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PubMed1992

Expression of c-myc and c-fos in rat skeletal muscle. Evidence for increased levels of c-myc mRNA during hypertrophy.

The levels of c-myc and c-fos mRNA were investigated in rat skeletal muscle by Northern hybridization. During post-natal development in the rat, c-myc mRNA levels were similar at birth and at 7 and 21 days of age, but then declined at 90 days and were barely detectable at 1 year. c-fos mRNA levels followed this pattern of expression until 90 days, but showed a large increase at 1 year. Hypertrophy of soleus and plantaris muscles was induced either by severance of the tendon to the synergistic gastrocnemius (tenotomy) or by administration of the beta-adrenoceptor agonist clenbuterol. In both cases hypertrophy was associated with a rapid increase in c-myc mRNA levels. Following tenotomy the increase was both greater (8-fold) and more rapid (3 h) in soleus than in plantaris (2-3 fold, 12 h). Similar effects were observed during clenbuterol administration. Neither treatment caused any alteration in c-fos mRNA levels in the plantaris muscle. The results show that increased c-myc mRNA levels are an early event in the response of skeletal muscle to hypertrophic stimuli; it is argued that this occurs within the differentiated skeletal muscle fibres.

Aging↗
PubMed2001

Expression of heat shock protein 72 in atrophied rat skeletal muscles.

Changes in the expression of heat shock protein 72 (HSP72) in response to atrophic-inducing perturbations of muscle involving chronic mechanical unloading and denervation were determined. Adult male Wistar rats were assigned randomly to a sedentary cage control (CON), hind limb unloading (HU, via tail suspension), HU plus tenotomy (HU + TEN), HU plus denervation (HU + DEN), or HU + TEN + DEN group. Tenotomy and DEN involved cutting the Achilles tendon and removing a segment of the sciatic nerve, respectively. After 5 days, HSP72 levels in the soleus of the HU + DEN and HU + TEN + DEN groups were 42 (P < 0.05) and 53% (P < 0.01) less than CON, respectively. Soleus weight decreased in both groups. Heat shock protein 72 levels in the plantaris of the HU + TEN, HU + DEN, and HU + TEN + DEN groups were 31, 25, and 30% lower than CON, respectively (P < 0.05). Plantaris weight decreased in the HU + DEN and HU + TEN + DEN, but not in the HU + TEN group. Hind limb unloading alone had little effect on the HSP72 level in either muscle. Reduced levels of HSP72 were associated with a decreased soleus (r=0.62, P < 0.01) and plantaris (r=0.78, P < 0.001) weight. These results indicate that the levels of HSP72 in both a slow and a fast rat plantarflexor are responsive to a chronic decrease in the levels of loading and/or activation and suggest that the neuromuscular activity level and the presence of innervation of a muscle are important factors that induce HSP72 expression.

Achilles Tendon↗
PubMedDate not supplied

Percutaneous tendo-Achilles lengthening with a large-gauge needle: a modification of the Ponseti technique for correction of idiopathic clubfoot.

The Ponseti technique has become standard for the treatment of congenital idiopathic clubfoot. Treatment includes serial manipulations and casting, accompanied by percutaneous tenotomy of the Achilles tendon. In this article, the authors describe a modification in the Achilles tenotomy technique by using a large-gauge hypodermic needle in the outpatient setting.

Achilles Tendon↗
PubMedDate not supplied

Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation.

PURPOSE: To report a new technique of arthroscopic biceps tenodesis using bioabsorbable interference screw fixation and the early results. TYPE OF STUDY: Prospective, nonrandomized study. METHODS TECHNIQUE: The principle of arthroscopic biceps tenodesis is simple: after biceps tenotomy, the tendon is exteriorized and doubled on a suture; the biceps tendon is then pulled into a humeral socket (7 or 8 mm x 25 mm) drilled at the top of the bicipital groove, and fixed using a bioabsorbable interference screw (8 or 9 mm x 25 mm) under arthroscopic control. PATIENTS: 43 patients treated with this technique between 1997 and 1999 were followed-up for at least 1 year. The technique was indicated in 3 clinical situations: (1) with arthroscopic cuff repair (3 cases), (2) in case of isolated pathology of the biceps tendon with an intact cuff (6 cases), and (3) as an alternative to biceps tenotomy in patients with massive, degenerative and irreparable cuff tears (34 cases). The biceps pathology was tenosynovitis (4 cases), prerupture (15 cases), subluxation (11 cases), and luxation (13 cases). RESULTS: The absolute Constant score improved from 43 points preoperatively to 79 points at review (P <.005). There was no loss of elbow movement and biceps strength was 90% of the strength of the other side. Two patients, operated on early in the series, presented with a rupture of the tenodesis. In both cases the bicipital tendon was very friable and the diameter of the screw proved to be insufficient (7 mm). No neurologic or vascular complications occurred. CONCLUSIONS: Arthroscopic biceps tenodesis using bioabsorbable screw fixation is technically possible and gives good clinical results. This technique can be used in cases of isolated pathologic biceps tendon or a cuff tear. A very thin, fragile, almost ruptured biceps tendon is the technical limit of this arthroscopic technique.

Absorbable Implants↗
PubMedDate not supplied

[Treatment of congenital clubfoot with the Ponseti method].

AIM: The primary therapy for congenital clubfoot is non-surgical involving manipulation and serial casting. With traditional casting, relatively large numbers of feet require extensive surgery to achieve full correction. The purpose of this study was to evaluate the efficacy of the Ponseti method. METHODS: Between 1.1.2004 und 31.12.2005, 29 patients with 41 clubfeet were treated with the Ponseti method. Only patients without any prior treatment were included. Classification followed Pirani's score. The number of casts to full correction, tenotomies, number of posteromedial releases, dorsi-, plantarflexion and hindfoot position were documented. The follow-up time was 1-9 months, the average follow-up time was 9.1 months. RESULTS: 39 clubfeet were successfully treated with the Ponseti method. The average Pirani score was 4.9. Percutaneous tenotomies were necessary in 34 of the clubfeet. Average dorsiflexion was 19 degrees and plantarflexion 42 degrees . After failed Ponseti treatment 2 feet were treated with a posteromedial release. CONCLUSION: With the Ponseti method the need for extensive corrective surgery is greatly reduced. We recommend the Ponseti method as standard therapy in clubfoot management.

Casts, Surgical↗
PubMed1991

[Short- and intermediate-term angular results of Cüppers retro-equatorial myopexy, with or without additional simultaneous recession].

79 variable esotropias underwent bilateral "Fadenoperations". In the first group, the posterior fixation has been performed alone. In the second series, conventional symmetrical recessions of the medial recti have been performed during the same procedure. Two further additional weakening techniques are compared in the last group: anterior medial tenotomies and the so-called "stretch effect". Concomittant recessions considerably enforced the amount of angle reduction for distance and near without affecting precision, predictibility and stability of the results. Tenotomies and stretching procedures were followed by inconstant results.

Accommodation, Ocular↗
PubMed1989

Inflammation, cellularity, and fibrillogenesis in regenerating tendon: implications for tendon rehabilitation.

The initial three weeks of tendon healing were followed via electron microscopy to elucidate the process of inflammation, fibrillogenesis, and the cellular and subcellular events in tenotomized Achilles tendons, a model that is commonly used to determine the biomechanical effects of electrical stimulation, physical activity, ultrasound, and other forms of physical therapy. The right Achilles tendons of 18 rabbits were tenotomized, sutured, and immobilized. On each of postoperative days 5, 7, 12, 15, 18, and 21, the right Achilles tendons of three experimental rabbits were excised and processed for electron microscopy. To compare these tendons to normal tendons, the Achilles tendons of three control rabbits were excised bilaterally without prior tenotomy and processed for electron microscopy. Electron micrographs thus obtained revealed 1) an initial period of inflammation lasting at least five days, 2) a subsequent period of fibroplasia and fibrillogenesis, and 3) a third period of progressive alignment and organization of the collagen fibrils into bundles that were oriented in the longitudinal axis of the tendon. Although healing in rabbits may not translate directly to healing in humans, the findings of this study indicate that healing begins soon after tenotomy and that the regenerating Achilles tendon undergoes different stages of healing. Because each stage entails a different set of ultrastructural events, therapeutic interventions should be modified to address the specific events of each stage.

Achilles Tendon↗
PubMed1997

The hip in children with cerebral palsy. Predicting the outcome of soft tissue surgery.

This study reviewed 56 hips in 37 children with cerebral palsy who had undergone an adductor tenotomy alone or in combination with an anterior obturator neurectomy. The mean review period was 5.3 years. At latest review, 25 of 30 (83%) hips with a preoperative migration percentage of less than 40% were reduced, but 20 of 26 (77%) hips with a preoperative migration percentage of 40% or more were subluxated or dislocated. Surgery was unsuccessful for 13 of 15 hips with an acetabular index of more than 27 degrees. Percutaneous adductor tenotomy alone was as effective as the combination of an open procedure with an anterior obturator neurectomy. The age at the time of surgery did not have a significant effect on the outcome. The preoperative migration percentage was the only significant predictor of outcome in this group of children.

Age Factors↗
PubMed1985

Freeze-fracture studies of denervated and tenotomized rat muscle.

We studied the effects of denervation and tenotomy on the freeze-fracture ultrastructure of rat extensor digitorum longus muscle. The muscle plasma membrane was analyzed for the density of orthogonal arrays and caveolae. A period was found up to 30 days of age where innervation is required for the development and maintenance of orthogonal arrays. Denervation of older animals had no effect on the density of orthogonal arrays. The caveolar density increased after denervation at all ages. Tenotomy delayed the development of normal arrays, but had no significant effect on caveolar density. The results obtained for neonatally denervated rat muscles are similar to those seen in the muscles of patients with Duchenne muscular dystrophy.

Animals↗
PubMed1998

Early cellular response in tendon injury: the effect of loading.

The effect of loading on the early cellular response to tendon injury was studied in a partial tenotomy (window) model in the extensor digitorum longus of the rat. Normal use of the limb was allowed, such that tendons were either loaded (group 1) or unloaded (group 2) when a distal tenotomy was performed. Thirty-four male Fischer rats were used. The tendons were harvested at intervals of 6 hours and 1, 3, 5, and 7 days. Quantitative cell counts were performed on light microscopic cross-sections of the window and tendon substance together with recording of cell orientation. Matrix changes in the tendon, window, and tendon-window junction were observed on transmission electron microscopy. There was a rapid and extensive change in the tendon structure with rapid loss of definition of the window edge, and an increase in cellularity of the tendon substance. The loaded tendons demonstrated less cellularity at 5 days (window cell density 3.48 +/- 0.49 cells per 0.01 mm2) with better longitudinal orientation of cells and matrix than the unloaded tendons(8.38 +/- 1.1 cells per 0.01 mm2). The numbers of inflammatory cells in both groups were roughly comparable (5 days: loaded 0.411 +/- 0.071 cells per 0.01 mm2; unloaded 0.554 +/- 0.11 cells per 0.01 mm2), but the unloaded windows had more fibroblasts at 5-day and 7-day stages (5 days: loaded 3.08 +/- 0.44 cells per 0.01 mm2; unloaded 7.82 +/- 1.0 cells per 0.01 mm2; p < 0.016). Cell counts in the tendon substance were also higher in the unloaded (3.99 +/- 0.44 cells per 0.01 mm2) than the loaded (1.95 +/- 0.45 cells per 0.01 mm2) tendons at 5 days. This study demonstrated that the cellular response after injury in this extensor tendon model is affected by tensile loading, there being increased cell numbers in both the window and tendon substance in the unloaded tendon.

Animals↗
PubMed1999

Surgical management of tendinopathy of the main body of the patellar tendon in athletes.

OBJECTIVE: To report the results of surgery for tendinopathy of the main body of the patellar tendon. DESIGN: Retrospective study. SETTING: A teaching hospital of the University of London. PATIENTS: Twenty-eight patients reviewed at an average follow-up of 42 months from surgery for tendinopathy of the main body of the patellar tendon after failed conservative treatment. INTERVENTION: Exploration of the affected patellar tendon, stripping of the paratenon, excision of pathological areas, and multiple longitudinal tenotomies. MAIN OUTCOME MEASURES: Postoperative complications, ability to return to sport, and subjective satisfaction, as measured by formal clinical assessment or telephone questionnaire. RESULTS: At follow-up, 23 patients were completely free of pain and had resumed full sporting activity at the same preoperative level. Three patients were improved enough to have returned to their preoperative sporting level or just below it. In two patients, the initial operation failed. In the patients who resumed sport, the average time from surgery to resuming full sporting activity was 7 months (range 6 weeks to 12 months). The most common early postoperative complications were wound hematoma and superficial infection. The most common late complications were related to the incision, with anterior knee pain on kneeling and skin dysesthesia. CONCLUSION: Surgical decompression of the patellar tendon with multiple longitudinal tenotomies is an effective treatment for patellar tendinopathy. In the middle term, patients do not seem to relapse once they have recovered, whereas those who do not respond to surgery do not recover at all and may need a new operation.

Adolescent↗
PubMed2006

Flexion contracture in total knee arthroplasty.

We retrospectively evaluated a surgical algorithm for treating flexion contracture in total knee arthroplasty using a prospectively collected database of 2898 knees. We asked how many steps were required to obtain correction with increasing severity of the flexion contracture. We further wanted to know whether correction was maintained at two years after surgery, and which complications occurred in relation to the algorithm. Our algorithm consisted of four steps executed until full extension was achieved: (1) mediolateral ligament balancing with resection of all osteophytes and overresection of the distal femur by 2 mm; (2) progressive posterior capsular release and gastrocnemius release; (3) additional resection of the distal femur up to a maximum of 4 mm; (4) hamstring tenotomy. A flexion contracture between 5 degrees and 15 degrees occurred in 794 cases, between 15 degrees and 30 degrees in 95 cases, and greater than 30 degrees in 35 cases. The data suggest 98.6% of the cases with flexion contracture less than 30 degrees could be corrected with Steps 1 and 2. Even in the 35 flexion contractures greater than 30 degrees, additional resection of the distal femur and hamstring tenotomy was performed in only 28.6% and 22.9% of cases, respectively.

Aged↗
PubMedDate not supplied

Treatment of idiopathic clubfoot utilizing botulinum A toxin: a new method and its short-term outcomes.

A pivotal point in most clubfoot management protocols is Achilles tendon lengthening or tenotomy to address hindfoot deformity. The effectiveness of botulinum A toxin (BTX-A) in attenuating the function of the triceps surae muscle complex as an alternative to tenotomy was investigated. Fifty-one patients with 73 idiopathic clubfeet were recruited. Outcome measures included surgical rate, Pirani clubfoot score, ankle dorsiflexion with knee in flexion and extension, and recurrences. Patients were divided according to age: group 1 (<30 days old) and group 2 (>30 days and <8 months old). Ankle dorsiflexion in knee flexion and extension remained above 20 degrees and 15 degrees, respectively, and Pirani scores below 0.5 following BTX-A injection for both groups. One of the 51 patients required limited posterior release and 9 patients required repeat manipulation and casting plus or minus BTX-A injection. The use of BTX-A as an adjunctive therapy in the noninvasive approach of manipulation and casting in idiopathic clubfoot is a safe and effective treatment.

Botulinum Toxins, Type A↗
PubMedDate not supplied

Calcaneus deformity in spina bifida: results of anterolateral release.

We reviewed a group of patients with 76 feet treated operatively for a calcaneus or a calcaneovalgus deformity by a simple anterior (tenotomy of the tibialis anterior, extensor digitorum communis and extensor hallucis longus), or anterolateral (associated tenotomy of the peroneus longus and brevis) release. The results were assessed considering bracing and shoewear problems or presence of pressure sores. The mean follow-up time was 4.66 years, and a good result was achieved in 62 feet (81.5%), with 14 poor results in 18.5%. Among the 14 poor results, six deformities have recurred and were operatively treated by the same technique and eight feet developed an equinus deformity requiring a heel cord release.

Adolescent↗
PubMed1973

Rubidium influx into rat skeletal muscles in relation to electrical activity.

1. Rates of (86)Rb influx were compared in vivo over 2, 4 and 6 hr periods in various tonic and phasic muscles of rat following its I.P. injection. During the 2 hr period its influx rate into soleus was about 4 times that of the vastus with the EDL muscles at an intermediate rate. Uptake by diaphragm was fastest reaching equilibrium within 2 hr.2. Unilateral section of the sciatic nerve 48 hr before (86)Rb injection reduced isotope uptake into soleus to about 50% of its contralateral control muscle over a 4 hr period. In EDL muscles on the other hand nerve section increased influx by about 75% of control in conscious rats and more than doubled influx in anaesthetized rats.3. Tenotomy of soleus reduced (86)Rb influx to 40% of control, but tenotomy in EDL was without effect in influx.4. Uptake of urea into muscles within 5 min of its I.V. injection was used to determine the possibility of muscle blood flow determining (86)Rb influx. Accumulation of urea was not significantly different in control and denervated EDL muscles nor between soleus and vastus muscles in anaesthetized rats, so it seems unlikely that blood flow is important here.5. Membrane depolarization in response to addition of 30 mM rubidium to external bathing fluid was greater in the case of denervated than in control EDL muscles which was in keeping with the greater (86)Rb influx seen in the former muscles. The ouabain sensitivity of rubidium-induced depolarization in the denervated EDL muscles would suggest, however, that rubidium enters the fibres actively.

Animals↗
PubMed1983

Effects of denervation on sodium, potassium and [3H]ouabain binding in muscles of normal and potassium-depleted rats.

K depletion leads to a selective loss of K from skeletal muscles, which is associated with a decrease in the number of [3H]ouabain binding sites. The significance of the nerve supply for these changes has been assessed in denervation experiments with K-depleted rats. In K-depleted rats (age 4-12 weeks) denervation led to a partial recovery of the K contents in soleus (46-77%), gastrocnemius (23%) and extensor digitorum longus (e.d.l.) muscles (19%) within 24 h. These effects were not prevented by beta-adrenoceptor blockade or mimicked by alpha-adrenoceptor blockade. In K-depleted rats the number of [3H]ouabain binding sites was not increased following denervation. In K-depleted rats 24 h of plaster immobilization of the entire hind limb caused 51% recovery of the total K content in soleus, whereas gastrocnemius and e.d.l. showed 49 and 16% recovery, respectively. Tenotomy for 3 h caused a rise in total K content of 33% in soleus muscles from K-depleted rats. Anaesthesia for 3 h increased the total K content by 23%. The recovery of K induced by denervation, immobilization in plaster, tenotomy or anaesthesia was associated with an equivalent decrease in Na content. Denervation performed before K depletion reduced the loss of K from soleus, but not from gastrocnemius and e.d.l. In both soleus and e.d.l. the number of [3H]ouabain binding sites, however, decreased to the same level as in the contralateral innervated muscles. Denervation reduced, but did not prevent, the increase in the number of [3H]ouabain binding sites seen after re-administration of K to K-depleted rats. It is concluded that the changes in Na-K contents seen after denervation in K-depleted rats are the outcome of cessation of muscle activity. The results give no support to the idea that the effects of K depletion on the K content and the number of [3H]ouabain binding sites in skeletal muscle are mediated by the peripheral nerves.

Animals↗
PubMed2003

Regenerative versus reparative healing in tendon: a study of biomechanical and histological properties in fetal sheep.

Previous studies have shown fetal tissues heal in a regenerative fashion without scar formation. The objective of this study is to compare the healing properties of adult and fetal tendons. Time-mated pregnant ewes at 80-85 days of gestation were utilized. A partial, midsubstance tenotomy was performed in the lateral extensor fetal tendons, and analogous tenotomies were created in the maternal limbs. One week after injury, the fetal and adult animals were sacrificed, and tendons were histologically and mechanically evaluated. Immunohistochemical staining for transforming growth factor beta isoform 1 (TGF-beta1) was performed. Histologically, a gap with granulation tissue and inflammatory cells was visible in the site of wounding in the adult tendons. In the fetal tendons, no abnormalities were noted in the wound, with reconstitution of collagen architecture. TGF-beta1 expression was low in fetal but upregulated in the adult wounds. No significant differences were found in the biomechanical properties between groups. We identified regenerative healing properties in injured fetal tendon, while adult tendon tissue healed reparatively with scar formation. Fetal tendons demonstrated a limited recovery of mechanical properties after injury that was no better than that of the adult tendons at seven days. A better understanding of the mechanisms of fetal healing may lead to novel therapeutic strategies in the clinical setting.

Aging↗
PubMed2004

Regulation of dihydropyridine receptor gene expression in mouse skeletal muscles by stretch and disuse.

This study examined dihydropyridine receptor (DHPR) gene expression in mouse skeletal muscles during physiological adaptations to disuse. Disuse was produced by three in vivo models-denervation, tenotomy, and immobilization-and DHPR alpha1s mRNA was measured by quantitative Northern blot. After 14-day simultaneous denervation of the soleus (Sol), tibialis anterior (TA), extensor digitorum longus (EDL), and gastrocnemius (Gastr) muscles by sciatic nerve section, DHPR mRNA increased preferentially in the Sol and TA (+1.6-fold), whereas it increased in the EDL (+1.6-fold) and TA (+1.8-fold) after selective denervation of these muscles by peroneal nerve section. It declined in all muscles (-1.3- to -2.6-fold) after 14-day tenotomy, which preserves nerve input but removes mechanical tension. Atrophy was comparable in denervated and tenotomized muscles. These results suggest that factor(s) in addition to inactivity per se, muscle phenotype, or associated atrophy can regulate DHPR gene expression. To test the contribution of passive tension to this regulation, we subjected the same muscles to disuse by limb immobilization in a maximally dorsiflexed position. DHPR alpha1s mRNA increased in the stretched muscles (Sol, +2.3-fold; Gastr, +1.5-fold) and decreased in the shortened muscles (TA, -1.4-fold; EDL, -1.3-fold). The effect of stretch was confirmed in vitro. DHPR protein did not change significantly after 4-day immobilization, suggesting that additional levels of regulation may exist. These results demonstrate that DHPR alpha1s gene expression is regulated as an integral part of the adaptive response of skeletal muscles to disuse in both slow- and fast-twitch muscles and identify passive tension as an important signal for its regulation in vivo.

Adaptation, Physiological↗