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PubMed2001

Fluoroquinolone use and the change in incidence of tendon ruptures in the Netherlands.

INTRODUCTION: Shortly after their introduction, fluoroquinolones were associated with reports of tendinitis and tendon rupture. During the past years, the number of reports has risen, possibly because of an increased use of fluoroquinolones. In this study, we describe the use of fluoroquinolones in the Dutch community and the possible public health effects of an association between fluoroquinolone use and tendon ruptures. METHODS: In the PHARMO drug database we identified all prescriptions for fluoroquinolones in the period 1991-1996. The incidence of fluoroquinolone use was expressed as the number of fluoroquinolone episodes per 1000 inhabitants in one year, and extrapolated to the Dutch population after standardisation on age and gender. The annual incidence of non-traumatic tendon ruptures in the period 1991-1996 was calculated with data from the nation-wide hospital registry. The expected number of fluoroquinolone attributable tendon ruptures was calculated on the basis of the use of fluoroquinolones, the number of non-traumatic tendon ruptures and an assumed relative risk of 1.5-10. RESULTS: In 1996, approximately 251,000 patients experienced 318,000 episodes of fluoroquinolone use in the Netherlands. Females used more often fluoroquinolones than males, and the number of episodes increased exponentially with age. In the period 1991 through 1996, the absolute number of fluoroquinolone episodes increased by 160%, from 122,000 to 318,000. The absolute number of hospitalised tendon ruptures increased with 28%, from 768 in 1991 to 984 in 1996. Assuming a relative risk of 1.5 to 10.0, 1 to 15 tendon ruptures could be attributed to fluoroquinolone use in 1996. Only 7% of the observed increase could be attributed to the increased use of fluoroquinolones. If the total increase of hospitalised non-traumatic tendon ruptures would be attributable to the increase in fluoroquinolone use, this would mean that the risk of non traumatic tendon ruptures to fluoroquinolones would be more than 250 times the risk during non-use. CONCLUSION: In the Netherlands, a large simultaneous increase in non-traumatic tendon ruptures and fluoroquinolone use was observed in the period between 1991 to 1996. Assuming a relative risk of 1.5 to 10.0 for tendon ruptures during fluoroquinolone use, only 0.5 to 7% of the increase in non-traumatic tendon ruptures could be attributed to the increased fluoroquinolone use. The increase in the incidence of non-traumatic hospitalised tendon ruptures in the Netherlands is not likely to be explained solely by the increased use of fluoroquinolones.

Adult↗
PubMed1992

Vascularized tendon grafting in the rabbit.

Using a conventional free tendon graft, adhesion formation, with a consequent loss of gliding ability, occurs if the surrounding soft tissue is heavily scarred. An animal experiment was conducted, to evaluate whether a free vascularized tendon graft provides a better gliding surface, with minimal adhesion formation. In order to scar the gliding floor, the lateral aspect of the legs of 40 adult rabbits, including the peroneus tendon and its surrounding soft tissue, was exposed to liquid nitrogen. Two weeks after this induction of frostbite, all the rabbits were randomly divided into two groups: a vascularized tendon graft group and a free tendon graft group. Histologic examination revealed less adhesion of the tendon to the surrounding soft tissues in the vascularized tendon graft group. The tendon pull-out test demonstrated that less pull-out weight was required for vascularized tendons. A microangiographic study disclosed better circulation through the tendon graft and the surrounding soft tissues in the vascularized tendons. These results suggest that, even if scarring is heavy, the free vascularized tendon graft is less likely to adhere to the surrounding soft tissue than the conventional free tendon graft and, consequently, it provides a better gliding surface.

Animals↗
PubMed2006

In vitro tendon engineering with avian tenocytes and polyglycolic acids: a preliminary report.

Although there are many reports of in vivo tendon engineering using different animal models, only a few studies involve the short-term investigation of in vitro tendon engineering. Our previous study demonstrated that functional tendon tissue could be engineered in vivo in a hen model using tenocytes and polyglycolic acid (PGA) fibers. This current study explored the feasibility of in vitro tendon engineering using the same type of cells and scaffold material. Tenocytes were extracted from the tendons of a hen's foot with enzyme digestion and cultured in DMEM plus 10% FBS. Unwoven PGA fibers were arranged into a cord-like construct and fixed on a U-shape spring, and tenocytes were then seeded on PGA fibers to generate a cell-PGA construct. In experimental group 1, 22 cell-scaffold constructs were fixed on the spring with no tension and collected at weeks 4 (n = 7), 6 (n = 7) and 10 (n = 8); in experimental group 2, five cell-scaffold constructs were fixed on the spring with a constant strain and collected after 6 weeks of culture. In the control group, three cell-free scaffolds were fixed on the spring without tension. The collected engineered tendons were subjected to gross and histological examinations and biomechanical analysis. The results showed that tendon tissue could be generated during in vitro culture. In addition, the tissue structure and mechanical property became more mature and stronger with the increase of culture time. Furthermore, application of constant strain could enhance tissue maturation and improve mechanical property of the in vitro engineered tendon (1.302 +/- 0.404 Mpa with tension vs 0.406 +/- 0.030 Mpa without tension at 6 weeks). Nevertheless, tendon engineered with constant strain appeared much thinner in its diameter than tendon engineered without mechanical loading. Additionally, its collagen fibers were highly compacted when compared to natural tendon structure, suggesting that constant strain may not be the optimal means of mechanical load. Thus, application of dynamic mechanical load with a bioreactor to the construction of tendon tissue will be our next goal in this series of in vitro tendon engineering study.

Animals↗
PubMed2006

In situ monitoring of tendon structural changes by elastic scattering spectroscopy: correlation with changes in collagen fibril diameter and crimp.

The aim of this study was to monitor structural changes in loaded rabbit digital flexor tendons in situ and ex situ via elastic scattering spectroscopy (ESS). The optical setup consisted of a xenon white light source (lambda = 320-860 nm), connected to a fiber optic probe (with a source-detector separation of approximately 350 microm) and a spectrometer, controlled by a personal computer (PC). Cadaveric rabbit tendons were studied in situ under 3 tensional regimens: unloaded (no extrinsic tension applied), stretched, and 1-kg loaded and compared with excised tendons (i.e., no tension). Four times more light was detected in in situ unloaded tendons perpendicular to the tendon long axis than parallel to it. Backscatter anisotropy was expressed as the anisotropy factor (AF600nm: ratio of greatest to least backscatter intensity, measured with orthogonal probe positions). Differences in backscatter anisotropy between tendons from different digits were not significant. AF600nm had the smallest value (2.72 +/- 0.38) for the least aligned tendon preparations (excised tendons), and increased to 7.17 +/- 0.54 (1-kg loaded) as in situ loads were applied. Electron microscopy revealed that the distribution of collagen fibril diameters changed as loads were applied, with the diameter of larger fibrils decreasing approximately 33% for 1-kg loaded compared with excised tendons. Polarized light microscopy showed a characteristic crimp pattern in excised tendons, but this was hardly detectable in unloaded tendons and not detectable in tendons fixed in situ under a 1-kg load. We propose that the increase in optical anisotropy is a function of collagen fibril straightening and reducing fibril diameter as the tendon undergoes progressive loading. These findings are important for monitoring structure in vivo and in bioreactors for tissue engineers.

Animals↗
PubMed1993

Short echo time magnetic resonance imaging of tendon.

RATIONALE AND OBJECTIVES: Current clinical magnetic resonance (MR) imaging studies provide almost no useful signal from normal tendon and have no clear advantage over other imaging modalities in the evaluation of tendon injuries. The authors believe that tendon MR signal may be T2-limited, and, if so, could be enhanced by short echo time (TE) pulse sequences. The relationship of tendon signal intensity and tendon infrastructure conspicuity to TE was assessed at three different field strengths. METHODS: Magnetic resonance imaging studies were performed on samples of normal equine tendon at 3 different field strengths with spin-echo or gradient-recalled-echo sequences of varying TE. Tendon signal-to-noise ratios (SNR) were determined for each study and images were evaluated for visual evidence of tendon infrastructure. RESULTS: Tendon SNR demonstrated a strong inverse relationship to TE at each field strength. Signal-to-noise ratio values of 10 to 40 were achieved on the shortest TE studies (TE < 3 msec). Tendon infrastructure could be visualized and was primarily dependent on in-plane resolution and to a lesser extent on SNR. CONCLUSIONS: Short echo time MR imaging enhances tendon signal. Under optimal imaging conditions, tendon infrastructure can be evaluated. As high-performance gradient coil systems become available for clinical imaging systems, the authors believe similar results will be achievable on routine diagnostic studies and foresee an expanding role for MRI in the evaluation of tendon disease.

Animals↗
PubMed2007

Crimp morphology in relaxed and stretched rat Achilles tendon.

Fibrous extracellular matrix of tendon is considered to be an inextensible anatomical structure consisting of type I collagen fibrils arranged in parallel bundles. Under polarized light microscopy the collagen fibre bundles appear crimped with alternating dark and light transverse bands. This study describes the ultrastructure of the collagen fibrils in crimps of both relaxed and in vivo stretched rat Achilles tendon. Under polarized light microscopy crimps of relaxed Achilles tendons appear as isosceles or scalene triangles of different size. Tendon crimps observed via SEM and TEM show the single collagen fibrils that suddenly change their direction containing knots. The fibrils appear partially squeezed in the knots, bent on the same plane like bayonets, or twisted and bent. Moreover some of them lose their D-period, revealing their microfibrillar component. These particular aspects of collagen fibrils inside each tendon crimp have been termed 'fibrillar crimps' and may fulfil the same functional role. When tendon is physiologically stretched in vivo the tendon crimps decrease in number (46.7%) (P<0.01) and appear more flattened with an increase in the crimp top angle (165 degrees in stretched tendons vs. 148 degrees in relaxed tendons, P<0.005). Under SEM and TEM, the 'fibrillar crimps' are still present, never losing their structural identity in straightened collagen fibril bundles of stretched tendons even where tendon crimps are not detectable. These data suggest that the 'fibrillar crimp' may be the true structural component of the tendon crimp acting as a shock absorber during physiological stretching of Achilles tendon.

Achilles Tendon↗
PubMed1997

Etiology and pathophysiology of tendon ruptures in sports.

Of all spontaneous tendon ruptures, complete Achilles tendon tears are most closely associated with sports activities (1-3). Schönbauer (3) reported that 75% of all ruptures of the Achilles tendon are related to sports. In Plecko & Passl (2) the number was 60%. In our material of 430 cases, the number of sports-related Achilles ruptures was very similar (62%), while only 2% of ruptures of other tendons were sports-related (P < 0.001) (1). Also, the majority of Achilles reruptures occurred in sports. The ruptures occurred most often in soccer (34%), track and field (16%) and basketball (14%). The distribution of Achilles ruptures according to different sports varies considerably from country to country, according to the national sport traditions. For example, in northern and middle Europe, soccer, tennis, track and field, indoor ball games, downhill skiing, and gymnastics are the most common; and in North America, football, basketball, baseball, tennis and downhill skiing dominate the statistics (1, 2, 4). In sports, some Achilles ruptures are not spontaneous or degeneration-induced but may occur as a consequence of the remarkably high forces that are involved in the performance (2). Ruptures in the high jump or triple jump are good examples. In such cases, failure in the neuromuscular protective mechanisms due to fatigue or disturbed co-ordination can frequently be found. The spontaneous complete rupture of the supraspinatus tendon of the rotator cuff does not occur very frequently in sports. Those sports that include high-energy throwing movements, such as American and Finnish baseball, American football, rugby and discuss and javelin throwing, may, however, produce this injury. Partial tears and inflammations of the rotator cuff complex are much more frequent in throwing sports. The complete rupture of the proximal long head of the biceps brachii tendon is rare among competitive and recreational athletes. In our material, under 2% of these ruptures were associated with sports activities (5). The rupture (avulsion) of the distal tendon of the biceps muscle is rare. In sports, gymnastics, body building and weight lifting have been said to be able to produce this injury (6). In general, complete ruptures of the quadriceps tendon and the patellar tendon occur most often in older individuals. In our study, the mean age of these patients was 65 years (5). However, these injuries do also occur in younger age groups, especially in athletes. In athletes, the rupture most frequently occurs in high-power sports events, such as high jump, basketball and weight lifting, at the age of 15-30 years. A chronic-patellar apicitis (jumper's knee) may predispose rupture of the tendon (7). As is the case with the rotator cuff complex, overuse inflammation and partial tears of the quadriceps and patellar tendons are one of the most characteristic athletic injuries. Complete spontaneous ruptures of other tendons in sports are rare, although the literature does provide case studies from almost every tendon the human body possesses (8-18).

Athletic Injuries↗
PubMed2005

Influence of decorin and biglycan on mechanical properties of multiple tendons in knockout mice.

Evaluations of tendon mechanical behavior based on biochemical and structural arrangement have implications for designing tendon specific treatment modalities or replacement strategies. In addition to the well studied type I collagen, other important constituents of tendon are the small proteoglycans (PGs). PGs have been shown to vary in concentration within differently loaded areas of tendon, implicating them in specific tendon function. This study measured the mechanical properties of multiple tendon tissues from normal mice and from mice with knock-outs of the PGs decorin or biglycan. Tail tendon fascicles, patellar tendons (PT), and flexor digitorum longus tendons (FDL), three tissues representing different in vivo loading environments, were characterized from the three groups of mice. It was hypothesized that the absence of decorin or biglycan would have individual effects on each type of tendon tissue. Surprisingly, no change in mechanical properties was observed for the tail tendon fascicles due to the PG knockouts. The loss of decorin affected the PT causing an increase in modulus and stress relaxation, but had little effect on the FDL. Conversely, the loss of biglycan did not significantly affect the PT, but caused a reduction in both the maximum stress and modulus of the FDL. These results give mechanical support to previous biochemical data that tendons likely are uniquely tailored to their specific location and function. Variances such as those presented here need to be further characterized and taken into account when designing therapies or replacements for any one particular tendon.

Animals↗
PubMed2006

Regional variation of tibialis anterior tendon mechanics is lost following denervation.

Denervation or inactivity is known to decrease the mass and alter the phenotype of muscle. The mechanical response of tendon to inactivity that has been determined experimentally differs from what is reported by patients. We investigated the hypothesis that this difference was the result of artifacts of the testing process and did not represent what occurred in vivo. To test this hypothesis, a novel approach was used to determine the mechanical properties of the tibialis anterior (TA) tendon by optically measuring the end-to-end mechanical strains as well as the local strains at specific regions of excised TA tendon units. When the end-to-end strain of normal TA tendon is determined, stress-strain response curves show considerably more extensibility than when strain is measured across only the midsection of the tendon (mid-tendon). The strain experienced by the region close to the muscle (muscle tendon) is five times greater than the strain in either the mid-tendon or near the bone (bone-tendon). Five weeks of denervation decreased muscle mass by 67%; increased tendon mass by 10%; and changed the entire shape of the nonlinear response curve, including a loss in regional variation in strain, a 3.9-fold increase in end-to-end tangent modulus, and a 70% reduction in the toe region, as a result of a drastic reduction of the extensibility in the muscle-tendon region. The stress-strain response in the mid-tendon region of a normal TA tendon is therefore not indicative of its overall ability to deform in vivo as it transmits forces from muscle to bone.

Animals↗
PubMedDate not supplied

Improved healing of transected rabbit Achilles tendon after a single injection of cartilage-derived morphogenetic protein-2.

BACKGROUND: Achilles tendon ruptures in humans might be treated more efficiently with the help of a growth factor. Cartilage-derived morphogenetic protein-2 has been shown to induce formation of tendon-like tissue. HYPOTHESIS: Cartilage-derived morphogenetic protein-2 has a positive effect on mechanical parameters for tendon healing in a rabbit model with Achilles tendon transection. STUDY DESIGN: Controlled laboratory study. METHODS: The right Achilles tendon of 40 rabbits was transected without tendon suture. Cartilage-derived morphogenetic protein-2 (10 micro g) or vehicle control (acetate buffer) was injected locally 2 hours postoperatively. All tendons were tested biomechanically at 8 and 14 days, and treated tendons were histologically and radiographically evaluated at 56 days. RESULTS: At 14 days, both failure load and stiffness of treated tendons were increased by 35%. The treated tendons had significantly larger callus size at 8 and 14 days. Histologic and radiographic examination showed no signs of ossification in the treated tendons after 56 days. CONCLUSIONS: A single injection of cartilage-derived morphogenetic protein-2 led to a stronger and stiffer tendon callus than that in the controls without inducing bone formation. CLINICAL RELEVANCE: Similar results from a larger animal model would suggest a possible future use of cartilage-derived morphogenetic protein-2 in the treatment of human Achilles tendon ruptures.

Achilles Tendon↗
PubMed2006

Surgical anatomy of the triceps brachii tendon: anatomical study and clinical correlation.

BACKGROUND: The triceps tendon has been described as a single unit with contribution from each of the 3 heads of the muscle. An observation at the time of surgical repair of a triceps tendon injury led to an anatomical study to further define the anatomy of this tendon as it inserts on the olecranon. HYPOTHESIS: The medial head of the triceps has a tendon that is distinct from, and deep to, the common tendon of the long and lateral heads. STUDY DESIGN: Descriptive laboratory study and case report. METHODS: Eight cadaveric elbows were dissected to examine the triceps tendon. None of the specimens had any evidence of prior injury or surgery to the elbow. All specimens were fresh-frozen and stored at -4 degrees C until they were thawed for use. Skin and subcutaneous tissue were removed, and the tendon of each head of the triceps was explored from the muscle to its bony insertion. RESULTS: In all 8 specimens, on gross inspection, the medial head had a separate insertion deep to the common insertion of the lateral and long heads. The muscle of the medial head extended further distally than did the long and lateral heads. The medial head was muscular to its deep insertion, with a small amount of tendon blended with the muscle distally. Histologic analysis demonstrated that the tendon of the medial head and that of the other 2 heads are confluent distally at their olecranon insertion. CONCLUSION: The medial head of the triceps has a tendon that is distinct from, and deep to, the common tendon of the long and lateral heads on gross inspection. Histologic studies show the insertion of these 2 tendons is confluent. CLINICAL RELEVANCE: This anatomy has important implications for surgical repair of these tendon injuries. Rupture of the deep triceps insertion alone can occur and lead to weakness of elbow extension with the elbow flexed beyond 90 degrees . Triceps strength should be tested with the elbow fully flexed when injury to the tendinous insertion is suspected.

Adult↗
PubMed1990

Longitudinal attrition of the peroneus brevis tendon in the fibular groove: an anatomic study.

There has been little research concerning the attrition of the peroneus brevis tendon since Meyer's observation in 1924. The purpose of our dissections was to establish the incidence of the attrition of the peroneus brevis tendon at the fibular groove, and observe the anatomical relationship of the tendon attrition to the bony anatomy of the distal fibula. One hundred and twenty-four fresh human cadavers ankles from 65 cadavers were dissected under loupe magnification. When attrition of the peroneus brevis was found, the extent of attrition was measured, and anatomic proximity of the tendon to distal fibular groove was observed. Evidence of other tendon attrition as well as the depth of the fibular groove was observed. Specimens which revealed attrition of the peroneus brevis were sketched and photographed. Attrition of the peroneus brevis tendon was found in 14 ankles (11.3% of specimens). The attrition was limited only to the peroneus brevis tendon, and in no specimens was the peroneus longus involved. The degree of tendon attrition varied from simple splaying out of the peroneus brevis in the fibular groove to longitudinal splits in the peroneus brevis tendon with significant fraying of the remaining halves of the tendon. The longitudinal ruptures in the peroneus brevis tendon averaged 1.9 cm (range 1-4 cm). In all cases, the central portion of the longitudinal split was centered over the distal tip of the fibula in the fibular groove. In no case was a complete rupture of the peroneus brevis tendon noted. There was gross evidence of chronic inflammation and synovitis in those ankles with attrition of the peroneus brevis tendon.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Comparative anatomy of rabbit and human achilles tendons with magnetic resonance and ultrasound imaging.

We sought to describe the comparative anatomy of the Achilles tendon in rabbits and humans by using macroscopic observation, magnetic resonance imaging, and ultrasonography. The calcaneus-Achilles tendon-gastrocnemius-soleus complexes from 18 New Zealand white rabbits underwent ultrasound (US) and magnetic resonance (MR) imaging and gross anatomic sectioning; these results were compared with those from a cadaveric gastrocnemius-soleus-Achilles tendon-calcaneus specimen from a 68-y-old human male. The medial and lateral gastrocnemius muscle tendons merged 5.2 +/- 0.6 mm proximal to the calcaneal insertion macroscopically, at 93% of their course, different from the gastrocnemius human tendons, which merged at 23% of their overall course. The rabbit flexor digitorum superficialis tendon, corresponding to the flexor digitorum longus tendon in human and comparable in size with the gastrocnemius tendons, was located medial and anterior to the medial gastrocnemius tendon proximally and rotated dorsally and laterally to run posterior to the Achilles tendon-calcaneus insertion. In humans, the flexor digitorum longus tendon tracks posteriorly to the medial malleolus. The soleus muscle and tendon are negligible in the rabbit; these particular comparative anatomic features in the rabbit were confirmed on the MR images. Therefore the rabbit Achilles tendon shows distinctive gross anatomical and MR imaging features that must be considered when using the rabbit as a research model, especially for mechanical testing, or when generalizing results from rabbits to humans.

Achilles Tendon↗
PubMed1996

The frequency of and relationship between the palmaris longus and plantaris tendons.

A study of 186 cadavers found that 156 cadavers (83.9%) had both palmaris and both plantaris tendons. The palmaris was absent in 22 cadavers (12%); 12 cadavers (6%) were missing the plantaris tendon. If the tendon was missing from one side, there was a 67% chance that the contralateral tendon would also be missing. In all instances where both a palmaris and a plantaris tendon were absent (2.2%), the tendons were missing bilaterally. Fourteen cadavers (7.5%) missing bilateral palmaris tendons still had bilateral plantaris tendons, and 2 cadavers (1%) had no plantaris but had both palmaris tendons. Of the cadavers that had plantaris tendons, 11% had tendons that were 2 mm or less in width and of questionable value for grafting purposes. No correlation was noted between the size of the plantaris tendon and the size of the individual or the size of the palmaris tendon.

Aged↗
PubMed2003

The splice variants 120 and 164 of the angiogenic peptide vascular endothelial cell growth factor (VEGF) are expressed during Achilles tendon healing.

BACKGROUND: The Achilles tendon is one of the most common sites of tendon injury and rupture. One of the early events of wound healing is angiogenesis, in which neovascularization prompts delivery of inflammatory cells and fibroblasts to the wound site. Angiogenesis is controlled by a variety of mitogenic, chemotactic, or inhibitory peptides and lipid factors that act on invading endothelial and smooth muscle cells. One of the most important angiogenic factors is the vascular endothelial cell growth factor (VEGF), a glycosylated protein of 46-48 kDa composed of two disulfide-linked subunits. METHODS: We therefore investigated the expression of VEGF during healing of artificial lesions of the Achilles tendon in a sheep model by immunohistochemical, biochemical, molecular, and cell biology methods. Two groups were created, the Achilles tendon was tenotomized, and the animals were killed at 3 and 24 weeks. Each group consisted of 6 specimens. Six animals which did not undergo surgery served as controls. RESULTS: VEGF could be immunostained in tenocytes of ruptured but not in normal adult tendons. At microvessels, the receptors VEGFR-1 (flt-1) and VEGFR-2 (KDR) could also be visualized. High VEGF levels in ruptured and negligible levels in normal Achilles tendons could be confirmed and quantified by enzyme-linked immunoassay (ELISA). The highest VEGF concentrations were found in ruptured tendons, whereas the VEGF content in healthy adult tendons was negligible. Interestingly, the VEGF concentration of the original tendon stump was higher after 3 weeks than that of the newly regenerated tendon tissue. However, this difference was not significant (p>0.05). Reverse transcription-polymerase chain reaction (RT-PCR) showed that the splice variants VEGF(120 )and VEGF(164) are expressed at 3 weeks and 24 weeks, respectively. CONCLUSION: These results prove the presence of the splice variants VEGF(120 )and VEGF(164) in ruptured tendons during the healing process. The demonstrated up-regulation of VEGF in intrinsic tenocytes suggests a role for VEGF in mechanisms of angiogenesis and Achilles tendon repair. Further research is needed to evaluate if VEGF might be a possible tool to enhance the process of tendon healing.

Animals↗
PubMed2004

Expression of genes for collagen production and NF-kappaB gene activation of in vivo healing flexor tendons.

PURPOSE: Collagen production and reorientation are core events in the healing of tendons and are essential for gaining tensile strength. Intrasynovial flexor tendons are composed chiefly of type I collagen; however, type III collagen is the earliest to be laid down in the wounds. We investigated the expression of genes for type I collagen, type III collagen and its promoter, and nuclear transcription factor kappa B (NF-kappaB) in an in vivo tendon injury model in chickens. METHODS: Flexor digitorum profundus tendons of the long toes of 12 white leghorn chickens were transected partially and repaired with the modified Kessler method. The repaired tendon segments were harvested at 2, 4, and 8 weeks after surgery with 4 chickens used each time. The uninjured tendons from 4 other chickens were used as the controls. We determined the expression of the collagen and NF-kappaB genes in the tendons with reverse transcription and polymerase chain reaction and semiquantitative analysis of gene bands in gel electrophoresis. RESULTS: Expression of the type III collagen gene was enhanced significantly in the tendons at 2, 4, and 8 weeks after repair. Levels of expression of the type III collagen promoter gene were increased significantly in the healing tendons at 2 and 4 weeks. Increases in the expression of the type I collagen gene occurred later than those of the type III collagen and NF-kappaB genes and were significant in the tendons after 4 and 8 weeks. The NF-kappaB gene was activated in the tendons at all the healing periods. CONCLUSIONS: Expression of type III collagen and its promoter genes is enhanced remarkably during in vivo flexor tendon healing. The NF-kappaB gene is activated during the healing process. Expression of the type I collagen gene increases remarkably at later periods of in vivo tendon healing and is proportional to that of the NF-kappaB gene.

Animals↗
PubMed2003

The changes in mechanical properties of regenerated and residual tissues in the patellar tendon after removal of its central portion.

OBJECTIVE: To know the temporal changes of the mechanical properties of the regenerated and the residual tissues in the patellar tendon after removal of the central portion.Design. The regenerated and the residual tissues were compared to sham-operated tendons. BACKGROUND: Although the structural properties of the whole patellar tendon after removal of the central portion have been investigated, no studies have distinguished between the regenerated and the residual tissues.Methods. For 52 skeletally mature rabbits, a full-thick, segmental defect was made at the central portion of the right patellar tendon, while a sham operation performed in the left tendon. At 3, 6, 12, and 24 weeks, we evaluated the mechanical properties and fibroblast density of the regenerated and the residual tissues as well as the blood flow and tissue dimensions of the patellar tendon. In addition, non-treated patellar tendons from six rabbits were served as the control for mechanical testing. RESULTS: The tangent modulus and the tensile strength of the regenerated tissue progressively increased with time. On the other hand, these parameters of the residual tendinous portion decreased until 6 weeks, although they gradually increased thereafter. The tensile strength of the regenerated and the residual tissues at 24 weeks were approximately 80% and 75%, respectively, of the non-treated, control tendon. Abundant blood flow and cell proliferation were observed in the regenerative tissue until 6 weeks. CONCLUSION: The mechanical properties of the regenerated and the residual tissues after removal of the central portion in the patellar tendon are much different from those of the original tendon. RELEVANCE: The present study showed inferior mechanical properties of the residual and the regenerated tissues for up to 24 weeks after removal of the central portion in the patellar tendon. Therefore, the aggressive rehabilitation that applies excessive load to the patellar tendon should be avoided at an early stage after harvesting the tendon for ligament reconstruction.

Adaptation, Physiological↗
PubMed2002

Biologic tendon fixation to metallic implant augmented with autogenous cancellous bone graft and bone marrow in a canine model.

Soft tissue attachment to a metallic prosthesis is required for the improvement of the functional outcome of endoprosthetic reconstructions. Direct tendon attachment to the metallic surface can be achieved through fibrous ingrowth, but such an attachment has a mechanical strength less than one fifth of that of a normal tendon insertion. Regeneration of a transitional structure between the tendon and the metallic surface similar to the normal morphology of a direct tendon insertion may improve the mechanical strength of the new tendon insertion. The objective of the study was to investigate the effect of placement of an interpositional autogenous cancellous bone plate augmented with bone marrow on the mechanical strength of the soft tissue attachment to the metallic surface. The insertion of the supraspinatus tendon was reattached to a porous titanium prosthesis in a canine shoulder model. An autogenous cancellous bone plate supplemented with bone marrow was positioned between the metallic surface and the tendon. Assessment of load-bearing, as a measure of functional recovery, and radiological analysis were performed at 3, 6, 9, 12, and 15 weeks. The animals were euthanized 16 weeks after surgery, and the specimens were subjected to tensile mechanical testing (six animals) and microradiographic-histologic evaluation (three animals). Functional analysis showed a 90.3% recovery of preoperative weight-bearing by 16 weeks (p < 0.05). The mineralized area around the prostheses increased by 63% over time (p < 0.05). Tensile stiffness and strength of the reconstruction were 43.6% and 42.8% of the intact tendon insertion values, respectively. These results were higher than in previous experiments using the direct tendon attachment (p < 0.01, p < 0.05, respectively) or the interpositional bone plate without marrow supplementation (p < 0.05, p < 0.05, respectively). Morphologically, the tendon reattachment site contained the basic tissue transition zones in normal tendon insertion to bone. Inductive bone grafting, supplemented with bone marrow, in the biologic augmentation of tendon anchoring onto a porous metallic prosthesis was an effective technique to increase the mechanical strength of the tendon attachment to the metallic prosthesis.

Animals↗