coated VC suture and evaluate its performance in the healing of Achilles tendon using a rat model of open repair for ATR. Structural analyses of the surface-modified suture indicated that the collagen was successfully coated on the VC/pDOPA suture. Postoperative in vivo biomechanical analysis, histological evaluation, ultrastructural/morphological analyses, and western blotting confirmed that the tendons in the VC/pDOPA/Col group exhibit superior healing than those in the VC and VC/pDOPA groups after 1 and 6 weeks following the surgery. The this study suggests that atelocollagen-coated PLGA/pDOPA sutures are preferable for future medical applications, especially in the repair of ATR.
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Affiliation(s)
- Yong Ho Yeo
- Department of Organic Materials Engineering, Chungnam National University, Daejeon, Republic of Korea
| | - Seong Kyeong Jo
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - Min Hee Kim
- Department of Textile Engineering, Kyungpook National University, Republic of Korea
| | - Su Jeong Lee
- R&D planning team, Organoid Sciences Co., Ltd., 331, Pangyo-ro, Bundang-gu, Seongnam-si, Republic of Korea
| | - Seung Yun Han
- Department of Anatomy, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Mun Hyang Park
- Department of Pathology, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Dae Young Kim
- Department of Pathology, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Dae Yeung Kim
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - In Ha Yoo
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jae Hwang Song
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea.
| | - Won Ho Park
- Department of Organic Materials Engineering, Chungnam National University, Daejeon, Republic of Korea.
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Acevedo D, Garcia JR, Grewal RS, Vankara A, Murdock CJ, Hardigan PC, Aiyer AA. Comparison of rerupture rates after operative and nonoperative management of Achilles tendon rupture in older populations: Systematic review and meta-analysis. J Orthop 2024; 52:112-118. [PMID: 38445100 PMCID: PMC10909967 DOI: 10.1016/j.jor.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Background This systematic review and meta-analysis investigated the treatment for Achilles tendon rupture (ATR) associated with the lowest risk of rerupture in older patients. Methods Five databases were searched through September 2022 for studies published in the past 10 years analyzing operative and nonoperative ATR treatment. Studies were categorized as "nonelderly" if they reported only on patients aged 18-60 years. Studies that included at least 1 patient older than age 70 were categorized as "elderly inclusive." Of 212 studies identified, 28 were eligible for inclusion. Of 2965 patients, 1165 were treated operatively: 429 (37%) from elderly-inclusive studies and 736 (63%) from nonelderly studies. Of the 1800 nonoperative patients 553 (31%) were from nonelderly studies and 1247 (69%) were from elderly-inclusive studies. Results For nonoperative treatment, the rate of rerupture was higher in nonelderly studies (83/1000 cases, 95% CI = 58, 113) than in elderly-inclusive studies (38/1000 cases, 95% CI = 22, 58; P<.001). For operative treatment no difference was found in the rate of rerupture between nonelderly studies (7/1000 cases, 95% CI = 0, 21) and elderly-inclusive studies (12/1000 cases, 95% CI = 0, 35; P<.78). Overall, operative treatment was associated with a rerupture rate of 1.5% (95% CI: 1.0%, 2.8%) (P<.001), which was lower than the 5% rate reported by other studies for nonoperative management (P<.001). Conclusion Older patients may benefit more than younger patients from nonoperative treatment of ATR. More studies are needed to determine the age at which rerupture rates decrease among nonoperatively treated patients. Level of Evidence 3.
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Affiliation(s)
- Daniel Acevedo
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, 3200 S University Drive, Davie, FL, 33328, USA
- The Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Jose R. Garcia
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, 3200 S University Drive, Davie, FL, 33328, USA
| | - Rajvarun S. Grewal
- California Health Sciences University, 120 Clovis Avenue, Clovis, CA, 93612, USA
| | - Ashish Vankara
- The Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Christopher J. Murdock
- The Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
| | - Patrick C. Hardigan
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, 3200 S University Drive, Davie, FL, 33328, USA
| | - Amiethab A. Aiyer
- The Johns Hopkins University School of Medicine, Department of Orthopaedic Surgery, 4940 Eastern Avenue, Baltimore, MD, 21224, USA
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Worsfold SI, Carter K, Akbar M, Hackett L, Millar NL, Murrell GAC. Rotator Cuff Tendinopathy: Pathways of Apoptosis. Sports Med Arthrosc Rev 2024; 32:12-16. [PMID: 38695498 DOI: 10.1097/jsa.0000000000000387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Rotator cuff repair is usually successful, but retear is not uncommon. It has been previously identified that there is a higher incidence of apoptosis in the edges of the torn supraspinatus tendon. A prospective cohort study was conducted with 28 patients-14 rotator cuff tear patients, 5 instability patients, and 9 Anterior cruciate ligament reconstruction patients to determine whether there was any increase in several genes implicated in apoptosis, including Fas receptor (FasR), Fas ligand, Aifm-1, Bcl-2, Fadd, Bax, and caspase-3. There was a significant expression of Bax (P=0.2) and FasR (P=0.005) in the edges of torn supraspinatus tendons, and in intact subscapularis tendons, there was a significant expression of caspase-3 (P=0.02) compared with samples from the torn supraspinatus tendon (P=0.04). The cytochrome c pathway, with its subsequent activation of caspase-3, as well as the TRAIL-receptor signaling pathway involving FasR have both been implicated. The elevated expression of Bax supported the model that the Bax to Bcl-2 expression ratio represents a cell death switch. The elevated expression of Bax in the intact subscapularis tissue from rotator cuff tear patients also may confirm that tendinopathy is an ongoing molecular process.
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Affiliation(s)
- Sophie I Worsfold
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, University of New South Wales, St George Hospital Campus, Sydney, NSW, Australia
| | - Kristyn Carter
- Institute of infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Moeed Akbar
- Institute of infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Lisa Hackett
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, University of New South Wales, St George Hospital Campus, Sydney, NSW, Australia
| | - Neal L Millar
- Institute of infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - George A C Murrell
- Department of Orthopaedic Surgery, Orthopaedic Research Institute, University of New South Wales, St George Hospital Campus, Sydney, NSW, Australia
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Johnson J, von Stade D, Gadomski B, Regan D, Easley J, Sikes KJ, Troyer K, Zhou T, Schlegel T, McGilvray K. Biomechanical and histological changes secondary to aging in the human rotator cuff: A preliminary analysis. J Orthop Res 2023; 41:2221-2231. [PMID: 36722700 DOI: 10.1002/jor.25529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 02/02/2023]
Abstract
The high failure rate of rotator cuff repair surgeries is positively correlated with age, yet the biomechanical changes to the tendons of the rotator cuff with age have not been described. As such, we sought to benchmark and characterize the biomechanical and histopathological properties with the accompanying gene expression of human rotator cuff tendons as a function of age and histopathological degeneration. All four rotator cuff tendons from fresh human cadaver shoulders underwent biomechanical, histopathological, and gene expression analyses. Following cadaver availability, samples were grouped into Younger (i.e., less than 36 years of age, n = 2 donors) and Aged (i.e., greater than 55 years of age, n = 3 donors) as a means of characterizing and quantifying the age-related changes exhibited by the tendons. Biomechanical testing and subsequent computational modeling techniques revealed both differences in properties between tendons and greater Young's moduli in the Younger tendons (supraspinatus 3.06x, infraspinatus 1.76x, subscapularis 1.25x, and teres minor 1.32x). Histopathological scoring using the semi-quantitative Bonar scoring scheme revealed a positive correlation with age across all tendons (r = 0.508, p < 0.001). These data contextualize the biomechanical and histopathological changes to tendons that occurs naturally with aging, highlighting the innate differences in biomechanical properties of all four rotator cuff tendons, as well as the difference in their degenerative trajectories. Additionally, the histopathological scoring revealed moderate signs of degeneration within the Younger supraspinatus tendons, suggesting tissue quality may decrease in this specific tendon in patients less than 40 years old, before clinical symptoms or tears.
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Affiliation(s)
- James Johnson
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado, USA
| | - Devin von Stade
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado, USA
| | - Ben Gadomski
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado, USA
| | - Daniel Regan
- Department of Microbiology, Immunology, & Pathology, Flint Animal Cancer Center, Fort Collins, Colorado, USA
| | - Jeremiah Easley
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, Colorado, USA
| | - Katie J Sikes
- Preclinical Surgical Research Laboratory, Colorado State University, Fort Collins, Colorado, USA
| | - Kevin Troyer
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado, USA
| | - Tianjian Zhou
- Department of Statistics, Colorado State University, Fort Collins, Colorado, USA
| | - Ted Schlegel
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kirk McGilvray
- Orthopaedic Bioengineering Research Laboratory, Colorado State University, Fort Collins, Colorado, USA
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Jo SK, Yoo IH, Park HY, Kang C, Han SY, Moon JH, Park WH, Yeo YH, Jun S, Yi YS, Lee SJ, Tae JY, Song JH. An Atelocollagen Injection Enhances the Healing of Nonoperatively Treated Achilles Tendon Tears: An Experimental Study in Rats. Orthop J Sports Med 2023; 11:23259671231200933. [PMID: 37868218 PMCID: PMC10586006 DOI: 10.1177/23259671231200933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background There is growing interest in nonoperative treatment for the management of Achilles tendon ruptures (ATRs). However, nonoperative treatment is limited by the risk of tendon reruptures and low satisfaction rates. Recently, atelocollagen injections have been reported to have beneficial effects on tendon healing. Purpose To evaluate the beneficial effects of injected atelocollagen on Achilles tendon healing and investigate the mechanism of atelocollagen on tendon healing. Study Design Controlled laboratory study. Methods Percutaneous tenotomy of the right Achilles tendon in 66 rats was performed. The animals were equally divided into the noninjection group (NG) and the collagen injection group (CG). At 1, 3, and 6 weeks, the Achilles functional index, cross-sectional area, load to failure, stiffness, stress, and the modified Bonar score were assessed. Transmission electron microscopy, western blotting, and immunohistochemistry were also performed. Results The Achilles functional index (-6.8 vs -43.0, respectively; P = .040), load to failure (42.1 vs 27.0 N, respectively; P = .049), and stiffness (18.8 vs 10.3 N/mm, respectively; P = .049) were higher in the CG than those in the NG at 3 weeks. There were no significant differences in histological scores between the 2 groups. Transmission electron microscopy analysis showed that the mean diameter of collagen fibrils in the CG was greater than that in the NG at 3 weeks (117.2 vs 72.6 nm, respectively; P < .001) and 6 weeks (202.1 vs 144.0 nm, respectively; P < .001). Western blot analysis showed that the expression of collagen type I in the CG was higher than that in the NG at 1 week (P = .005) and 6 weeks (P = .001). Conclusion An atelocollagen injection had beneficial effects on the healing of nonoperatively treated Achilles tendon injuries. The Achilles tendon of CG rats exhibited better functional, biomechanical, and morphological outcomes compared with NG rats. The molecular data indicated that the mechanism of atelocollagen injections may be associated with an increased amount of collagen type I. Clinical Relevance An atelocollagen injection might be a good adjuvant option for the nonoperative treatment of ATRs.
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Affiliation(s)
- Seong Kyeong Jo
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - In Ha Yoo
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeon Yeong Park
- Department of Occupational Therapy, College of Medical Science, Konyang University, Daejeon, Republic of Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seung Yun Han
- Department of Anatomy, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Ji Hyun Moon
- Department of Anatomy, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Won Ho Park
- Department of Organic Materials Engineering, Chungnam National University, Daejeon, Republic of Korea
| | - Yong Ho Yeo
- Department of Organic Materials Engineering, Chungnam National University, Daejeon, Republic of Korea
| | - Sangmi Jun
- Center for Research Equipment, Korea Basic Science Institute, Daejeon, Republic of Korea
| | - Yoon-Sun Yi
- Center for Research Equipment, Korea Basic Science Institute, Daejeon, Republic of Korea
| | - Su Jeong Lee
- Department of Microbiology, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Jung Yeon Tae
- Department of Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Jae Hwang Song
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
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Rong X, Tang Y, Cao S, Xiao S, Wang H, Zhu B, Huang S, Adeli M, Rodriguez RD, Cheng C, Ma L, Qiu L. An Extracellular Vesicle-Cloaked Multifaceted Biocatalyst for Ultrasound-Augmented Tendon Matrix Reconstruction and Immune Microenvironment Regulation. ACS NANO 2023; 17:16501-16516. [PMID: 37616178 DOI: 10.1021/acsnano.3c00911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The healing of tendon injury is often hindered by peritendinous adhesion and poor regeneration caused by the accumulation of reactive oxygen species (ROS), development of inflammatory responses, and the deposition of type-III collagen. Herein, an extracellular vesicles (EVs)-cloaked enzymatic nanohybrid (ENEV) was constructed to serve as a multifaceted biocatalyst for ultrasound (US)-augmented tendon matrix reconstruction and immune microenvironment regulation. The ENEV-based biocatalyst exhibits integrated merits for treating tendon injury, including the efficient catalase-mimetic scavenging of ROS in the injured tissue, sustainable release of Zn2+ ions, cellular uptake augmented by US, and immunoregulation induced by EVs. Our study suggests that ENEVs can promote tenocyte proliferation and type-I collagen synthesis at an early stage by protecting tenocytes from ROS attack. The ENEVs also prompted efficient immune regulation, as the polarization of macrophages (Mφ) was reversed from M1φ to M2φ. In a rat Achilles tendon defect model, the ENEVs combined with US treatment significantly promoted functional recovery and matrix reconstruction, restored tendon morphology, suppressed intratendinous scarring, and inhibited peritendinous adhesion. Overall, this study offers an efficient nanomedicine for US-augmented tendon regeneration with improved healing outcomes and provides an alternative strategy to design multifaceted artificial biocatalysts for synergetic tissue regenerative therapies.
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Affiliation(s)
- Xiao Rong
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuanjiao Tang
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Sujiao Cao
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China
| | - Sutong Xiao
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China
| | - Haonan Wang
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Bihui Zhu
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Songya Huang
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Mohsen Adeli
- Department of Organic Chemistry, Lorestan University, Khorramabad 6815144316, Iran
| | - Raul D Rodriguez
- Tomsk Polytechnic University, Lenina Avenue 30, 634034, Tomsk, Russia
| | - Chong Cheng
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China
| | - Lang Ma
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Li Qiu
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
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Tarantino D, Mottola R, Resta G, Gnasso R, Palermi S, Corrado B, Sirico F, Ruosi C, Aicale R. Achilles Tendinopathy Pathogenesis and Management: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6681. [PMID: 37681821 PMCID: PMC10487940 DOI: 10.3390/ijerph20176681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
The Achilles tendon is the thickest and strongest tendon of the human body, and it is frequently injured during sports activity. The incidence of Achilles tendon pathologies has increased over recent decades, especially in the last few years, because of increased sports participation among the general population and due to the diffusion of competitive sports at a high level. Tendinopathies are common in athletes and in middle-aged overweight patients. The term "tendinopathy" refers to a condition characterised clinically by pain and swelling, with functional limitations of tendon and nearby structures, and consequently to chronic failure of healing response process. Tendinopathies can produce marked morbidity, and at present, scientifically validated management modalities are limited. Despite the constantly increasing interest and number of studies about Achilles tendinopathy (AT), there is still not a consensual point of view on which is the best treatment, and its management is still controversial. AT can be treated conservatively primarily, with acceptable results and clinical outcomes. When this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions with a relatively high rate of success with few complications and the decision for treatment in patients with AT should be tailored on patient's needs and level of activity. The aim of this article is to give insights about the pathogenesis and most used and recent treatment options for AT.
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Affiliation(s)
- Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Rosita Mottola
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Giuseppina Resta
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, 74121 Taranto, Italy;
| | - Rossana Gnasso
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Stefano Palermi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Bruno Corrado
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Felice Sirico
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Carlo Ruosi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy;
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Ikuta Y, Nakasa T, Kawabata S, Adachi N. Achilles Tendon Reconstruction Using a Hamstring Tendon Autograft for Chronic Rupture of the Achilles Tendon in Patients Over 70 Years of Age: A Retrospective Case Series. Cureus 2023; 15:e42788. [PMID: 37664307 PMCID: PMC10469802 DOI: 10.7759/cureus.42788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Reconstruction techniques using autologous hamstring tendons were generally applied for chronic Achilles tendon rupture with a large defect size. Previous studies have reported good clinical results of this technique for young or middle-aged patients, however, the clinical outcomes in older patients have been unclear. This retrospective case series reviewed four male patients aged >70 years (mean age, 78.5 years) who underwent Achilles tendon reconstruction using the hamstring tendon autograft for chronic rupture of the Achilles tendon with a large tendon defect. The proximal-distal length between the healthy tendon stumps was measured using sagittal T2-weighted magnetic resonance imaging (MRI). The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and postoperative complications were evaluated. The duration from the traumatic event or appearance of symptoms to surgery was 3.8 (range, 2-6) months. The mean measured gap between the healthy tendon stumps was 67.5 mm on MRI. The AOFAS ankle-hindfoot score improved from 67.3 to 99.5 at the mean follow-up period of 40.3 (range, 23-75) months. No donor site morbidity was observed in all patients. Re-rupture was detected at the five-month follow-up in one patient who had removed a hinged ankle-foot orthosis with adjustable heel wedges without permission. Achilles tendon reconstruction using a hamstring tendon is a viable option for treating selected patients with chronic rupture of the Achilles tendon with a large tendon defect even in older patients. To improve clinical outcomes, a better understanding should be provided to family members as well as older patients regarding the postoperative rehabilitation program.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tomoyuki Nakasa
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shingo Kawabata
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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11
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Vila-Dieguez O, Heindel MD, Awokuse D, Kulig K, Michener LA. Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery. Shoulder Elbow 2023; 15:233-249. [PMID: 37325389 PMCID: PMC10268139 DOI: 10.1177/17585732231172166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors. Tendon structure plays a role in RC tendinopathy, with decreased stiffness, increased thickness, and collagen disorganization. Neuromuscular performance deficits of altered kinematics, muscle activation, and force are present in RC tendinopathy, but advanced methods of assessing muscle performance are needed to fully assess these factors. Psychological factors of depression, anxiety, pain catastrophizing, treatment expectations, and self-efficacy are present and predict patient-reported outcomes. Central nervous system dysfunctions also exist, specifically altered pain and sensorimotor processing. Resisted exercise may normalize these factors, but limited evidence exists to explain the relationship of the four proposed domains to trajectory of recovery and defining persistent deficits limiting outcomes. Clinicians and researchers can use this model to understand how exercise mediates change in patient outcomes, develop subgroups to deliver patient-specific approach for treatment and define metrics to track recovery over time. Supporting evidence is limited, indicating the need for future studies characterizing mechanisms of recovery with exercise for RC tendinopathy.
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Affiliation(s)
- Oscar Vila-Dieguez
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Matthew D. Heindel
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Daniel Awokuse
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A. Michener
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
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12
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Sgadari A, Izzo A, Smeraglia F, Coviello A, Patel S, Mariconda M, Bernasconi A. Analysis of the 50 Most Cited Articles on Achilles Tendon Injury. Orthop J Sports Med 2023; 11:23259671231170846. [PMID: 37223076 PMCID: PMC10201165 DOI: 10.1177/23259671231170846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 05/25/2023] Open
Abstract
Background Achilles tendon injuries represent one of the most common reasons for referral to orthopaedic surgeons. Purpose To outline the characteristics, examine trends in publication, and evaluate the correlation between citations and study quality of the 50 most cited articles on Achilles tendon injury. Study Design Cross-sectional study. Methods After searching the Web of Science for articles published in orthopaedic journals, we identified the 50 most cited articles on Achilles tendon injury and abstracted their characteristics. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). Multiple bivariate analyses (Pearson or Spearman correlation coefficient) were used to evaluate the association among number of citations, citation rate (citations/year), 2020 journal impact factor (JIF), year of publication, level of evidence (LoE), study type (tendon rupture or chronic tendinopathy), sample size, and mCMS. Results The top 50 articles were cited 12,194 times. Each article had a mean ± SD 244 ± 88.8 citations (range, 157-657) and a citation rate of 12.6 ± 5.4 per year (range, 3-28). A total of 35 studies (70%) were published between 2000 and 2010. The citation rate of the 16 most recent studies was almost double that of the 16 oldest studies (17.5 vs 9.9; P < .001). Nineteen studies (49%) were classified as having poor quality (mCMS <50 points). The mean JIF of the 9 journals that published the studies was 5.1. The citation rate correlated with the number of citations (r = 0.56; P < .001), publication year (r = 0.60; P < .001), and LoE (r = -0.44; P = .005). The publication year correlated with the LoE (r = -0.40; P = .01). Study quality in terms of mCMS correlated with the JIF (r = 0.35; P = .03) and LoE (r = -0.48; P = .003) but not the citation rate (P = .15). Conclusion The mean LoE and the citation rate of the most cited articles on Achilles tendon injury both significantly increased over time. Although the JIF was positively correlated with study quality, almost half of the studies had poor-quality methodology.
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Affiliation(s)
- Arianna Sgadari
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Antonio Izzo
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Francesco Smeraglia
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Antonio Coviello
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Shelain Patel
- Foot and Ankle Unit, Royal National
Orthopaedic Hospital, Stanmore, UK
| | - Massimo Mariconda
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Alessio Bernasconi
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
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13
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Pedaprolu K, Szczesny SE. Mouse Achilles tendons exhibit collagen disorganization but minimal collagen denaturation during cyclic loading to failure. J Biomech 2023; 151:111545. [PMID: 36944295 PMCID: PMC10069227 DOI: 10.1016/j.jbiomech.2023.111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
While overuse is a prominent risk factor for tendinopathy, the fatigue-induced structural damage responsible for initiating tendon degeneration remains unclear. Denaturation of collagen molecules and collagen fiber disorganization have been observed within certain tendons in response to fatigue loading. However, no studies have investigated whether these forms of tissue damage occur in Achilles tendons, which commonly exhibit tendinopathy. Therefore, the objective of this study was to determine whether mouse Achilles tendons undergo collagen denaturation and collagen fiber disorganization when cyclically loaded to failure. Consistent with previous testing of other energy-storing tendons, we found that cyclic loading of mouse Achilles tendons produced collagen disorganization but minimal collagen denaturation. To determine whether the lack of collagen denaturation is unique to mouse Achilles tendons, we monotonically loaded the Achilles and other mouse tendons to failure. We found that the patellar tendon was also resistant to collagen denaturation, but the flexor digitorum longus (FDL) tendon and tail tendon fascicles were not. Furthermore, the Achilles and patellar tendons had a lower tensile strength and modulus. While this may be due to differences in tissue structure, it is likely that the lack of collagen denaturation during monotonic loading in both the Achilles and patellar tendons was due to failure near their bony insertions, which were absent in the FDL and tail tendons. These findings suggest that mouse Achilles tendons are resistant to collagen denaturation in situ and that Achilles tendon degeneration may not be initiated by mechanically-induced damage to collagen molecules.
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Affiliation(s)
- Krishna Pedaprolu
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, United States
| | - Spencer E Szczesny
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, United States; Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, United States.
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14
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Quintero D, Perucca Orfei C, Kaplan LD, de Girolamo L, Best TM, Kouroupis D. The roles and therapeutic potentialof mesenchymal stem/stromal cells and their extracellular vesicles in tendinopathies. Front Bioeng Biotechnol 2023; 11:1040762. [PMID: 36741745 PMCID: PMC9892947 DOI: 10.3389/fbioe.2023.1040762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Tendinopathies encompass a highly prevalent, multi-faceted spectrum of disorders, characterized by activity-related pain, compromised function, and propensity for an extended absence from sport and the workplace. The pathophysiology of tendinopathy continues to evolve. For decades, it has been related primarily to repetitive overload trauma but more recently, the onset of tendinopathy has been attributed to the tissue's failed attempt to heal after subclinical inflammatory and immune challenges (failed healing model). Conventional tendinopathy management produces only short-term symptomatic relief and often results in incomplete repair or healing leading to compromised tendon function. For this reason, there has been increased effort to develop therapeutics to overcome the tissue's failed healing response by targeting the cellular metaplasia and pro-inflammatory extra-cellular environment. On this basis, stem cell-based therapies have been proposed as an alternative therapeutic approach designed to modify the course of the various tendon pathologies. Mesenchymal stem/stromal cells (MSCs) are multipotent stem cells often referred to as "medicinal signaling cells" due to their immunomodulatory and anti-inflammatory properties that can produce a pro-regenerative microenvironment in pathological tendons. However, the adoption of MSCs into clinical practice has been limited by FDA regulations and perceived risk of adverse events upon infusion in vivo. The introduction of cell-free approaches, such as the extracellular vesicles of MSCs, has encouraged new perspectives for the treatment of tendinopathies, showing promising short-term results. In this article, we review the most recent advances in MSC-based and MSC-derived therapies for tendinopathies. Preclinical and clinical studies are included with comment on future directions of this rapidly developing therapeutic modality, including the importance of understanding tissue loading and its relationship to any treatment regimen.
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Affiliation(s)
- Daniel Quintero
- Department of Orthopaedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Carlotta Perucca Orfei
- Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Lee D. Kaplan
- Department of Orthopaedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Laura de Girolamo
- Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Thomas M. Best
- Department of Orthopaedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Dimitrios Kouroupis
- Department of Orthopaedics, UHealth Sports Medicine Institute, Miller School of Medicine, University of Miami, Miami, FL, United States,Diabetes Research Institute & Cell Transplant Center, Miller School of Medicine, University of Miami, Miami, FL, United States,*Correspondence: Dimitrios Kouroupis,
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15
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Is Curcumine Useful in the Treatment and Prevention of the Tendinopathy and Myotendinous Junction Injury? A Scoping Review. Nutrients 2023; 15:nu15020384. [PMID: 36678255 PMCID: PMC9860696 DOI: 10.3390/nu15020384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Physical activity in general and sports in particular, is a mechanism that produces stress and generates great force in the tendon and in the muscle-tendon unit, which increases the risk of injury (tendinopathies). Eccentric and repetitive contraction of the muscle precipitates persistent microtraumatism in the tendon unit. In the development of tendinopathies, the cellular process includes inflammation, apoptosis, vascular, and neuronal changes. Currently, treatments with oral supplements are frequently used. Curcumin seems to preserve, and even repair, damaged tendons. In this systematic review, we focus more especially on the benefits of curcumin. The biological actions of curcumin are diverse, but act around three systems: (a) inflammatory, (b) nuclear factor B (NF-κB) related apoptosis pathways, and (c) oxidative stress systems. A bibliographic search is conducted under the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) as a basis for reporting reliable systematic reviews to perform a Scoping review. After analysing the manuscripts, we can conclude that curcumin is a product that demonstrates a significant biological antialgic, anti-inflammatory, and antioxidant power. Therefore, supplementation has a positive effect on the inflammatory and regenerative response in tendinopathies. In addition, curcumin decreases and modulates the cell infiltration, activation, and maturation of leukocytes, as well as the production of pro-inflammatory mediators at the site of inflammation.
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16
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Alabau-Dasi R, Nieto-Gil P, Ortega-Avila AB, Gijon-Nogueron G. Variations in the Thickness of the Plantar Fascia After Training Based in Training Race. A Pilot Study. J Foot Ankle Surg 2022; 61:1230-1234. [PMID: 35370051 DOI: 10.1053/j.jfas.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 08/11/2021] [Accepted: 02/14/2022] [Indexed: 02/03/2023]
Abstract
Plantar fascia (PF) is a connective tissue made up of mostly type 1 collagen that is subjected to constant loads. This study evaluated the effect of continuous running on tissue stress in the PF by measuring changes in the thickness of the PF using ultrasound scans. It was a cross-sectional study involving 24 runners from the University of Valencia, recruited as volunteers between December 2018 and February 2019. A variety of data was recorded: (age, body mass index, type of footwear, number of workouts per week, KM run per week, sports injuries in the last year, pre and postrace ultrasound PF measurements). There were significant differences in the 3 postrace measurements of the left foot (<0.001). PF thicknesses were measured before and after running, with a minimal average difference of 0.4 mm in the medial and central fascicles, and 0.3 mm in the lateral fascicle. We observed PF thicknesses above 4mm in asymptomatic patients with no signs of vascularisation, proving that increased PF thickness is not the only criterion for diagnosis of plantar fasciitis.
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Affiliation(s)
| | - Pilar Nieto-Gil
- Department of Nursing and Podiatry, University of Valencia, Valencia, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Faculty of Health Sciences. University of Malaga, Spain; Biomedical Research Institute (IBIMA), Malaga, Spain.
| | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences. University of Malaga, Spain; Biomedical Research Institute (IBIMA), Malaga, Spain
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17
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Park JH, Chung SG, Jun JY, Lee JJ, Lee K. Quantitative analysis of tendon histopathology using digital pathology in rat models with Achilles tendon injury. Connect Tissue Res 2022; 63:463-474. [PMID: 34974783 DOI: 10.1080/03008207.2021.2011251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although digital image analysis methods that quantify histopathologic features have emerged, no validated quantitative methods are available to evaluate tendon injury. This study aimed to propose and validate a quantitative analysis method to identify the histopathologic features of tendon injuries. The histopathologic features of two Achilles tendon injury models (a partial full-thickness defect model and a collagenase injection model) using Sprague-Dawley rats were evaluated by semiquantitative grading and a quantitative analysis method using a digital pathology software at weeks 1 and 4 after tendon injury (six tendons per group at each time point). The outcome variables between tendon injury models and between time points were compared, and the correlation between semiquantitative scores and the results of the quantitative analysis was investigated. The proposed analysis method quantified the severity of the histopathological features after tendon injury. Quantitative analysis differentiated the cell morphology between tendon injury models and time points better than semiquantitative scoring. The results from quantitative measurements correlated significantly with the semiquantitative scores. The proposed quantitative method can be effective in evaluating the histopathology of tendon injuries.
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Affiliation(s)
- Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Sun G Chung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Aging, Seoul National University, Seoul, Republic of Korea
| | - Ji-Young Jun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Ju Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
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18
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Schulze-Tanzil GG, Delgado-Calcares M, Stange R, Wildemann B, Docheva D. Tendon healing: a concise review on cellular and molecular mechanisms with a particular focus on the Achilles tendon. Bone Joint Res 2022; 11:561-574. [PMID: 35920195 PMCID: PMC9396922 DOI: 10.1302/2046-3758.118.bjr-2021-0576.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Tendon is a bradytrophic and hypovascular tissue, hence, healing remains a major challenge. The molecular key events involved in successful repair have to be unravelled to develop novel strategies that reduce the risk of unfavourable outcomes such as non-healing, adhesion formation, and scarring. This review will consider the diverse pathophysiological features of tendon-derived cells that lead to failed healing, including misrouted differentiation (e.g. de- or transdifferentiation) and premature cell senescence, as well as the loss of functional progenitors. Many of these features can be attributed to disturbed cell-extracellular matrix (ECM) or unbalanced soluble mediators involving not only resident tendon cells, but also the cross-talk with immigrating immune cell populations. Unrestrained post-traumatic inflammation could hinder successful healing. Pro-angiogenic mediators trigger hypervascularization and lead to persistence of an immature repair tissue, which does not provide sufficient mechano-competence. Tendon repair tissue needs to achieve an ECM composition, structure, strength, and stiffness that resembles the undamaged highly hierarchically ordered tendon ECM. Adequate mechano-sensation and -transduction by tendon cells orchestrate ECM synthesis, stabilization by cross-linking, and remodelling as a prerequisite for the adaptation to the increased mechanical challenges during healing. Lastly, this review will discuss, from the cell biological point of view, possible optimization strategies for augmenting Achilles tendon (AT) healing outcomes, including adapted mechanostimulation and novel approaches by restraining neoangiogenesis, modifying stem cell niche parameters, tissue engineering, the modulation of the inflammatory cells, and the application of stimulatory factors.Cite this article: Bone Joint Res 2022;11(8):561-574.
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Affiliation(s)
| | - Manuel Delgado-Calcares
- Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, Regensburg, Germany
| | - Richard Stange
- Department of Regenerative Musculoskeletal Medicine, Institute for Musculoskeletal Medicine (IMM), University Hospital Münster, Münster, Germany
| | - Britt Wildemann
- Department of Experimental Trauma Surgery, University Hospital Jena, Jena, Germany
| | - Denitsa Docheva
- Department of Musculoskeletal Tissue Regeneration, Orthopaedic Hospital König-Ludwig-Haus, University of Würzburg, Würzburg, Germany
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19
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Effects and Mechanism of Particulate Matter on Tendon Healing Based on Integrated Analysis of DNA Methylation and RNA Sequencing Data in a Rat Model. Int J Mol Sci 2022; 23:ijms23158170. [PMID: 35897746 PMCID: PMC9332732 DOI: 10.3390/ijms23158170] [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] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
Exposure to particulate matter (PM) has been linked with the severity of various diseases. To date, there is no study on the relationship between PM exposure and tendon healing. Open Achilles tenotomy of 20 rats was performed. The animals were divided into two groups according to exposure to PM: a PM group and a non-PM group. After 6 weeks of PM exposure, the harvest and investigations of lungs, blood samples, and Achilles tendons were performed. Compared to the non-PM group, the white blood cell count and tumor necrosis factor-alpha expression in the PM group were significantly higher. The Achilles tendons in PM group showed significantly increased inflammatory outcomes. A TEM analysis showed reduced collagen fibrils in the PM group. A biomechanical analysis demonstrated that the load to failure value was lower in the PM group. An upregulation of the gene encoding cyclic AMP response element-binding protein (CREB) was detected in the PM group by an integrated analysis of DNA methylation and RNA sequencing data, as confirmed via a Western blot analysis showing significantly elevated levels of phosphorylated CREB. In summary, PM exposure caused a deleterious effect on tendon healing. The molecular data indicate that the action mechanism of PM may be associated with upregulated CREB signaling.
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20
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Noriega-González DC, Drobnic F, Caballero-García A, Roche E, Perez-Valdecantos D, Córdova A. Effect of Vitamin C on Tendinopathy Recovery: A Scoping Review. Nutrients 2022; 14:2663. [PMID: 35807843 PMCID: PMC9267994 DOI: 10.3390/nu14132663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
Tendinopathies represent 30-50% of all sports injuries. The tendon response is influenced by the load (volume, intensity, and frequency) that the tendon support, resulting in irritability and pain, among others. The main molecular component of tendons is collagen I (60-85%). The rest consist of glycosaminoglycans-proteoglycans, glycoproteins, and other collagen subtypes. This study's aim was to critically evaluate the efficacy of vitamin C supplementation in the treatment of tendinopathies. At the same time, the study aims to determine the optimal conditions (dose and time) for vitamin C supplementation. A structured search was carried out in the SCOPUS, Medline (PubMed), and Web of Science (WOS) databases. The inclusion criteria took into account studies describing optimal tendon recovery when using vitamin C alone or in combination with other compounds. The study design was considered, including randomized, double-blind controlled, and parallel designs in animal models or humans. The main outcome is that vitamin C supplementation is potentially useful as a therapeutic approach for tendinopathy recovery. Vitamin C supplementation, alone or in combination with other products, increases collagen synthesis with a consequent improvement in the patient's condition. On the other hand, vitamin C deficiency is mainly associated with a decrease in procollagen synthesis and reduced hydroxylation of proline and lysine residues, hindering the tendon repair process.
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Affiliation(s)
- David C. Noriega-González
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, Hospital Clínico Universitario de Valladolid, 47002 Valladolid, Spain;
| | | | - Alberto Caballero-García
- Department of Anatomy and Radiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, Campus Los Pajaritos, University of Valladolid, 42004 Soria, Spain;
| | - Enrique Roche
- Department of Applied Biology-Nutrition, Institute of Bioengineering, University Miguel Hernández, 03202 Elche, Spain;
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Daniel Perez-Valdecantos
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain;
| | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain;
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Yoshikawa T, Mifune Y, Inui A, Nishimoto H, Yamaura K, Mukohara S, Shinohara I, Kuroda R. Quercetin treatment protects the Achilles tendons of rats from oxidative stress induced by hyperglycemia. BMC Musculoskelet Disord 2022; 23:563. [PMID: 35689230 PMCID: PMC9188208 DOI: 10.1186/s12891-022-05513-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Quercetin, a flavonoid abundantly in vegetables and fruits, exerts antioxidant and anti-inflammatory effects. We investigated the protective effects of quercetin against oxidative stress in the Achilles tendons of diabetic rats. Methods Cells were collected from the Achilles tendons of Sprague–Dawley rats and cultured under four conditions: regular glucose (RG) without quercetin (Quer-), RG with quercetin (Quer +), high-glucose (HG) Quer-, and HG Quer + . The expression of genes related to NADPH oxidase (NOX) and inflammation, reactive oxygen species accumulation, and apoptosis rates was analyzed. Additionally, diabetic rats were divided into two groups and subjected to quercetin (group Q) or no quercetin (group C) treatment. Histological evaluation and expression analysis of relevant genes in the Achilles tendon were performed. Results In rat tendon-derived cells, the expression of Nox1, Nox4, and Il6; reactive oxygen species accumulation; and apoptosis rates were significantly decreased by quercetin treatment in the HG group. The collagen fiber arrangement was significantly disorganized in the diabetic rat Achilles tendons in group C compared with that in group Q. The mRNA and protein expression levels of NOX1 and NOX4 were significantly decreased upon quercetin treatment. Furthermore, the expression of Il6, type III collagen, Mmp2, and Timp2 was significantly decreased, whereas that of type I collagen was significantly increased in group Q compared with that in group C. Conclusions Quercetin treatment decreases NOX expression and thus exerts antioxidant and anti-inflammatory effects in the Achilles tendons of diabetic rats. Quercetin treatment may be effective against diabetic tendinopathy.
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Affiliation(s)
- Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Issei Shinohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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22
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Song JH, Kang C, Han SY, Park WH, Kim MH, Moon JH, Tae JY, Park HY, Yoo IH, Park JH, Yeo YH, Kim DY. Comparative analysis of Achilles tendon healing outcomes after open tenotomy versus percutaneous tenotomy: An experimental study in rats. J Orthop Res 2022; 40:1446-1456. [PMID: 34370341 DOI: 10.1002/jor.25159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/25/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
There is growing interest in conservative treatment of Achilles tendon rupture. However, the majority of experimental studies of Achilles tendon have been performed by open tenotomy. More appropriate model of conservative treatment of Achilles tendon rupture is required. We performed an experimental study to evaluate whether outcomes differ between open tenotomy and percutaneous tenotomy of the Achilles tendon in rats. The Achilles tendons of 48 rats were transected. The animals were divided into two groups according to surgical technique: open tenotomy or microscopy-assisted percutaneous tenotomy. After 1, 2, and 4 weeks, functional, biomechanical, and histological analyses were performed. Western blot was performed for quantitative molecular analysis at 1 week. The Achilles functional index was superior in the percutaneous tenotomy group, compared with the open tenotomy group, at 1 week. The cross-sectional area was significantly larger in the percutaneous tenotomy group than in the open tenotomy group at 4 weeks. Relative to the native tendons, load to failure and stiffness yielded comparable results at 2 weeks in the percutaneous tenotomy group and at 4 weeks in the open tenotomy group. The histological score was significantly better in the percutaneous tenotomy group than in the open tenotomy group at 1 week. At 1 week, interleukin-1β expression in the open tenotomy group was higher than in the percutaneous tenotomy group. In summary, Achilles tendon healing was substantially affected by the tenotomy method. We presume that our percutaneous tenotomy method might constitute a useful experimental animal model for conservative treatment of Achilles tendon rupture.
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Affiliation(s)
- Jae H Song
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seung Y Han
- Department of Anatomy, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Won H Park
- Department of Advanced Organic Materials and Textile Engineering System, Chungnam National University, Daejeon, Republic of Korea
| | - Min H Kim
- Department of Biomedical Engineering, Purdue School of Engineering & Technology, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Ji H Moon
- Department of Anatomy, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Jung Y Tae
- Department of Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Hyeon Y Park
- Department of Occupational Therapy, Konyang University, Daejeon, Republic of Korea
| | - In H Yoo
- Department of Occupational Therapy, Konyang University, Daejeon, Republic of Korea
| | - Jong H Park
- Department of Biomedical Material, College of Medical Engineering, Konyang University, Daejeon, Republic of Korea
| | - Yong H Yeo
- Department of Advanced Organic Materials and Textile Engineering System, Chungnam National University, Daejeon, Republic of Korea
| | - Dae Y Kim
- Department of Orthopedic Surgery, Konyang University Hospital, Daejeon, Republic of Korea
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Trache T, Camenzind RS, Bachmann E, Viehöfer A, Jud L, Wirth S, Imhoff FB. A Biomechanical Analysis of Peroneus Brevis Split Lesions, Repair, and Partial Resection. Foot Ankle Int 2022; 43:710-716. [PMID: 35073766 DOI: 10.1177/10711007211069558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneus brevis tendon tears are associated with chronic ankle pain and instability following sprain injuries. The aim of this study is to elucidate the biomechanical changes induced by a peroneus brevis split and surgical treatment by tubularizing suture or partial resection. METHODS Nine human lower leg specimens were biomechanically tested. Preexisting tendon pathology was ruled out by magnetic resonance imaging and histology. Specimens were subjected to sequential testing of 4 conditions of the peroneus brevis tendon: (1) native, (2) longitudinal lesion, (3) tubularizing suture, and (4) 50% resection. The outcome parameters were the tendon stiffness (N/mm) and the length variation of the split portion at 5 N load. RESULTS The median specimen age at death was 55.8 years (range 50-64 years). The longitudinal tendon split led to an elongation by 1.21 ± 1.15 mm, which was significantly reduced by tubularizing suture to 0.24 ± 0.97 mm (P = .021). Furthermore, 50% resection of the tendon elongated it by a mean 2.45 ± 1.9 mm (P = .01) and significantly reduced its stiffness compared to the intact condition (4.7 ± 1.17 N/mm, P = .024) and sutured condition (4.76 ± 1.04 N/mm, P = .011). CONCLUSION Longitudinal split and 50% resection of the peroneus brevis tendon led to elongation and loss of tendon stiffness. These properties were improved by tubularizing suture. The significance of these changes in the clinical setting needs further investigation. CLINICAL RELEVANCE Tubularizing suture of a peroneus brevis split can restore biomechanical properties to almost native condition, potentially aiding ankle stability in symptomatic cases. A split lesion and partial resection of the tendon showed reduced stiffness and increased elongation.
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Affiliation(s)
- Tudor Trache
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Roland S Camenzind
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Elias Bachmann
- Institute for Biomechanics, Balgrist Campus, University of Zurich, Zurich, Switzerland
| | - Arnd Viehöfer
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Stephan Wirth
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
| | - Florian B Imhoff
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Zurich, Switzerland
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Yoshikawa T, Mifune Y, Inui A, Nishimoto H, Yamaura K, Mukohara S, Shinohara I, Kuroda R. Influence of Diabetes-Induced Glycation and Oxidative Stress on the Human Rotator Cuff. Antioxidants (Basel) 2022; 11:antiox11040743. [PMID: 35453426 PMCID: PMC9032678 DOI: 10.3390/antiox11040743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Most shoulder rotator cuff tears (RCTs) are caused by non-traumatic age-related rotator cuff degeneration, of which hyperglycemia is a risk factor due to its glycation reaction and oxidative stress. We aimed to identify the influence of diabetes-induced glycation and oxidative stress in patients with non-traumatic shoulder RCTs. Twenty patients, aged over 50 years, with non-traumatic shoulder RCTs participated in this study. Patients with a history of diabetes mellitus or preoperative HbA1c ≥ 6.5% were assigned to the diabetic group (n = 10), and the rest to the non-diabetic group (n = 10). Cell proliferation; expression of genes related to oxidative stress, glycation reaction, inflammation, and collagen; intracellular reactive oxygen species (ROS) levels; and apoptosis rates were analyzed. The diabetic group had significantly lower cell proliferation than the non-diabetic group. In the diabetic group, the mRNA expression levels of NOX1, NOX4, IL6, RAGE, type III collagen, MMP2, TIMP1, and TIMP2 were significantly higher; type I collagen expression was significantly lower; and the rate of ROS-positive cells and apoptotic cells, as well as the expression of advanced glycation end-products (AGEs) and the receptor for AGEs (RAGE), was significantly higher. In conclusion, hyperglycemia caused by diabetes mellitus increased AGE and RAGE expression, and led to increased NOX expression, ROS production, and apoptosis in the human rotator cuff. This provides scope to find a preventive treatment for non-traumatic RCTs by inhibiting glycation and oxidative stress.
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Affiliation(s)
| | - Yutaka Mifune
- Correspondence: ; Tel.: +81-78-382-5985; Fax: +81-78-351-6944
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25
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Modelling gluteus medius tendon degeneration and repair in a large animal model. Arch Orthop Trauma Surg 2022; 142:1-12. [PMID: 32813126 DOI: 10.1007/s00402-020-03573-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gluteus medius tendon tears often occur in the context of chronic tendinopathy and remain a difficult clinical problem. Surgical repair is challenging as it is often delayed and performed in degenerative tendons. No animal model currently exists to mimic the delayed repair of tendinopathic gluteus medius tears. The aims of this study were to develop a chronic model of gluteus medius tendinopathy and tear and then compare this model to an acute gluteus medius tear and repair. MATERIALS AND METHODS Six gluteus medius muscles were dissected and examined in mature sheep to confirm anatomical similarity to the human counterpart. Ten separate adult sheep underwent tendon detachment, followed by relook and histological sampling at 6 and 16 weeks to assess the extent of tendon degeneration. Six adult sheep underwent tendon repair at 6 weeks and were later assessed for healing of the tendon and compared to a further four adult sheep who underwent an acute tendon detachment and repair procedure. RESULTS The sheep gluteus medius muscle consisted of three compartments, the anterior, middle and posterior. All compartments inserted via the common tendon on the superolateral aspect of the greater trochanter. At both 6 and 16 weeks, there was significant tendinopathic changes on histology compared to controls as assessed by modified Movin's score (p = 0.018, p = 0.047) but no difference between the 6- and 16-week groups (p = 0.25). There were significant differences between delayed and acute repair in both histological appearance (p = 0.025) and biomechanical properties (p = 0.019), with acute repair superior in both. CONCLUSIONS Tendon detachment for 6 weeks is sufficient to produce histological changes similar to chronic tendinopathy and repair of this degenerative tendon results in significantly poorer healing when compared to an acute repair model. Animal models for gluteus medius tears should use a delayed repair model to improve clinical validity.
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26
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Zhu YX, Huang JQ, Ming YY, Zhuang Z, Xia H. Screening of key biomarkers of tendinopathy based on bioinformatics and machine learning algorithms. PLoS One 2021; 16:e0259475. [PMID: 34714891 PMCID: PMC8555777 DOI: 10.1371/journal.pone.0259475] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/19/2021] [Indexed: 12/30/2022] Open
Abstract
Tendinopathy is a complex multifaceted tendinopathy often associated with overuse and with its high prevalence resulting in significant health care costs. At present, the pathogenesis and effective treatment of tendinopathy are still not sufficiently elucidated. The purpose of this research is to intensely explore the genes, functional pathways, and immune infiltration characteristics of the occurrence and development of tendinopathy. The gene expression profile of GSE106292, GSE26051 and GSE167226 are downloaded from GEO (NCBI comprehensive gene expression database) and analyzed by WGCNA software bag using R software, GSE26051, GSE167226 data set is combined to screen the differential gene analysis. We subsequently performed gene enrichment analysis of Gene Ontology (GO) and "Kyoto Encyclopedia of Genes and Genomes" (KEGG), and immune cell infiltration analysis. By constructing the LASSO regression model, Support vector machine (SVM-REF) and Gaussian mixture model (GMMs) algorithms are used to screen, to identify early diagnostic genes. We have obtained a total of 171 DEGs through WGCNA analysis and differentially expressed genes (DEGs) screening. By GO and KEGG enrichment analysis, it is found that these dysregulated genes were related to mTOR, HIF-1, MAPK, NF-κB and VEGF signaling pathways. Immune infiltration analysis showed that M1 macrophages, activated mast cells and activated NK cells had infiltration significance. After analysis of THE LASSO SVM-REF and GMMs algorithms, we found that the gene MACROD1 may be a gene for early diagnosis. We identified the potential of tendon disease early diagnosis way and immune gene regulation MACROD1 key infiltration characteristics based on comprehensive bioinformatics analysis. These hub genes and functional pathways may as early biomarkers of tendon injuries and molecular therapy level target is used to guide drug and basic research.
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Affiliation(s)
- Ya xi Zhu
- District 1, Department of Orthopedics, Xiangtan Central Hospital, Yuhu District, Xiangtan City, Hunan Province, China
- Nanhua University, Hengyang City, Hunan Province, China
| | - Jia qiang Huang
- District 1, Department of Orthopedics, Xiangtan Central Hospital, Yuhu District, Xiangtan City, Hunan Province, China
| | - Yu yang Ming
- Nanhua University, Hengyang City, Hunan Province, China
- Department of Orthopedics, Xiangtan Central Hospital, Yuhu District, Xiangtan City, Hunan Province, China
| | - Zhao Zhuang
- Academy of Anesthesiology, Weifang Medical University, Weifang, China
| | - Hong Xia
- Department of Orthopedics, Xiangtan Central Hospital, Yuhu District, Xiangtan City, Hunan Province, China
- * E-mail:
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27
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Longo UG, Mazzola A, Carotti S, Francesconi M, Catapano S, Magrì F, Perrone G, Morini S, De Salvatore S, Denaro V. The role of estrogen and progesterone receptors in the rotator cuff disease: a retrospective cohort study. BMC Musculoskelet Disord 2021; 22:891. [PMID: 34670550 PMCID: PMC8529750 DOI: 10.1186/s12891-021-04778-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Rotator cuff (RC) tears represent a common cause of shoulder pain and dysfunction in adults. The disease affects primarily women and occurs mainly in the postmenopausal period. This study aimed to investigate immunohistochemically the presence of estrogen receptor-alpha (ER-⍺), estrogen receptor-beta (ER-β) and progesterone receptor (PR) in the supraspinatus tendon of patients with RC tendinopathy, searching for gender differences of expression. A secondary aim was to evaluate potential links between their expression and the typical histopathological findings of the ailment. Methods Biopsies of the supraspinatus tendon were collected intraoperatively from 15 postmenopausal women and 9 men undergoing RC surgery. Specimens were stained with Haematoxylin/Eosin, Masson-Goldner Trichrome, Alcian Blu and immunohistochemical stainings for ER-⍺, ER-β and PR were performed. Tendon alterations were evaluated with the Bonar histopathological scale. Statistical tests used in this study were the Spearman correlation coefficient and the Mann-Whitney U test. Results In the supraspinatus tendon, cells expressed ER-⍺ (p = 0.043), ER-β (p = 0.048) and PR (p = 0.004) with statistically significant differences related to age and sex of patients. Immunoreactivity was seen in the nuclei of tenocytes and vascular cells. Postmenopausal women’s samples showed a markedly higher expression of these receptors compared to their male counterpart. There was a positive correlation between the expression of ER-⍺ and ER-β (r = 0.59; p = 0.02) and between ER-β and PR (r = 0.72; p = 0.002) in women’s samples. Furthermore, in postmenopausal women the PR expression decreased with age (r = − 0.56; p = 0.027). Only in women, the ER-β expression positively correlated with the total Bonar histopathological score (p = 0.019) and the ER-β vascular expression positively correlated with ground substance alterations (p = 0.029). Conclusions These results reveal that ERs and PR are present in the supraspinatus tendon of patients with RC tears, suggesting a role of sex hormones in the pathogenesis of the disease.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy.
| | - Alessandro Mazzola
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy
| | - Simone Carotti
- Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy
| | - Maria Francesconi
- Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy
| | - Simone Catapano
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy
| | - Francesco Magrì
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy
| | - Giuseppe Perrone
- Department of Human Pathology, University Campus Bio-Medico, Rome, Italy
| | - Sergio Morini
- Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, Trigoria, 00128, Rome, Italy
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Hodgens BH, Geller JS, Rizzo MG, Munoz J, Kaplan J, Aiyer A. Performance Outcomes After Surgical Repair of Achilles Tendon Rupture in the Women's National Basketball Association. Orthop J Sports Med 2021; 9:23259671211030473. [PMID: 34527757 PMCID: PMC8436311 DOI: 10.1177/23259671211030473] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Achilles tendon ruptures are devastating in elite athletes. There are currently no studies examining the effects of Achilles tendon rupture on performance outcomes in the Women’s National Basketball Association (WNBA). Hypothesis: Athletes in the WNBA who sustained an Achilles tendon rupture and underwent subsequent surgical repair will sustain declines in performance metrics when compared with their preinjury statistics and matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Seventeen WNBA players who sustained an Achilles tendon rupture from 2000 to 2019 were identified through publicly available injury reports and player profiles. Athlete information collected included age, body mass index, position, and service in the WNBA when the tear occurred. Statistics were collected for 1 season before and 2 seasons after the injury, and the player efficiency rating (PER) was calculated. Players were matched to uninjured controls by service in the WNBA, position, and performance statistics. Results: On average, players were 28 years of age at the time of Achilles tendon rupture, with a service time in the WNBA of 6.5 years. Four players never returned to play in the WNBA, while 7 players failed to play more than 1 season. Players who did return played significantly fewer minutes per game compared with preinjury in both postinjury seasons 1 and 2 (mean difference, –6.11 and –6.54 min/game, respectively; P < .01 for both) and had a significantly decreased PER in postinjury season 2 (mean difference, –2.53; P = .024). After returning to play, the injured players experienced significant decreases when compared with controls in field goals (–0.85 vs +0.20; P = .047), free throws (–1.04 vs +0.12; P < .01), steals (–0.48 vs +0.24; P = .018), and points scored (–2.89 vs +0.58; P = .014). Conclusion: WNBA players experienced significant decreases in performance metrics after Achilles tendon rupture compared with their preinjury levels and compared with uninjured controls. Overall, 23.5% of players failed to return to the WNBA, while 41.2% failed to play for more than 1 season.
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Affiliation(s)
- Blake H Hodgens
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph S Geller
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Michael G Rizzo
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Julianne Munoz
- University of Miami Sports Medicine Institute, Miami, Florida, USA
| | | | - Amiethab Aiyer
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
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29
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Mukohara S, Mifune Y, Inui A, Nishimoto H, Kurosawa T, Yamaura K, Yoshikawa T, Kuroda R. In vitro and in vivo tenocyte-protective effectiveness of dehydroepiandrosterone against high glucose-induced oxidative stress. BMC Musculoskelet Disord 2021; 22:519. [PMID: 34090401 PMCID: PMC8180149 DOI: 10.1186/s12891-021-04398-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/17/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Dehydroepiandrosterone (DHEA), an adrenal steroid, has a protective role against diabetes. This study aimed to investigate the in vitro and in vivo protective effects of DHEA against high glucose-induced oxidative stress in tenocytes and tendons. METHODS Tenocytes from normal Sprague-Dawley rats were cultured in low-glucose (LG) or high-glucose (HG) medium with or without DHEA. The experimental groups were: control group (LG without DHEA), LG with DHEA, HG without DHEA, and HG with DHEA. Reactive oxygen species (ROS) production, apoptosis, and messenger RNA (mRNA) expression of NADPH oxidase (NOX) 1 and 4, and interleukin-6 (IL-6) were determined. Further, diabetic rats were divided into a control group and a DHEA-injected group (DHEA group). NOX1 and NOX4 protein expression and mRNA expression of NOX1, NOX4, IL-6, matrix metalloproteinase (MMP)-2, tissue inhibitors of matrix metalloproteinase (TIMP)-2, and type I and III collagens in the Achilles tendon were determined. RESULTS In rat tenocytes, DHEA decreased the expression of NOX1 and IL-6, ROS accumulation, and apoptotic cells. In the diabetic rat Achilles tendon, NOX1 protein expression and mRNA expression of NOX1, IL-6, MMP-2, TIMP-2, and type III collagen were significantly lower while type I collagen expression was significantly higher in the DHEA group than in the control group. CONCLUSIONS DHEA showed antioxidant and anti-inflammatory effects both in vitro and in vivo. Moreover, DHEA improved tendon matrix synthesis and turnover, which are affected by hyperglycemic conditions. DHEA is a potential preventive drug for diabetic tendinopathy.
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Affiliation(s)
- Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Hanako Nishimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Takashi Kurosawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Tomoya Yoshikawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, 650-0017, Kobe, Japan
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30
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Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers 2021; 7:1. [PMID: 33414454 DOI: 10.1038/s41572-020-00234-1] [Citation(s) in RCA: 293] [Impact Index Per Article: 97.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibres, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis. Although diagnosis is mostly achieved based on clinical symptoms, in some cases, additional pain-provoking tests and imaging might be necessary. Management consists of different exercise and loading programmes, therapeutic modalities and surgical interventions; however, their effectiveness remains ambiguous. Future research should focus on elucidating the key functional pathways implicated in clinical disease and on improved rehabilitation protocols.
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Affiliation(s)
- Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
| | | | - Kristian Thorborg
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Paul D Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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31
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Mansur NSB, Fonseca LF, Matsunaga FT, Baumfeld DS, Nery CADS, Tamaoki MJS. Achilles Tendon Lesions - Part 2: Ruptures. Rev Bras Ortop 2020; 55:665-672. [PMID: 33364642 PMCID: PMC7748929 DOI: 10.1055/s-0040-1702948] [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] [Received: 09/10/2019] [Accepted: 12/05/2019] [Indexed: 11/07/2022] Open
Abstract
The increasing incidence of calcaneal tendon ruptures has substantially impacted orthopedic care and costs related to its treatment and prevention. Primarily motivated by the increasing of life expectancy, the growing use of tenotoxic drugs and erratic access to physical activity, this injury accounts for considerable morbidity regardless of its outcome. In recent years, the evolution of surgical and rehabilitation techniques gave orthopedists better conditions to decide the most appropriate conduct in acute tendon rupture. Although still frequent due to their high neglect rate, Achilles chronic ruptures currently find simpler and more biological surgical options, being supported by a new specialty-focused paradigm.
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Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Lucas Furtado Fonseca
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Fábio Teruo Matsunaga
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Daniel Soares Baumfeld
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Caio Augusto de Souza Nery
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Marcel Jun Sugawara Tamaoki
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
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32
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Mansur NSB, Fonseca LF, Matsunaga FT, Baumfeld DS, Nery CADS, Tamaoki MJS. Achilles Tendon Lesions - Part 1: Tendinopathies. Rev Bras Ortop 2020; 55:657-664. [PMID: 33364641 PMCID: PMC7748930 DOI: 10.1055/s-0040-1702953] [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] [Received: 09/10/2019] [Accepted: 11/29/2019] [Indexed: 11/24/2022] Open
Abstract
Calcaneal tendon injuries are extremely common in the general population and in orthopedics routine care. Its increasing incidence, which is motivated by an aging population, improved access to the health care system, increased prescription of continuous-use medication, erratic participation in sports and other factors, has had a direct impact on society. Consolidated treatment options for tendinopathies lack quality scientific support for many modalities. New therapies have emerged to enhance nonsurgical approach outcomes and to reduce the number of patients requiring surgery. Although these operative procedures provide good pain relief and functional outcomes, they are costly and may lead to complications.
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Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Lucas Furtado Fonseca
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Fábio Teruo Matsunaga
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Daniel Soares Baumfeld
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Caio Augusto de Souza Nery
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - Marcel Jun Sugawara Tamaoki
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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33
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Zhu MF, Smith B, Krishna S, Musson DS, Riordan PR, McGlashan SR, Cornish J, Munro JT. The pathological features of hip abductor tendon tears - a cadaveric study. BMC Musculoskelet Disord 2020; 21:778. [PMID: 33243210 PMCID: PMC7690166 DOI: 10.1186/s12891-020-03784-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/10/2020] [Indexed: 01/06/2023] Open
Abstract
Background The hip abductors are crucial in maintaining pelvic stability. Tears in these tendons are common and often debilitating. There is uncertainty regarding both the histological and macroscopic features of hip abductor tears. This study aims to clarify both the macroscopic and microscopic features of the tendon and enthesis in hip abductor tendon tears. Methods Thirty-six cadavers with an average age of 81 were dissected, and the hip abductor mechanisms removed en-bloc. The presence, location and size of the tears were recorded and analysed. The samples were processed into histological blocks and viewed using both transmitted and polarised light. Tendon histology was graded using the modified Movin’s score in three sections (deep, middle and superficial layers) and the enthesis graded separately using 5-point criteria. Analysis of variance was used to confirm histological features associated with tears. Results Tears were found in 24 of 36 samples (67%). The most common finding was an isolated tear in the gluteus minimus (46%), followed by concurrent gluteus medius and gluteus minimus tears (33%). Histology revealed significantly more degeneration in both the tendon (p = 0.0005) and enthesis (p = 0.0011) when tears were present. Furthermore, these changes were concentrated in the deeper layers of the tendon (p = 0.0002) and enthesis (p = 0.003). Conclusion This study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. Degenerative changes occur in both the tendon and enthesis, with the deeper layers predominantly affected. These findings are important for guiding surgical repair techniques and to aid the development of novel materials and biologics. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03784-3.
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Affiliation(s)
- Mark F Zhu
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand. .,Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand.
| | - Brittany Smith
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Sanjeev Krishna
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - David S Musson
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Peter R Riordan
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, New Zealand
| | - Sue R McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, New Zealand
| | - Jillian Cornish
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Jacob T Munro
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand
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34
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Aicale R, Oliviero A, Maffulli N. Management of Achilles and patellar tendinopathy: what we know, what we can do. J Foot Ankle Res 2020; 13:59. [PMID: 32993702 PMCID: PMC7523300 DOI: 10.1186/s13047-020-00418-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Tendinopathies are challenging conditions frequent in athletes and in middle-aged overweight patients with no history of increased physical activity. The term “tendinopathy” refers to a clinical condition characterised by pain, swelling, and functional limitations of tendons and nearby structures, the effect of chronic failure of healing response. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed primarily conservatively, obtaining good results and clinical outcomes, but, when this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively high rate of success with few complications. The purpose of this narrative review is to critically examine the recent available scientific literature to provide evidence-based opinions on these two common and troublesome conditions.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy. .,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy. .,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England. .,Institute of Science and Technology in Medicine, Keele University, School of Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England.
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35
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Ferrer GA, Miller RM, Yoshida M, Wang JH, Musahl V, Debski RE. The Correlation of Quantitative Ultrasound Measures and Supraspinatus Tendon Quality: A Pilot Study. J Med Ultrasound 2020; 28:162-168. [PMID: 33282660 PMCID: PMC7709527 DOI: 10.4103/jmu.jmu_104_19] [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] [Received: 10/29/2019] [Revised: 11/12/2019] [Accepted: 12/23/2019] [Indexed: 11/07/2022] Open
Abstract
Background: The objective of this study was to determine the feasibility of assessing tendon quality as quantified by histology through changes in quantitative ultrasound measures. Methods: Eight cadaveric shoulders (four with a small supraspinatus tendon tear) were examined using conventional B-mode ultrasound in the transverse plane by internally rotating and hyperextending the humerus. Quantitative ultrasound measures (skewness, kurtosis, variance, and echogenicity) were calculated based on the grayscale distribution of the ultrasound image taken of the supraspinatus tendon near the insertion site. The specimens were then dissected to the supraspinatus tendon where tendon biopsies were taken near the insertion site, mid-substance, and myotendinous junction. Through histology, tendon quality was evaluated based on collagen fiber organization, fatty infiltration, nuclei shape, and cellularity. Correlations between quantitative ultrasound measures and histological grades of tendon quality were determined through Pearson or Spearman's rho correlations. Results: A total of three significant correlations between quantitative ultrasound measures and histological parameters of tendon quality were found. Significant correlations between kurtosis and cellularity at the insertion site (r = 0.724) (P < 0.05) as well as variance and fatty infiltration at the myotendinous junction (ρ = −0.843) (P < 0.05) and for the whole tendon (ρ = −0.826) (P < 0.05) were found. Conclusion: The results show the potential for quantitative ultrasound measures to assess factors of tendon quality that can only be determined through histology. With further development of the methodology that utilizes quantitative ultrasound measures, clinicians might be able to evaluate the tendon quality noninvasively in future.
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Affiliation(s)
- Gerald A Ferrer
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - R Matthew Miller
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masahito Yoshida
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James H Wang
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard E Debski
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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36
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Abstract
Hip abductor tendon tear is a difficult problem to manage. The hip abductor mechanism is made up of the gluteus medius and minimus muscles, both of which contribute to stabilising the pelvis through the gait cycle. Tears of these tendons are likely due to iatrogenic injury during arthroplasty and chronic degenerative tendinopathy. Ultrasound and magnetic resonance imaging have provided limited clues regarding the pattern of disease and further work is required to clarify both the macro and microscopic pattern of disease. While surgery has been attempted over the last 2 decades, the outcomes are variable and the lack of high-quality studies have limited the uptake of surgical repair. Hip abductor tendon tears share many features with rotator cuff tears, hence, innovations in surgical techniques, materials and biologics may apply to both pathologies.
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Affiliation(s)
- Mark F Zhu
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
| | | | | | - Simon W Young
- The University of Auckland, Auckland, New Zealand.,North Shore Hospital, Auckland, New Zealand
| | - Jacob T Munro
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
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37
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Effect of localized tendon remodeling on supraspinatus tear propagation. J Biomech 2020; 108:109903. [PMID: 32636012 DOI: 10.1016/j.jbiomech.2020.109903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022]
Abstract
Rotator cuff tear propagation is multifactorial and may be due to localized changes in mechanical properties from tendon remodeling based on the inhomogeneous stresses experienced by a tendon with a tear. The objective of this study was to investigate the effect of localized tendon remodeling on tear propagation for simulated supraspinatus tendon tears. A validated computational model of a supraspinatus tendon using subject-specific geometry and material properties with a 1 cm wide anterior tear was used. The medial edge of the supraspinatus tendon was displaced 5 mm to induce tear propagation and cohesive elements were used to model tear propagation. Four remodeling scenarios were investigated: (1) Baseline (no remodeling), (2) Positive remodeling (increased fiber stiffness) and (3) Negative remodeling (decreased fiber stiffness) at tear tips, and (4) Negative remodeling along the medial-lateral tear edge. Output parameters included the amount of tear propagation, critical load to propagate the tear, and maximum principal stress at the tear tips. Positive remodeling at the tear tips resulted in the largest amount of tear propagation (18.4 mm), highest peak maximum principal stress (25.2 MPa), and lowest critical load to propagate the tear (249N). Conversely, negative remodeling at the tear tips resulted in the least amount of tear propagation (16 mm), lowest peak maximum principal stress (17.6 MPa) and highest critical load to propagate the tear (278N). Overall, remodeling at the tear tips has the greatest effect on tear propagation. Therefore, a better method for clinicians to measure tendon stiffness at the tear tips would be helpful to improve outcome of patients.
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38
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Aicale R, Bisaccia RD, Oliviero A, Oliva F, Maffulli N. Current pharmacological approaches to the treatment of tendinopathy. Expert Opin Pharmacother 2020; 21:1467-1477. [DOI: 10.1080/14656566.2020.1763306] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno, Italy
| | - Rocco Domenico Bisaccia
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Department of Pharmacology, School of Medicine and Surgery, University of Salerno , Baronissi, Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London , London, UK
- Keele University, Faculty of Medicine, School of Pharmacology and Bioengineering, Guy Hilton Research Centre , Stoke-on-Trent, UK
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39
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Schmidt EC, Hullfish TJ, O'Connor KM, Hast MW, Baxter JR. Ultrasound echogenicity is associated with fatigue-induced failure in a cadaveric Achilles tendon model. J Biomech 2020; 105:109784. [DOI: 10.1016/j.jbiomech.2020.109784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/16/2020] [Accepted: 03/29/2020] [Indexed: 01/25/2023]
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40
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Tendon and ligament mechanical loading in the pathogenesis of inflammatory arthritis. Nat Rev Rheumatol 2020; 16:193-207. [PMID: 32080619 DOI: 10.1038/s41584-019-0364-x] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
Mechanical loading is an important factor in musculoskeletal health and disease. Tendons and ligaments require physiological levels of mechanical loading to develop and maintain their tissue architecture, a process that is achieved at the cellular level through mechanotransduction-mediated fine tuning of the extracellular matrix by tendon and ligament stromal cells. Pathological levels of force represent a biological (mechanical) stress that elicits an immune system-mediated tissue repair pathway in tendons and ligaments. The biomechanics and mechanobiology of tendons and ligaments form the basis for understanding how such tissues sense and respond to mechanical force, and the anatomical extent of several mechanical stress-related disorders in tendons and ligaments overlaps with that of chronic inflammatory arthritis in joints. The role of mechanical stress in 'overuse' injuries, such as tendinopathy, has long been known, but mechanical stress is now also emerging as a possible trigger for some forms of chronic inflammatory arthritis, including spondyloarthritis and rheumatoid arthritis. Thus, seemingly diverse diseases of the musculoskeletal system might have similar mechanisms of immunopathogenesis owing to conserved responses to mechanical stress.
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Mechanical properties and collagen fiber orientation of tendon in young and elderly. Clin Biomech (Bristol, Avon) 2020; 71:5-10. [PMID: 31675513 DOI: 10.1016/j.clinbiomech.2019.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 08/09/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of this study was to investigate differences in the mechanical properties and collagen fiber orientation of tendon structures between young and elderly groups. METHODS The mechanical properties of tendon structures in medial gastrocnemius muscle were measured using ultrasonography during ramp and ballistic contractions. Tendon collagen fiber orientation was estimated from coefficient of variation (CV) of echogenicity on transverse ultrasonic images of Achilles tendon. FINDINGS Differences in elongation between ramp and ballistic contractions of elderly were significantly smaller than those of young group at 20-80% of MVC. During ramp contraction, hysteresis of elderly was significantly higher than that of young, whereas no difference in hysteresis during ballistic contraction was found between the two groups. Difference in hysteresis between ramp and ballistic contractions of elderly tended to be lower than that of young group. Mean echogenicity of elderly was significantly higher than that of young group, whereas no difference in CV of echogenicity was found between the two groups. INTERPRETATION These results suggest that smaller differences in elongation and hysteresis between ramp and ballistic contractions of elderly may be related to decreased water content within tendons. Furthermore, no difference in collagen fiber orientation of tendons was noted between the two groups.
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Ferrer GA, Miller RM, Yoshida M, Wang JHC, Musahl V, Debski RE. Localized Rotator Cuff Tendon Degeneration for Cadaveric Shoulders with and Without Tears Isolated to the Supraspinatus Tendon. Clin Anat 2019; 33:1007-1013. [PMID: 31750575 DOI: 10.1002/ca.23526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 01/13/2023]
Abstract
Localized differences in tissue degeneration throughout intact and torn rotator cuff tendons have not been well quantified. The objective of this study was to investigate histological differences in localized degeneration in tendons with and without rotator cuff tears isolated to the supraspinatus tendon. Four intact shoulders and four shoulders with rotator cuff tears isolated to the supraspinatus tendon were dissected down to the infraspinatus and supraspinatus tendons. Biopsies were taken throughout the tendon insertion, mid-substance, myotendinous junction, and around the tear if present. Samples were stained with hematoxylin and eosin and tendon degeneration was graded based on collagen fiber organization, nuclei shape, cellularity, and lipoid degeneration. Comparisons in degeneration parameters were made based on the tendon type (supraspinatus vs. infraspinatus), location within the tendon, and presence of a tear. Supraspinatus tendons exhibited more degeneration than the infraspinatus tendon (P < 0.05). Significant increases in lipoid degeneration were found near the myotendinous junction compared to the rest of the tendon (P < 0.001). Tendons with rotator cuff tears showed greater amounts of lipoid degeneration compared to intact tendons (P = 0.03). A strong negative correlation was found between lipoid degeneration and collagen fiber organization (r = -0.922, P = 0.001). No differences in degeneration were found between medial, anterior, and posterior edges of the tear. The study highlights specific factors of tendon degeneration contributing to the local differences in tendon degeneration. By understanding local differences in tendon degeneration, surgical protocols for repair can be improved. Clin. Anat., 33:1007-1013, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Gerald A Ferrer
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Matthew Miller
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Masahito Yoshida
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James H-C Wang
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Park YH, Kim TJ, Choi GW, Kim HJ. Achilles tendinosis does not always precede Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 2019; 27:3297-3303. [PMID: 30267184 DOI: 10.1007/s00167-018-5172-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 09/21/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE Degenerative change is a typical histologic finding of Achilles tendinosis and is thought to be a factor associated with Achilles tendon rupture; however, this relationship remains controversial. Therefore, the aim of this study was to review the histological findings of ruptured Achilles tendons and analyze demographics and injury patterns. METHODS Retrospective analysis was performed for all patients who underwent Achilles tendon repair for acute Achilles tendon rupture at our institution between 2008 and 2015. The presence of Achilles tendinosis was determined by light microscopic histology of ruptured Achilles tendons. Patients were grouped according to the presence of Achilles tendinosis and patient demographics, sports activities, and clinical outcomes were compared. Ankle activity score was used to evaluate the level of sports activity and Achilles tendon total rupture score (ATRS) was used to evaluate clinical outcomes. RESULTS A total of 152 Achilles tendon ruptures were included: 112 (77%) showed Achilles tendinosis at a ruptured Achilles tendon on histology and 40 (23%) did not. Patients who had no Achilles tendinosis prior to rupture had a lower ankle activity score (P < 0.05) and higher incidence of non-sports related injury (P < 0.05). ATRS was not significantly different between the groups at final follow-up (P = n.s.). CONCLUSION In contrast to previous reports, Achilles tendon rupture can occur without prior Achilles tendinosis, especially in non-sports-related injuries and in patients with low sports activity. Although the direct clinical applications of these results are limited, the findings of this study can improve our understanding of the etiology of Achilles tendon rupture. LEVEL OF EVIDENCE Prognostic, Level III.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Tae Jin Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea
| | - Gi Won Choi
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Seoul, South Korea
| | - Hak Jun Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
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Baldwin M, Snelling S, Dakin S, Carr A. Augmenting endogenous repair of soft tissues with nanofibre scaffolds. J R Soc Interface 2019; 15:rsif.2018.0019. [PMID: 29695606 DOI: 10.1098/rsif.2018.0019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022] Open
Abstract
As our ability to engineer nanoscale materials has developed we can now influence endogenous cellular processes with increasing precision. Consequently, the use of biomaterials to induce and guide the repair and regeneration of tissues is a rapidly developing area. This review focuses on soft tissue engineering, it will discuss the types of biomaterial scaffolds available before exploring physical, chemical and biological modifications to synthetic scaffolds. We will consider how these properties, in combination, can provide a precise design process, with the potential to meet the requirements of the injured and diseased soft tissue niche. Finally, we frame our discussions within clinical trial design and the regulatory framework, the consideration of which is fundamental to the successful translation of new biomaterials.
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Affiliation(s)
- Mathew Baldwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Snelling
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephanie Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Rajpar I, Barrett JG. Optimizing growth factor induction of tenogenesis in three-dimensional culture of mesenchymal stem cells. J Tissue Eng 2019; 10:2041731419848776. [PMID: 31205672 PMCID: PMC6535701 DOI: 10.1177/2041731419848776] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022] Open
Abstract
Adult tissue stem cells have shown promise for the treatment of debilitating tendon injuries. However, few comparisons of stem cells from different tissue sources have been made to determine the optimum stem cell source for treating tendon. Moreover, it is likely that the application of tenogenic growth factors will improve tendon stem cell treatments further, and a comprehensive comparison of a number of growth factors is needed. Thus far, different types of stem cells cannot be evaluated in a high-throughput manner. To this end, we have developed an approach to culture mesenchymal stem cells isolated from bone marrow in collagen type I hydrogels with tenogenic growth factors using economical, commercially available supplies. To optimize growth factors for this assay, FGF-2, TGF-β1, IGF-1, and/or BMP-12 were tested singly and in novel combinations of (1) BMP-12 and IGF-1, (2) TGF-β1 and IGF-1, and/or (3) BMP-12 and FGF-2 over 10 days. Our data suggest that BMP-12 supplementation alone results in the strongest expression of tendon marker genes, controlled contractility of constructs, a higher degree of cell alignment, and tendon-like tissue morphology. This easy-to-use benchtop assay can be used to screen novel sources of stem cells and cell lines for tissue engineering and tendon healing applications.
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Affiliation(s)
- Ibtesam Rajpar
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Leesburg, VA, USA
| | - Jennifer G Barrett
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Leesburg, VA, USA
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Sugiyama Y, Naito K, Goto K, Kojima Y, Furuhata A, Igarashi M, Nagaoka I, Kaneko K. Effect of aging on the tendon structure and tendon-associated gene expression in mouse foot flexor tendon. Biomed Rep 2019; 10:238-244. [PMID: 30972219 DOI: 10.3892/br.2019.1200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/07/2019] [Indexed: 01/23/2023] Open
Abstract
To evaluate the biological changes in tendons during the aging process, the present study examined the effect of aging on the tendon structure, distribution of collagen types I and III, and expression of tendon-associated genes, using flexor tendons in a mouse model. Histological assessment of the tendon structure and distribution of collagen types I and III were performed, and the expression of tendon-associated genes was evaluated in flexor digitorium longus tendons of young (8 weeks) and aged (78 weeks) female C57BL/6 mice. The results indicated that the Soslowsky score, based on the analysis of cellularity, fibroblastic changes, and collagen fiber orientation and disruption, was significantly increased, or worsened, in the tendons of the aged group compared with those in the young group. Furthermore, in the aged group, the distribution of type I collagen was decreased and the distribution of type III collagen was relatively increased compared with the young group. Finally, the mRNA expression levels of collagen (type I and type III) and tenogenic markers (Mohawk homeobox, tenomodulin and scleraxis BHLH transcription factor) were significantly decreased in the aged group compared with the young group. The present observations demonstrated that the structure of the tendons, distribution of types I and III collagen and the expression of tendon-associated genes were modulated by aging in the flexor tendon, and that these changes may contribute to the degeneration of tendons in tendinopathy.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Kiyohito Naito
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Kenji Goto
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Yuko Kojima
- Laboratory of Morphology and Image Analysis, Research Support Center, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Atsushi Furuhata
- Laboratory of Morphology and Image Analysis, Research Support Center, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Mamoru Igarashi
- Department of Host Defense and Biochemical Research, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Isao Nagaoka
- Department of Host Defense and Biochemical Research, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Kazuo Kaneko
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
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Cury DP, Schäfer BT, de Almeida SRY, Righetti MMDS, Watanabe IS. Application of a Purified Protein From Natural Latex and the Influence of Suture Type on Achilles Tendon Repair in Rats. Am J Sports Med 2019; 47:901-914. [PMID: 30759353 DOI: 10.1177/0363546518822836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prolonged tendon-healing process, the high costs associated with treatment, the increase in the number of injuries over the past decades, and the lack of consensus on the optimal treatment of tendon injuries are a global problem. Restoring the normal tendon anatomy and decreasing the healing time are key factors for treatment advancement. HYPOTHESIS Application of a purified protein from natural latex (PPNL) accelerates the healing process, increasing collagen synthesis and decreasing metalloproteinases. PPNL associated with a simpler suture technique should decrease the healing time. STUDY DESIGN Controlled laboratory study. METHODS Injury, surgery, and treatment with PPNL were conducted with male Sprague-Dawley rats. Two suture techniques were used: U-suture, a simpler and lesser traumatic technique, and Kessler-Tajima, to avoid strangulation of the microcirculation. Achilles tendons were completely sectioned, and 100 µL of 0.1% PPNL was applied on the tendon during surgery. Tendon morphology, distribution, and quantity of collagen types I and III, as well as expression of TIMP-1, TIMP-2, MMP-2, and MMP-9 and ultrastructural aspects of cells and collagen fibrils, were assessed after 2 and 4 weeks. RESULTS PPNL treatment improved collagen type I synthesis and reduced MMP-2 expression. All groups showed a 6.8-times increase in tendon weight as compared with the control group after 2 weeks and a 5.2-times increase after 4 weeks. All groups showed an increase in diameter after 4 weeks, except for the ones treated with PPNL, which showed a slight reduction in diameter. The peak of concentration of collagen fibrils with a 80-nm diameter was 27.79% in the control group; all other experimental groups presented fibrils between 50 and 60 nm. However, the best results were observed with Kessler-Tajima suture associated with PPNL. CONCLUSION/CLINICAL RELEVANCE There are no known medicines or substances capable of aiding the tendon healing process besides surgery. The discovery of a substance able to improve this process and decrease its duration represents an important advancement in orthopaedic medicine.
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Affiliation(s)
- Diego Pulzatto Cury
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Bárbara Tavares Schäfer
- Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil
| | | | | | - Ii-Sei Watanabe
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Patients with Achilles Tendon Rupture Have a Degenerated Contralateral Achilles Tendon: An Elastography Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2367615. [PMID: 30627544 PMCID: PMC6304598 DOI: 10.1155/2018/2367615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/21/2018] [Indexed: 02/08/2023]
Abstract
Purpose To evaluate differences of Achilles tendon (AT) hardness and morphology between asymptomatic tendons in patients with acute AT ruptures on the contralateral side and asymptomatic tendons in healthy people by using computer-assisted quantification on axial-strain sonoelastography (ASE). Methods The study consisted of 33 asymptomatic tendons in 33 patients (study group) and 34 tendons in 19 healthy volunteers (control group). All the tendons were examined by both ASE and conventional ultrasound. Computer-assisted quantification on ASE was applied to extract hardness variables, including the mean (Hmean), 20th percentile (H20), median (H50) and skewness (Hsk) of the hardness within tendon, and the ratio of the mean hardness within tendon to that outside tendon (Hratio) and three morphological variables: the thickness (THK), cross-sectional area, and eccentricity (ECC) of tendons. Results The Hmean, Hsk, H20, H50, and Hratio in the proximal third of the tendon body in study group were significantly smaller than those in control group (Hmean: 0.43±0.09 vs 0.50±0.07, p=0.001; Hsk: -0.53±0.51 vs -1.09±0.51, p<0.001; H20: 0.31±0.10 vs 0.40±0.10, p=0.001; H50: 0.45±0.10 vs 0.53±0.08, p<0.001; Hratio: 1.01±0.25 vs 1.20±0.23, p=0.003). The THK and cross-sectional area of tendons in the study group were larger than those in the control group (p<0.05). Conclusions As a quantitative objective method, the computer-assisted ASE reveals that the asymptomatic ATs contralateral to acute rupture are softer than those of healthy control group at the proximal third and the asymptomatic tendons in people with rupture history are thicker, larger, and rounder than those of normal volunteers especially at the middle and distal thirds of AT body.
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Arthroscopic patellar release allows timely return to performance in professional and amateur athletes with chronic patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2018; 26:3553-3559. [PMID: 29806056 DOI: 10.1007/s00167-018-4985-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Return to sports rates in amateur and professional athletes with chronic patellar tendinopathy following arthroscopic patellar release are unpredictable. The present study aims to analyse the effectiveness of arthroscopic patellar release in professional compared to amateur athletes. METHODS A total of 34 amateur and 20 professional athletes with chronic patellar tendinopathy, refractory to conservative treatment, were studied prospectively and underwent arthroscopic tendon release at the inferior patellar pole. Impact of grouped sports on clinical and functional outcome, subjective patient satisfaction and return to sports rates were assessed. Additionally, preoperative MRI-scans of the knee were evaluated and correlated with clinical outcome. RESULTS In 40 patients (74.1%) arthroscopic patellar release resulted in complete recovery and return to preinjury exercise levels. Full return to sports was achieved after a median of 3.0 (range 0.5-12.0) months. Functional outcome measures VISA-P (Victorian Institute of sport assessment for patella) and modified Blazina scores improved significantly from pre- to postoperatively (VISA-P: 48.8 vs. 94.0 pts., respectively, p < 0.0001; Blazina: 4.47 vs. 0.5, respectively, p < 0.0001). CONCLUSION As rapid recovery and timely return to sports are crucial for professional athletes, arthroscopic patellar release should be considered after failed conservative treatment. LEVEL OF EVIDENCE IV.
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Kubo K. Effects of static stretching on mechanical properties and collagen fiber orientation of the Achilles tendon in vivo. Clin Biomech (Bristol, Avon) 2018; 60:115-120. [PMID: 30342379 DOI: 10.1016/j.clinbiomech.2018.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/21/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The study was designed to examine changes in tendon properties measured during ramp and ballistic contractions after static stretching and to elucidate the relationship between stretching-induced changes in tendon properties (particularly hysteresis) and collagen fiber orientation. METHODS Thirteen males performed static stretching, in which the ankle was passively flexed to 36° dorsiflexion and remained stationary for 10 min. Before and after stretching, the stiffness and hysteresis of tendon structures in the medial gastrocnemius muscle were measured using ultrasonography during ramp and ballistic contractions. Tendon collagen fiber orientation was also estimated from the coefficient of variation (CV) of echogenicity on transverse ultrasonic images of the Achilles tendon. FINDINGS The hysteresis of tendon structures significantly decreased by 15.5% (p = 0.005) during ramp contractions and by 15.3% (p = 0.003) during ballistic contractions after stretching, whereas stiffness did not. The mean echogenicity of the Achilles tendon significantly increased by 6.0% (p = 0.002) after stretching, whereas the CV of echogenicity did not (p = 0.148). Furthermore, the relative change in mean echogenicity, which reflected interstitial fluid movement within tendons, tended to be correlated to that in hysteresis measured during ballistic contractions (r = 0.439, p = 0.133). INTERPRETATION These results suggest that the hysteresis, but not stiffness, of tendon structures measured during ramp and ballistic contractions significantly decreased after stretching. Furthermore, a decline in the hysteresis of tendon structures after static stretching was associated with interstitial fluid movement within tendons, but not to changes in collagen fiber orientation.
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Affiliation(s)
- Keitaro Kubo
- Department of Life Science (Sports Sciences), The University of Tokyo, Meguro, Tokyo, Japan.
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