Ultrasound in Assessment of Supraspinatus Tendon Injury： Correlation with Arthroscopy

INTRODUCTIONRotator cuffinjuries are common in all athletic. Of all rotator cuff injuries, the supraspinatus tendon involves mostly. Severe supraspinatus tendon injury may affect the patient＇s quality of life. However, supraspinatus tendon injury can be relatively asymptomatic in some cases and may require sonographic examination for diagnosis, With continued improvement in shoulder arthroscopy, surgical treatment for supraspinatus tendon injury has become more effective and less invasive.

Epidemiology of insertional and midportion Achilles tendinopathy in runners:A prospective cohort study

Background:Achilles tendinopathy(AT)is a common problem among runners.There is only limited evidence for risk factors for AT,and most studies have not defined the AT subcategories.No study has compared the incidence and risk factors between insertional AT and midportion AT,though they are considered distinct.This study aimed to assess incidence and risk factors of AT based on data from a large prospective cohort.The secondary aim was to explore differences in risk factors between insertional and midportion AT.Methods:Participants were recruited from among registered runners at registration for running events.Questionnaires were completed at baseline,1 month before the event,1 week before the event,and 1 month after the event.Information concerning demographics,training load,registered events,and running-related injuries were collected at baseline.The follow-up questionnaires collected information about new injuries.A pain map was used to diagnose midportion and insertional AT.The primary outcome was the incidence of AT.Multivariable logistic regression analysis was applied to identify risk factors for the onset.Results:We included 3379 participants with a mean follow-up of 20.4 weeks.The incidence of AT was 4.2%.The proportion of insertional AT was 27.7%and of midportion AT was 63.8%;the remaining proportion was a combined type of insertional and midportion AT.Men had a significantly higher incidence(5%,95%confidence interval(95%CI):4.1%-6.0%)than women(2.8%,95%CI:2.0%-3.8%).AT in the past12 months was the most predominant risk factor for new-onset AT(odds ratio(OR)=6.47,95%CI:4.27-9.81).This was similar for both subcategories of AT(insertional:OR=5.45,95%CI:2.51-11.81;midportion:OR=6.96,95%CI:4.24-11.40).Participants registering for an event with a distance of 10/10.55 km were less likely to develop a new-onset AT(OR=0.59,95%CI:0.36-0.97)or midportion AT(OR=0.47,95%CI:0.23-0.93).Higher age had a significant negative association with insertional AT(OR=0.97,95%CI:0.94-1.00).Conclusion:The incidence of new-onset AT among recreational runners was 4.2%.The proportion of insertional and midportion AT was 27.7%and 63.8%,respectively.AT in the past 12 months was the predominant risk factor for the onset of AT.Risk factors varied between insertional and midportion AT,but we could not identify clinically relevant differences between the 2 subtypes.

Motor Response of Mirror Therapy after Reconstruction of Extensor Mechanism Caused by Glass Cut Injury

Treatment by mirror therapy (MT) restores motion in injured limbs without invasive procedures. This process is widely accepted for rehabilitating patients with phantom limb pain, stroke victims, or patients who need therapy after nerve damage. The procedure is specifically useful in restoring motion to the hand after surgical repairs to the extensor muscle and tendons. Mirror therapy rewires the brain by making the restored limb remember hand motions by observing the motions of a normal hand. The concept of a mirror image is that the movement of the uninjured arm forms the illusion of the same movement in the affected arm. Efforts to repeat hand movements elicit the same reaction in the affected hand in what is referred to as Hebbian learning. This case study evaluated MT’s effectiveness in motion restoration after a glass injury. This case study showed restoration of normal hand motions in a patient following surgery to repair a glass cut to the arm. Surgery repaired the lacerated extensor tendon and radial nerve. The muscle belly was repaired, and a graft fixed the nerve gap. Once the arm healed, the patient underwent rehabilitation in mirror therapy to restore normal function in his hand. After conducting mirror therapy, the pain was eliminated, and the patient restored normal function of moving the hand and finger extension. In addition, the therapy could be conducted at home without needing a professional. The effectiveness of mirror therapy was seen in the functional restoration of hand and finger movement. The process is also less complicated as it can be performed at home.

Advances in the application of hydrogel-based scaffolds for tendon repair

Tendon injuries often lead to joint dysfunction due to the limited self-regeneration capacity of tendons.Repairing tendons is a major challenge for surgeons and imposes a signif-icant financial burden on society.Therefore,there is an urgent need to develop effective stra-tegies for repairing injured tendons.Tendon tissue engineering using hydrogels has emerged as a promising approach that has attracted considerable interest.Hydrogels possess excellent biocompatibility and biodegradability,enabling them to create an extracellular matrix-like growth environment for cells.They can also serve as a carrier for cells or other substances to accelerate tendon repair.In the past decade,numerous studies have made significant prog-ress in the preparation of hydrogel scaffolds for tendon healing.This review aims to provide an overview of recent research on the materials of hydrogel-based scaffolds used for tendon tis-sue engineering and discusses the delivery systems based on them.

An Investigation into Cold-Therapy of the Equine Metacarpus, Following Temperature Changes with Exercise as Well as Post Intervention

There is some discussion as to whether exercise-induced hyperthermia of the superficial digital flexor tendon (SDFT) affects tenocyte viability and pre-disposes to injury. Cold-therapy is commonly used as a preventative measure and treatment for acute tendon injuries, but only a few studies have evaluated the effect of cold-therapy on metacarpal temperatures in the horse. For this reason, this study has measured skin surface temperatures after moderate exercise and after application of cold-therapy, and additionally monitored the duration of any effects. Four horses were recruited into a semi blinded controlled study with repeated measurements that involved lunged exercise for 16 minutes at moderate intensity. Skin surface temperature was measured using a thermographic camera before and after lunging, and every 40 minutes for two hours post cold-therapy. Cold-therapy was applied using a Jacks Whirlpool Boot with ice-water immersion at a level just distal to the carpus for 20 minutes. The right leg was treated, and the left leg was used as an untreated control. The experiment was conducted twice on all four horses. Moderate exercise resulted in an increase in skin surface temperature of 10°C. Application of cold-therapy for 20 minutes resulted in a reduction in skin surface temperature by 14°C. The effect of cold-therapy persisted for at least 40 minutes post treatment. It is concluded that exercise leads to an increase in skin surface temperature which is counteracted by the application of cold-therapy. These findings would seem to indicate that cold-therapy can be used after exercise to counteract hyperthermia within the metacarpal region of the horse’s leg.

Why forefoot striking in minimal shoes might positively change the course of running injuries

It is believed that human ancestors evolved the ability to run bipedally approximately 2 million years ago. This form of locomotion may have been important to our survival and likely has influenced the evolution of our body form. As our bodies have adapted to run, it seems unusual that up to 79% of modern day runners are injured annually. The etiology of these injuries is clearly multifactorial. However, 1 aspect of running that has significantly changed over the past 50 years is the footwear we use. Modern running shoes have become increasingly cushioned and supportive, and have changed the way we run. In particular, they have altered our footstrike pattern from a predominantly forefoot strike(FFS) landing to a predominantly rearfoot strike(RFS) landing. This change alters the way in which the body is loaded and may be contributing to the high rate of injuries runners experience while engaged in an activity for which they were adapted. In this paper, we will examine the benefits of barefoot running(typically an FFS pattern),and compare the lower extremity mechanics between FFS and RFS. The implications of these mechanical differences, in terms of injury, will be discussed. We will then provide evidence to support our contention that FFS provides an optimal mechanical environment for specific foot and ankle structures, such as the heel pad, the plantar fascia, and the Achilles tendon. The importance of footwear will then be addressed, highlighting its interaction with strike pattern on mechanics. This analysis will underscore why footwear matters when assessing mechanics. Finally, proper preparation and safe transition to an FFS pattern in minimal shoes will be emphasized. Through the discussion of the current literature, we will develop a justification for returning to running in the way for which we were adapted to reduce running-related injuries.

Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture： a meta-analysis

Background There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture- operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures. Methods We searched multiple databases in English （including EMBASE, PubMed, and OVID） and in Chinese （including CNKI, WANFANG, and VIP）, as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software. Results Eight randomized controlled trials （RCTs） involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher （Z=3.33, P 〈0.01）. However, the moderate （Z--4.27, P 〈0.01） and minor （Z--5.59, P 〈0.01） complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter （Z=2.65, P 〈0.01）. The inability to return to previous level sporting rate and ankle joint decreased range of motion （ROM） rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups. Conclusions Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alternative especially for the older and patients with lower sporting requirements.

Gait analysis combined with the expression of TGF-β1,TGF-β3 and CREB during Achilles tendon healing in rat

Purpose:To observe the changes of gait behavior and the expression of wound healing factors of transforming growth factor-β1(TGF-β1),TGF-β3 and cAMP response element binding protein-1(CREB-1)during the healing of Achilles tendon in a rat model,and to investigate whether gait analysis can be used to evaluate the tendon healing.Methods:Achilles tendon of 40 healthy male Sprague-Dawley rats were transected and sutured to establish the Achilles tendon injury(ATI)model.They were randomly divided into 4 groups based on the observational time point at 1,2,4 and 6 weeks after injury(n=10 for each group).Before modeling,9 rats were randomly selected for CatWalk gait analysis,which contained step cycle,single stance time and average speed.Data were recorded as the normal controls.After then,ATI models were established in the left hind limbs of the all 40 rats(ATI group),while the right hind limbs were only cut and sutured without injury of the Achilles tendon(sham operation group).At 1,2,4 and 6 weeks after injury,the gait behavior of the corresponding group of rats(n=9)as observed and recorded by CatWalk platform.After then,the rats were sacrificed and Achilles tendon of both limbs was harvested.The tendon healing was observed by gross anatomy and histological examination,and the protein and mRNA expression of TGF-β1,TGF-β3,CREB-1 were observed by immunohistochemistry and qPCR.The results of tendon gross grading were analyzed by Wilcoxon rank sum test,and other data were analyzed by one-way analysis of variance among multiple groups.Results:Compared with normal controls,all gait indexes(step cycle,single stance time and average speed)were greatly affected following ATI,which however improved with time.The step cycle was significantly lower at 1,2 and 4 weeks after ATI(compared with normal controls,allp<0.05),but almost returned to the normal level at 6 weeks((0.694±0.102)vs.(0.503±0.094)s,p>0.05).The single stance time of the ATI group was significantly shorter at 1 and 2 weeks after operation((0.078±0.010)s at 1 week,(0.078±0.020)s at 2 weeks,allp<0.001)and revealed no significant difference at 4 weeks(p=0.120).The average speed of ATI group at 1,2,4,6 weeks was significantly lower than that in the normal control group(allp<0.001).Conclusion:Gait behavior indexes are associated with Achilles tendon healing.The study gives an insight of TGF-β1,TGF-β3,CREB-1 changes in the coursing of Achilles tendon healing and these cytokines may be able to be used to regulate the Achilles tendon healing.

Repair of flexor tendon defects of rabbit with tissue engineering method

Objective: To repair rabbit tendon defects with tissue engineering method. Methods: The third passage of fetal skin fibroblast cells was labeled with 5 bromo 2 deoxyuridine (Brdu) and then seeded on human amnion extracellular matrix ( HA ECM ). Using 1 cm long Achilles tendon defects as repairing models in the experimental group, tendon defects were core bridged with polydioxanone (PDS) and then capsulated with the complex of fibroblasts HA ECM . In the control group I, defective tendons were sutured with PDS following the former procedure and capsulated with HA ECM (without fibroblasts). In the control group II, only PDS was applied to connect the defective tendons. Gross examination, light microscopy, scanning electronmicroscopy and biomechanical measurement of the repaired tendons were respectively performed at postoperative 1, 2, 3 month as well as immunohistochemical examination. Results: The optimal cell concentration for seeding fibroblasts was 3.5 ×10 6 cells/ml. Cells grew well and radiated or paralleled on HA ECM . Immunohistochemistry showed that the labeled seed fibroblasts played an important role in tendonization. The results of light microscopy, electron microscopy, and biomechanical assessment suggested that the rate and quality of tendonization in the experimental group was superior to those of the control group I and II. The tensile strength in the experimental group was the greatest, the next was in the control group I, and the worst in the control group II (P< 0.05 ). Conclusions: HA ECM is the excellent carrier for fibroblasts. Fibroblasts HA ECM complex has the capability to repair tendon defect and to tendonize with rapid rate and good performance three months after operation. Its tensile strength is 81.8 % of that of normal tendon.

Adipose-derived stromal vascular fraction improves tendon healing in rabbits

Objective： To evaluate the potential effects of uncultured adipose-derived stromal vascular fraction on tendon healing. Methods： Twenty five adult male New Zealand white rabbits weighing 2.5-3.0 kg were used. Five rabbits were used as donors of adipose tissue and the rest were divided into control and treatment groups. The injury model was completed by unilateral tenotomy through the middle one third of deep digital flexor tendon. Immediately after suture repair, either fresh stromal vascular fraction from enzymatic digestion of adipose tissue or placebo was intratendinously injected at tendon stumps in treatment and control groups, respectively. Immobilization with cast was continued for two weeks after surgery. Animals were sacrificed at eight weeks after surgery and tendons underwent histological, immunohistochemical, and mechanical evaluations. Statistical analyses of quantitative and qualitative data were assessed using one-way analysis of variance and MannWhitney U-test, respectively. Results： Histological evaluations demonstrated superior fibrillar linearity and continuity, and decreased vascularity in treatment group indicated improved organization and remodeling of neotendons. Immunohistochemistry demonstrated a significant increase in collagen I expression in treatment group. Ultimate load and energy absorption capacity were both significantly increased in cell-treated repairs compared with controls. Conclusion： The present study shows that intratendinous injection of uncultured adipose-derived stromal vascular fraction results in improved structural and mechanical properties of tendon repairs and it could be an effective modality for treating tendon injury.

Simultaneous bilateral patellar tendon rupture without predisposing systemic disease or steroid use： a case report

There is a dearth of case reports describing simultaneous bilateral patellar tendon ruptures in the medical literature.These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use.The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar tendon ruptures without any history of systemic disease or steroidal medication.We repaired and reattached the ruptured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement.One year after operation,the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag.The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event.

Mallet finger deformities treated by buried purse-string suture

Objective： To investigate the efficacy of buried purse-string suture in the treatment of mallet finger deformities. Methods： From February 2009 to February 2010, 12 patients with closed non-fracture mallet fingers were treated by buried purse-string suture. The rupture tendons were sutured by purse-string suture with an atraumatic needle, and the knots were buried under subcutaneous tissue. External fixator was used at the extension position of the finger every night within three weeks after operation. Results： All patients were followed up for 6-12 months, mean 7 months. According to the Patel＇s evaluation criteria, 2 cases （17%） obtained excellent results, 7 good （58%）, 2 fair （17%） and 1 poor （8%）. The overall rate of the cases with excellent and good outcomes was 75%. Conclusion： Buried purse-string suture is an easy and effective way to treat mallet finger deformities, with no serious postoperative complications or no need for reoperation.