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The American Journal of Sports Medicine Jan 2022Achilles tendon ruptures are painful and debilitating injuries and are most common in middle-aged patients. There is a lack of understanding of the underlying causes for...
BACKGROUND
Achilles tendon ruptures are painful and debilitating injuries and are most common in middle-aged patients. There is a lack of understanding of the underlying causes for increased rupture rates in middle-aged patients and how healing outcomes after a rupture might be affected by patient age. Therefore, the objective of this study was to define age-specific Achilles tendon healing by assessing ankle functional outcomes and Achilles tendon mechanical and histological properties after a rupture using a rat model.
HYPOTHESIS
Rats representing the middle-aged patient population would demonstrate reduced healing capability after an Achilles tendon rupture, as demonstrated by a slower return to baseline ankle functional properties and inferior biomechanical and histological tendon properties.
STUDY DESIGN
Controlled laboratory study.
METHODS
Fischer 344 rats were categorized by age to represent young, middle-aged, and old patients, and Achilles tendon ruptures were induced in the right hindlimb. Animals were allowed to heal and were euthanized at 3 or 6 weeks after the injury. In vivo functional assays and ultrasound imaging were performed throughout the healing period, and ex vivo tendon mechanical and histological properties were assessed after euthanasia.
RESULTS
Rats representing middle-aged patients displayed reduced healing potential compared with the other age groups, as they demonstrated decreased recovery of in vivo functional and ultrasound assessment parameters and inferior mechanical and histological properties after an Achilles tendon rupture.
CONCLUSION
These findings may help explain the increased rupture rate observed clinically in middle-aged patients by suggesting that there may be altered tendon responses to daily trauma.
CLINICAL RELEVANCE
The results provide novel data on age-specific healing outcomes after an Achilles tendon rupture, which underscores the importance of considering a patient's age during treatment and expectations for outcomes.
Topics: Achilles Tendon; Animals; Humans; Rats; Rats, Inbred F344; Rupture; Tendon Injuries; Treatment Outcome; Wound Healing
PubMed: 34851182
DOI: 10.1177/03635465211055476 -
The Physician and Sportsmedicine Nov 2021: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain...
: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, = 0.010 for Achilles; relative risk = 2.52, = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, = 0.039 for Achilles; hazard ratio = 2.73, = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; = 0.001) and patellar tendons (relative risk = 3.81; = 0.001).: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.
Topics: Achilles Tendon; Humans; Musculoskeletal Pain; Patellar Ligament; Prospective Studies; Tendinopathy; Ultrasonography
PubMed: 33153352
DOI: 10.1080/00913847.2020.1847004 -
International Journal of Environmental... May 2023After Achilles tendon tenorraphy, tendon tissue undergoes a long period of biological healing. During this period, tissue turnover shows heterogeneity between its...
After Achilles tendon tenorraphy, tendon tissue undergoes a long period of biological healing. During this period, tissue turnover shows heterogeneity between its peripheral and central regions. This case report concerns the description of the tendon healing process of an athlete who underwent an Achilles tendon tenorraphy. As the reparative processes progressed, magnetic resonance imaging (MRI) showed centralization of the hyperintensity area and the tendon assumed a doughnut-like appearance. At the same time, ultrasound (US) assessment showed a progressive reorganization of the tendon fibrillar structure. Therefore, for the athlete, MRI and US assessment together represent a useful tool for the decision-making process after Achilles tendon tenorraphy.
Topics: Humans; Achilles Tendon; Metaphor; Rupture; Wound Healing; Ultrasonography; Magnetic Resonance Imaging
PubMed: 37297589
DOI: 10.3390/ijerph20115985 -
Advanced Drug Delivery Reviews Apr 2018Due to the increasing age of our society and a rise in engagement of young people in extreme and/or competitive sports, both tendinopathies and tendon ruptures present a... (Review)
Review
Due to the increasing age of our society and a rise in engagement of young people in extreme and/or competitive sports, both tendinopathies and tendon ruptures present a clinical and financial challenge. Tendon has limited natural healing capacity and often responds poorly to treatments, hence it requires prolonged rehabilitation in most cases. Till today, none of the therapeutic options has provided successful long-term solutions, meaning that repaired tendons do not recover their complete strength and functionality. Our understanding of tendon biology and healing increases only slowly and the development of new treatment options is insufficient. In this review, following discussion on tendon structure, healing and the clinical relevance of tendon injury, we aim to elucidate the role of stem cells in tendon healing and discuss new possibilities to enhance stem cell treatment of injured tendon. To date, studies mainly apply stem cells, often in combination with scaffolds or growth factors, to surgically created tendon defects. Deeper understanding of how stem cells and vasculature in the healing tendon react to growth factors, common drugs used to treat injured tendons and promising cellular boosters could help to develop new and more efficient ways to manage tendon injuries.
Topics: Achilles Tendon; Animals; Humans; Stem Cells; Wound Healing
PubMed: 29278683
DOI: 10.1016/j.addr.2017.12.016 -
BMC Musculoskeletal Disorders Jul 2021Familial hypercholesterolemia is a genetic condition characterized by life-long elevations of plasma low-density lipoprotein cholesterol. In addition to life-threatening...
BACKGROUND
Familial hypercholesterolemia is a genetic condition characterized by life-long elevations of plasma low-density lipoprotein cholesterol. In addition to life-threatening cardiovascular complications, intratendinous cholesterol deposits (xanthomas) can lead to pain and tendon thickening, particularly in the Achilles. Clinical detection of xanthomas currently relies upon visual assessment and palpation, or ultrasound-based measures of tendon thickening or echotexture. Misdiagnosis of xanthoma can delay the commencement of potentially life-saving lipid-lowering therapy. Our primary purpose was to determine whether analysis of separated fat and water magnetic resonance images may be able to differentiate between xanthomatic and nonxanthomatic Achilles tendons through quantification of intratendinous fat content. The main hypothesis was that Achilles tendon xanthomas will demonstrate greater lipid content than Achilles tendinopathy or healthy control tendons.
METHODS
Bilateral MRI scans of Achilles tendons from 30 participants (n = 10 Achilles tendon xanthoma, n = 10 Achilles overuse tendinopathy, n = 10 healthy controls) were analyzed for total lipid content using the Dixon method of fat and water signal separation. Secondary outcome measures included tendon water content, as well as ultrasound characterization of tendon tissue organization and thickness.
RESULTS
Fat content was greater in Achilles tendon xanthomas compared to the tendinopathy (p < 0.0001) and control groups (p < 0.0001). Water content was also greater in Achilles tendon xanthomas compared to the tendinopathy (p < 0.0001) and control groups (p = 0.0002). Ultrasound tissue characterization revealed worse tissue organization in Achilles tendon xanthoma tendons compared to Achilles tendinopathy (p < 0.05) but demonstrated largely overlapping distributions. Achilles tendon xanthoma tendons were, on average, significantly thicker than the tendons of the other two groups (p < 0.01 and p < 0.001, respectively).
CONCLUSION
MRI-derived measures of Achilles tendon fat content may be able to distinguish xanthomas from control and tendinopathic tissue. Dixon method MRI warrants further evaluation in an adequately powered study to develop and test clinically relevant diagnostic thresholds.
Topics: Achilles Tendon; Cross-Sectional Studies; Humans; Magnetic Resonance Imaging; Tendinopathy; Xanthomatosis
PubMed: 34271888
DOI: 10.1186/s12891-021-04494-0 -
Journal of Orthopaedic Surgery (Hong... 2021This study aims to measure the distance between the common site of Achilles tendon rupture and calcaneal insertion through ultrasound and to compare the outcomes between...
PURPOSE
This study aims to measure the distance between the common site of Achilles tendon rupture and calcaneal insertion through ultrasound and to compare the outcomes between proximal and distal rupture groups.
METHODS
We investigated the electronic medical records of 117 patients and preoperative ultrasound describing the rupture site. Among 88 patients, we compared the patient-reported outcome and re-rupture rate of proximal and distal rupture groups.
RESULTS
The mean rupture site of the 117 included subjects was 4.5 ± 1.3 cm. The rupture site had a weak negative correlation with body mass index ( = -0.230, = 0.013). Furthermore, 77% of the patients with distal rupture reported good outcome (Achilles Tendon Rupture Score > 80) compared to 56% of the patients with proximal rupture ( = 0.041).
CONCLUSION
Patients with proximal rupture had less satisfactory postoperative outcomes than those with distal rupture.
Topics: Achilles Tendon; Adolescent; Adult; Aged; Calcaneus; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Reported Outcome Measures; Prognosis; Plastic Surgery Procedures; Retrospective Studies; Rupture; Tendon Injuries; Treatment Outcome; Young Adult
PubMed: 33845659
DOI: 10.1177/23094990211007616 -
Journal of Biomechanics Feb 2022Immediately prior to inserting into bone, many healthy tendons experience impingement from nearby bony structures. However, super-physiological levels of impingement are...
Immediately prior to inserting into bone, many healthy tendons experience impingement from nearby bony structures. However, super-physiological levels of impingement are implicated in insertional tendinopathies. Unfortunately, the mechanisms underlying the connection between impingement and tendon pathology remain poorly understood, in part due to the shortage of well-characterized animal models of impingement at clinically relevant sites. As a first step towards developing a model of excessive tendon impingement, the objective of this study was to characterize the mechanical strain environment in the mouse Achilles tendon insertion under passive dorsiflexion and confirm that - like humans - mice experience impingement of the tendon insertion from the calcaneus (heel bone) in dorsiflexed ankle positions. Based on previous work in humans, we hypothesized that during dorsiflexion, the mouse Achilles tendon insertion would experience high levels of transverse compressive strain due to calcaneal impingement. A custom-built loading platform was used to apply passive dorsiflexion, while an ultrasound transducer positioned over the Achilles tendon captured radiofrequency images. A non-rigid image registration algorithm was then used to map the transverse compressive strain based on the acquired ultrasound image sequences. Our results demonstrate that during passive dorsiflexion, transverse compressive strains were produced throughout the Achilles tendon, with significantly larger strain magnitudes at the tendon insertion than at the midsubstance. Furthermore, there was increasing transverse compressive strain observed within the Achilles tendon as a function of increasing dorsiflexion angle. This study enhances our understanding of the unique mechanical loading environment of the Achilles tendon under physiologically relevant conditions.
Topics: Achilles Tendon; Animals; Ankle; Ankle Joint; Mice; Tendinopathy; Ultrasonography
PubMed: 34998182
DOI: 10.1016/j.jbiomech.2021.110920 -
Sensors (Basel, Switzerland) Nov 2021The consideration of the Achilles tendon (AT) curvature is crucial for the precise determination of AT length and strain. We previously established an...
The consideration of the Achilles tendon (AT) curvature is crucial for the precise determination of AT length and strain. We previously established an ultrasound-kinematic-based method to quantify the curvature, using a line of reflective foil skin markers covering the AT from origin to insertion. The current study aimed to simplify the method by reducing the number of markers while maintaining high accuracy. Eleven participants walked (1.4 m/s) and ran (2.5, 3.5 m/s) on a treadmill, and the AT curvature was quantified using reflective foil markers aligned with the AT between the origin on the gastrocnemius myotendinous-junction (tracked by ultrasound) and a marker on the calcaneal insertion. Foil markers were then systematically removed, and the introduced error on the assessment of AT length and strain was calculated. We found a significant main effect of marker number on the measurement error of AT length and strain (p<0.001). Using more than 30% of the full marker-set for walking and 50% for running, the R2 of the AT length error saturated, corresponding to average errors of <0.1 mm and <0.15% strain. Therefore, a substantially reduced marker-set, associated with a marginal error, can be recommended for considering the AT curvature in the determination of AT length and strain.
Topics: Achilles Tendon; Biomechanical Phenomena; Humans; Muscle, Skeletal; Running; Ultrasonography; Walking
PubMed: 34770691
DOI: 10.3390/s21217387 -
British Journal of Sports Medicine Mar 2021
Topics: Achilles Tendon; Consensus; Humans; Sports Medicine; Tendinopathy
PubMed: 33055134
DOI: 10.1136/bjsports-2020-102863 -
Acta Bio-medica : Atenei Parmensis Apr 2023Achilles insertional tendinopathy (AIT) is a common injury and its pathogenesis is still not entirely clear. It manifests with worsening pain and functional limitations....
BACKGROUND AND AIM
Achilles insertional tendinopathy (AIT) is a common injury and its pathogenesis is still not entirely clear. It manifests with worsening pain and functional limitations. When conservative treatment fails, surgical treatment is indicated. The purpose of our research is to evaluate the outcome after one year in patients affected by AIT (calcific and non-calcific AIT) who were treated at our centre.
METHODS
Between 2014 and 2021, 42 patients suffering from AIT - a total of 47 feet - underwent surgery at our centre. The patients filled in the VISA-A and AOFAS questionnaires at the pre-operative consultation and at the clinical check-up after one year of follow up.
RESULTS
Of the 47 feet treated, 28 were calcific AITs treated by medial access and tendon reinsertion using a knotless double suture anchor system (Achilles Suture Bridge™) and 19 were non-calcific tendinopathies treated using a lateral paratendinous approach. The one-year clinical results show an increase in VISA-A scores of 48.6 and AOFAS scores of 44.1 and the absence of complications. Only one patient reported a recurrence of certain symptoms and none of the patients were hospitalized for recurrence.
CONCLUSIONS
The literature is unable to establish a gold standard of treatment for AIT. The method we have used has shown excellent short- and medium-term results without any complications. Further studies are needed to prove its effectiveness in the long term.
Topics: Humans; Retrospective Studies; Tendinopathy; Conservative Treatment; Neurosurgical Procedures; Achilles Tendon; Treatment Outcome
PubMed: 37092637
DOI: 10.23750/abm.v94i2.13834