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PubMed2000

Longitudinal split of peroneus brevis tendon. A report on two cases.

BACKGROUND AND AIMS: To describe the clinical findings and surgical treatment of peroneus brevis split. MATERIAL AND METHODS: Two cases of longitudinal split of the peroneus brevis tendon are reported. One of the patients was a healthy middle-aged woman, who had fallen out of a car in a traffic accident and sprained her right ankle. Lateral ankle sprain was diagnosed and treated with a compression bandage. Lateral ankle pain persisted, however, with some swelling in the peroneal tendon region. MRI revealed a longitudinal partial rupture of the peroneus brevis tendon, which was treated surgically 12 months after the trauma. The second case was a 53-year-old woman, who had been suffering from rheumatoid arthritis for 2 years. Chronic pain and swelling in the peroneal tendon region were treated with 6 local corticosteroid injections without significant relief. Preoperative ultrasonography showed effusion of the peroneal tenosynovium, but the operation revealed a longitudinal split in the peroneus brevis tendon. RESULTS: In the first case, a single central peroneus brevis split was repaired with side-to-side suturation. After four weeks with a below-knee cast the patient was allowed to walk freely. At follow-up 12 months postoperatively, she was satisfied, although she still had some exertion pain in her ankle. In the second case, the torn fragment of the peroneus brevis tendon was excised and the ankle was mobilized early. Healing was complicated by a wound fistula, which was treated with antibiotics. Subluxation of the peroneus longus tendon necessitated a reoperation, which revealed a rerupture and a defect of the peroneus brevis tendon. The subluxation was repaired and the ruptured tendon ends were revised, followed by four weeks of below-knee cast immobilization, after which the patient was allowed to walk freely. The outcome was good. CONCLUSION: Peroneus brevis split easily goes unrecognised or misdiagnosed. It must be considered in patients with a history of single or recurrent ankle sprain or a chronic inflammatory disease. Lateral ankle pain, diffuse or local swelling in the peroneal tendon region, and a stable or instable ankle with no peroneal weakness are the main symptoms and findings. MRI is the most exact method for diagnosing tendon split. Surgical treatment usually gives good results.

Adult↗
PubMed2000

Results of the superior oblique tendon elongation procedure for severe Brown's syndrome.

PURPOSE: To evaluate the outcomes of the silicone tendon expander for the treatment of Brown's syndrome. METHODS: This paper consists of 2 parts: a chart review of patients who have under gone the silicone tendon elongation procedure for Brown's syndrome and a survey of the surgical experience of the members of the American Association of Pediatric Ophthalmology and Strabismus. Charts of 15 consecutive Brown's syndrome patients who underwent the superior oblique tendon expander were reviewed by the author from 1987 to 1997. An additional patient referred to the author for management of complications of the silicone tendon expander procedure after surgery elsewhere for Brown's syndrome is reported. The second aspect of the study is a fax survey sent to all 450 members of the American Association of Pediatric Ophthalmology and Strabismus listed in the 1997-1998 directory. Pediatric ophthalmologists were asked to answer questions regarding their experience using the silicone tendon expander for Brown's syndrome. RESULTS: Of 15 patients operated on by the author, preoperative limitation of elevation in adduction measured -4 in 14 patients and -3 in 1 patient preoperatively. Postoperatively, 14 of the 15 patients showed improved motility, with essentially normal versions in 10 patients (no more than +/- 1 oblique dysfunction); 3 patients were undercorrected (2 mild and 1 severely); and 2 had a consecutive superior oblique paresis (1 mild and 1 requiring an inferior oblique weakening procedure). The 1 patient with a severe undercorrection that did not improve after the silicone tendon elongation procedure showed continued restriction by intraoperative forced ductions after superior oblique tenotomy. Superior oblique tendon was not the cause of Brown's syndrome in this patient. The average final result graded on a scale of 1 to 10 (10 being best) was 8.3. Thirteen of 15 patients (87%) achieved a final result score of 7 or better with a single surgery, and an additional patient was corrected with a second surgery providing an overall success rate of 93%. Ten of the 15 patients had at least 11 months' follow-up, and 6 of the 10 patients showed a delayed improvement over a 4- to 6-month period. Five patients had more than 5 years of follow-up, and 4 (80%) had an excellent long-term outcome (final result, 9 to 10) with a single operations; all 5 had a good final outcome (final result, 7 to 10, mean 9.2) with 1 patient requiring a second surgery. There were no long-term complications, including no extrusions, no restriction of ocular rotations, and no infections. The patient who underwent the procedure elsewhere demonstrated limited movement of the eye to adduction elevation, and there was underaction of the ipsilateral superior oblique muscle. A reoperation performed by the author revealed positive forced ductions up and nasal ward. There were scars and adhesions in the area of the silicone implant, including scar to superior nasal sclera and superior rectus muscle. The silicone implant was removed and scar excised until forced ductions improved. This resulted in improved motility. Thirty-nine AAPOS members reported on 140 patients who had undergone the silicone tendon elongation procedure for Brown's syndrome. Judged by the surgeon on a scale of 1 to 10 (10 being best), 26 surgeons rated 91 patients (65%) as good with a score of 8 to 10, and 14 surgeons rated 18 patients (13%) poor with scores of 1 to 3. Complications were recorded for 9 patients and included scarring and restriction with removal of silicone implant in 4 and spontaneous extrusion in 5. Three of the 5 spontaneous extrusions came from the same surgeon, and in another case a surgeon used a 10 mm length of silicone. CONCLUSIONS: A novel procedure, the silicone tendon expander, is an effective option for correcting Brown's syndrome caused by a stiff or inelastic superior oblique tendon; long-term outcomes are excellent. Proper technique with maintenance of the tendon capsule is critical to the successful outcome of the procedure.

Eye Movements↗
PubMed2002

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 x 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.

Amnion↗
PubMed1992

Angiogenesis in healing autogenous flexor-tendon grafts.

On the basis of recent evidence that flexor tendon grafts may heal without the ingrowth of vascular adhesions, eighteen autogenous donor tendons of intrasynovial and extrasynovial origin were transferred to the synovial sheaths in the forepaws of nine dogs, and controlled passive mobilization was instituted early in the postoperative period. The angiogenic responses of the tendon grafts were determined with perfusion studies with India ink followed by cleaing of the tissues with the Spalteholz technique at two, four, and six weeks. A consistent pattern of neovascularization was noted in the donor tendons of extrasynovial origin. Vascular adhesions arising from the flexor digitorum superficialis and the tendon sheath enveloped the tendon grafts by two weeks. By six weeks, the vascularity of the tendon grafts of extrasynovial origin appeared completely integrated with that of the surrounding tissues. Examination of cross sections revealed that the segments of tendon had been completely vascularized by obliquely oriented intratendinous vessels. In contrast, the flexor tendon grafts of intrasynovial origin healed without ingrowth of vascular adhesions. Primary intrinsic neovascularization took place from the proximal and, to a lesser extent, distal sites of the sutures. Examination of cross sections revealed vessels extending through the surface layer of the tendon graft, with small vessels penetrating the interior of the tendons at regular intervals.

Animals↗
PubMed1992

Anatomy of the prepubic tendon in the horse, cow, sheep, goat, and dog.

Analyses of the fibers in the prepubic tendon of the horse and ruminants have shown that it is composed of the crossed and uncrossed tendons of origin of the pectineus muscles, the pelvic tendons of the rectus and obliquus abdominis muscles, and the tendons of origin of the cranial parts of the gracilis muscles. Pelvic attachments of the linea alba and the yellow abdominal tunic are incorporated in it. It is not a transverse ligament, and it is not homologous to the human superior (cranial) pubic ligament. The dog differs in 4 respects: (1) the pectineus tendons do not cross, but each originates from the pubic bone of the same side; (2) an iliopubic cartilage is intercalated in the prepubic tendon on each side at the junction of the pectineus tendon and the abdominal and pelvic tendons of the external oblique at the caudal angle of the superficial inguinal ring; (3) in some dogs, the caudal border of the aponeurosis of the transversus abdominis joins the prepubic tendon; (4) the gracilis tendon does not extend to the prepubic tendon. The clinical anatomy was described, illustrated, and compared between species. Conflicting descriptions in the literature were discussed and resolved by new approaches to the dissection. Studies of the inguinal region in the cat and pig were reviewed. A table of nomenclature is included.

Animals↗
PubMed1989

Effects of short-term immobilization versus continuous passive motion on the biomechanical and biochemical properties of the rabbit tendon.

Little work has been done on the effect that continuous passive motion (CPM) may have on maintaining the mechanical and biochemical characteristics of tendons deprived of normal load-bearing stimuli. This study compared changes in mechanical properties and collagen concentrations of the tibialis anterior tendon between two groups of rabbits: control animals that received no treatment and experimental animals that received CPM to one ankle and immobilization to the other. Treatment duration was three weeks. Mechanical testing yielded values for elastic modulus, stiffness, stress, strain, and strain energy density at linear and maximum loads. Hydroxyproline concentrations were measured to determine tendon collagen content. Findings indicated that cyclic tensile loading of tendons by CPM lessened the harmful effects of immobilization. Linear load and stress for CPM and control tendons were similar, while the same measures for immobilized tendons were 16% and 25% less than control tendons. Ultimate strength of the control tendons, however, exceeded CPM tendons by 16% and immobilized tendons by 20%. Hydroxyproline levels were comparable for the CPM, control, and immobilized tissues. For a short duration (three weeks), CPM reduced the detrimental effects of immobilization in the tendon, primarily in the linear-load region.

Animals↗
PubMed1983

Mechanical and functional properties of implanted freeze-dried flexor tendons.

Tendons harvested from donor dogs were freeze-dried and implanted as free allografts in the paws of recipient experimental animals; the tendons were subsequently tested for mechanical properties, clinical function, and histologic appearance. Free tendon autografts, normal tendons in the operated experimental paw, and normal tendons in the unoperated paw were used as controls and compared with the allografts. Mechanically, the free tendon allografts and autografts were similar. The ultimate strength of the two grafts was statistically the same but significantly less, about one-third, than that of normal tendons. The implanted allografts appeared to be tolerated well by the host and to allow flexor tendon function similar to that allowed by autografts. The histologic appearance of the allograft and autograft tendons was similar at three and six months. Freeze-dried flexor tendon allografting is a satisfactory alternative to free tendon autografting.

Animals↗
PubMed1980

[Achilles tendon rupture and achillodynia. The importance of tissue regeneration].

Ruptures of the Achilles tendon mainly occur in males aged 30 to 40 years; in an analysis of 561 specimens taken from ruptured tendons only 25% were classified as degenerative tendopathy. Ultrastructural studies of areas in and near the tendon rupture and of specimens of tendonitis show more collagen fibres with small diameter in comparison to normal samples. These morphological changes correspond to structures of tendon tissue after reversible damage of rabbit tendons. Test models were throttling of the Arteria poplitea or Arteria femoralis, sheathing of the Achilles tendon and deflecting the tendon in order to increase the tension. The electrophoretic determination of collagen showed increasing type III collagen with formation of repair tissue. First of all the experimental findings as well as the clinical fact of rare secondary ruptures after operatively treated ruptures of Achilles tendons prove good conditions for tendon repair. But probably an increasing number of small diameter collagen fibres and changings in the pattern of collagen types weaken the mechanical properties of the tendon.

Achilles Tendon↗
PubMed1995

[Spontaneous tendon ruptures. Etiology, pathogenesis and therapy].

Spontaneous tendon ruptures are ascribed to recurrent microtrauma resulting from continuous mechanical loading in a critical zone, to muscular imbalance combined with poor coordination as a result of inappropriate training, and also to deteriorating circulation with increasing age. Ruptures of the rotator cuff occur more frequently with increasing age, and the size of the rupture also correlates with age. The frequency of the complaint in men, the predominant involvement of the dominant shoulder, and also the above-average occurrence in occupations involving strenuous physical work indicate that degenerative change plays a role. In about 50% of patients presenting with a ruptured rotator cuff, the genesis is clearly traumatic. A trauma will almost always be the cause of an isolated rupture of the subscapularis tendon. The choice of reconstruction technique for a ruptured rotator cuff depends on the patient's age and level of activity in daily life. In the case of young patients, further surgical measures to repair the defect are indicated following failure of primary suture of the tendon, but in older patients subacromial debridement alone is considered the appropriate procedure. Rupture of the long head of the biceps tendon is usually a sequela of a rotator cuff rupture and the resulting loss of protective cover. Isolated ruptures of the long head of the biceps tendon are much rarer. They tend to occur in middle-aged patients and are usually the result of a relatively minor trauma. Ruptures of the distal biceps tendon are also relatively rare (3%) and are always of traumatic origin. There is no absolute indication for surgical intervention for a ruptured long head of the biceps tendon. Surgical repair is essential in the case of rupture of the distal biceps tendon. Transosseous reinsertion at the tuberosity of the radius is the recommended method of repair. Today's frequent cases of rupture of the Achilles tendon in the framework of sports activities are ascribed to inappropriate training procedures in combination with poor muscular coordination. An exogenous cause is the administration of local injections for pain relief in the form of a so-called tendon anesthetic. Today an increasingly important role is assigned to functional therapy with ultrasound support, although suturing the tendon is still the intervention of choice to meet the high functional demands imposed in the framework of top-level sports.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMedDate not supplied

[The echographic and clinical follow-up of patients operated on for subcutaneous rupture of the Achilles tendon].

Thanks to its good long-term results, surgery is the method of choice to treat subcutaneous ruptures of the Achilles tendon. Reconstructed tendons present typical morphological and functional US patterns which depend partly on the kind of surgical reconstruction and partly on the time passed since surgery. The authors report the results of the clinical and US follow-up of a series of 62 surgical patients treated in 7 years for the subcutaneous rupture of the Achilles tendon. The patients were 55 men and 7 women, whose mean age was 36 years (range: 25-65 years). The left-hand side was affected in 38 patients and the right-hand side in 24 patients. All patients were operated on using an end-to-end suture and reinforcement plastic surgery pulling down a gastrocnemius tendon flap. To homogenize the results, all the US exams were performed by the same operator, in the presence of the orthopedic specialist and under the same conditions: both the involved and the contralateral Achilles tendons were studied, longitudinal and transverse scans were performed with the foot in max. plantar and dorsal flexion and, whenever possible, dynamic scans were also performed making the sural triceps contract against resistance. The following parameters were studied clinically: pain (which was absent in 39 patients, occasional in 11, after stress in 9 and on walking in 3 patients), skin scar trophism (which was eutrophic in 53.23% of patients, keloid in 27.42% and hypertrophic in 19.35% of patients), ankle joint excursion (plantar flexion was impaired in 32.3% and dorsal flexion in 36% of patients), walking on tiptoe (in all, 22.6% of patients complained of difficulties walking on tiptoe) and, finally, work activity resumption (which all patients achieved). US depicted the surgical tendons as much bigger than the contralateral ones (3-4 times on the average), which increase in volume lasted throughout the follow-up. In 75% of patients the echo structure of the surgical tendons was inhomogeneous, with scattered hypoechoic and hyperechoic areas. In the extant 25% of patients, nearly all of them followed-up for over 6 years, US depicted a clear-cut hyperechoic area whose size and echo structure were similar to the healthy tendons'. Our results strongly suggest that tenorrhaphy and flap plastic surgery be used to repair subcutaneous ruptures of the Achilles tendon. US proved to be the most reliable and feasible method also in the follow-up. The US images of the patients submitted to surgery more than 6 years earlier revealed fibrillate reorganization patterns and tendon restructuring. These processes involve both ends of the sutured tendon and not the reinforcement flap, which further confirms the exclusively mechanical, and not biological, function of the latter.

Achilles Tendon↗
PubMed1996

Patellar tendon length after anterior cruciate ligament reconstruction.A prospective study.

Shortening of the patellar tendon after anterior cruciate ligament (ACL) reconstruction has been implicated as a cause of postoperative complications such as anterior knee pain, patella infera syndrome, and traumatic patellar tendon rupture. This prospective study was designed to asses whether closure of the patellar tendon defect during ACL reconstruction with mid-third bone-patellar tendon-bone autograft leads to radiographic evidence of patellar tendon shortening. One hundred fourteen patients underwent arthroscopically assisted ACL reconstruction using mid-third bone-patellar tendon-bone autograft. Group I (59 patients) had the patellar tendon defect left open. Group II (55 patients) had the defect sutured closed. The paratenon was approximated in all patients. Lateral knee radiographs were taken pre- and post-operatively. The pre- and postoperative patellar tendon lengths were measured and compared. Group I (defect left open) showed virtually no patellar tendon shortening (average 0.3%). Group II (defect closed) showed minimal but slightly more shortening (average: 0.51%). The maximum shortening was 2.3% in Group I and 4.3% in Group II. Therefore, closure of the patellar tendon defect does not significantly alter the length of the patellar tendon after ACL reconstruction.

Adult↗
PubMed2005

Effects of administration of transforming growth factor (TGF)-beta1 and anti-TGF-beta1 antibody on the mechanical properties of the stress-shielded patellar tendon.

Previous studies have shown that, in the stress-shielded patellar tendon, the mechanical properties of the tendon were dramatically reduced and TGF-beta was over-expressed in tendon fibroblasts. In the present study, therefore, we tested two supportive hypotheses using 40 rabbits: One was that an application of TGF-beta1 might significantly increase the tensile strength and the tangent modulus of the stress-shielded patellar tendon. The other one was that an administration of anti-TGF-beta1 antibody might significantly reduce the mechanical properties of the stress-shielded patellar tendon. In the results, an application of 4-ng TGF-beta1 significantly increased the tangent modulus of the stress-shielded patellar tendon at 3 weeks (p = 0.019), compared with the sham treatment. Concerning the tensile strength, the 4-ng TGF-beta1 application increased the average value, but a statistical significance was not reached. An application of 50-microg anti-TGF-beta1 antibody significantly reduced the tangent modulus and the tensile strength of the stress-shielded patellar tendon at 3 weeks (p = 0.0068 and p = 0.0355), compared with the sham treatment. Because the stress-shielding treatment used in this study dramatically reduces the tangent modulus and the tensile strength of the patellar tendon, the present study suggested that an administration of TGF-beta1 weakly but significantly inhibited the reduction of the mechanical properties of the stress-shielded patellar tendon, and that inactivation of TGF-beta1 with its antibody significantly enhanced the reduction of the mechanical properties that occurs in the stress-shielded patellar tendon. These results suggested that TGF-beta1 plays an important role in remodeling of the stress-shielded patellar tendon.

Animals↗
PubMed2006

The biomechanical function of the patellar tendon during in-vivo weight-bearing flexion.

Few studies have investigated the function of the patellar tendon in-vivo. This study quantified the three-dimensional (3D) kinematics of the patellar tendon during weight-bearing flexion. Eleven subjects were imaged using magnetic resonance (MR). Sagittal plane images were outlined to create a 3D model of the patella, tibia, and femur and included the attachment sites of the patellar tendon. Each attachment site was divided into central, medial, and lateral thirds. Next, the subjects were imaged using fluoroscopy from two orthogonal directions while performing a single-leg lunge. The models and fluoroscopic images were used to reproduce the motion of the patella, tibia, and femur. The apparent elongation, sagittal plane angle, and coronal plane angle of each third of the patellar tendon were measured from the relative motion of the attachment sites. All three portions of the patellar tendon deformed similarly with flexion. The length of the patellar tendon significantly from full extension to 30 degrees . From 30 degrees -110 degrees , no significant change in the length of the patellar tendon was observed. The patellar tendon was oriented anteriorly at flexion angles less than 60 degrees and posteriorly thereafter. From full extension to 60 degrees , the medial orientation of the patellar tendon decreased significantly with flexion. These data may have important implications for anterior cruciate ligament reconstruction using patellar tendon autografts and for the design of rehabilitation regimens for patients of patellar tendon repair.

Adult↗
PubMed2000

The effects of stress enhancement on the extracellular matrix and fibroblasts in the patellar tendon.

The purpose of the present study is to determine the effect of the stress enhancement and intrinsic fibroblasts on the extracellular matrix of the patellar tendon. Thirty-two female Japanese White rabbits were divided into four groups. In Group 1, the patellar tendon underwent the in situ freeze-thaw treatment to kill intrinsic fibroblasts of the patellar tendon and the patellar tendon underwent the wrapping treatment with nylon membrane filters to inhibit extrinsic cell infiltration. In Group 2, the medial and the lateral portions of the frozen-thawed patellar tendon were resected to enhance the stress, and then the central two-thirds of the patellar tendon underwent the wrapping treatment. In Group 3, the patellar tendon without the freeze/thaw treatment underwent the wrapping treatment. In Group 4, the patellar tendon was narrowed and wrapped in the same manner. All rabbits were killed 6 weeks after surgery. While the elastic modulus and the tensile strength of the patellar tendon in Group 2 were significantly less than those in Group 1, we could not find any significant differences in these parameters between Groups 3 and 4. Histologically, while no fibroblasts were observed in Groups 1 and 2, fibroblasts were found in Groups 3 and 4. This study revealed that stress enhancement decreases the elastic modulus and the tensile strength of the extracellular matrix of the patellar tendon and that intrinsic fibroblasts prevent the detrimental effect of stress enhancement on mechanical properties of the patellar tendon.

Analysis of Variance↗
PubMed2006

Patellar tendons with normal imaging and pain: change in imaging and pain status over a volleyball season.

OBJECTIVE: Patellar tendon injury commonly presents as abnormal imaging with pain or abnormal imaging without pain. Normal imaging with pain has also been reported clinically, but little is known about the behavior of these tendons over time. This study investigated the behavior of tendons with normal imaging and pain over a volleyball season. DESIGN: Prospective study. SETTING: Institutional. PARTICIPANTS: One hundred and one male and female volleyball players. MAIN OUTCOME MEASUREMENTS: At the beginning and end of the season ultrasound determined imaging status and the single leg decline squat test determined pain. The imaging and pain status at follow-up of tendons with normal imaging and pain at baseline was reported and contrasted to the imaging and pain status of the other patellar tendon injuries. RESULTS: Tendons with normal imaging and pain [relative risk (RR) 15.1], abnormal imaging without pain (RR 14.6), and abnormal imaging with pain (RR 51.5) had a greater risk of having abnormal imaging with pain at the end of the season when compared with normal tendons (P < 0.01). Among tendons with normal imaging and pain at baseline, 27% had abnormal imaging without pain and 21% contained abnormal imaging with pain at the end of the season. CONCLUSIONS: Patellar tendons with normal imaging and pain at the beginning of a volleyball season are equally as likely to have abnormal imaging and pain at the end of the season as tendons with abnormal imaging without pain. Normal imaging with pain may represent a clinically relevant patellar tendon injury.

Adolescent↗
PubMed2005

The effect of dynamic knee-extension exercise on patellar tendon and quadriceps femoris muscle glucose uptake in humans studied by positron emission tomography.

Both tendon and peritendinous tissue show evidence of metabolic activity, but the effect of acute exercise on substrate turnover is unknown. We therefore examined the influence of acute exercise on glucose uptake in the patellar and quadriceps tendons during dynamic exercise in humans. Glucose uptake was measured in five healthy men in the patellar and quadriceps tendons and the quadriceps femoris muscle at rest and during dynamic knee-extension exercise (25 W) using positron emission tomography and [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG). Glucose uptake index was calculated by dividing the tissue activity with blood activity of [18F]FDG. Exercise increased glucose uptake index by 77% in the patellar tendon (from 0.30 +/- 0.09 to 0.51 +/- 0.16, P = 0.03), by 106% in the quadriceps tendon (from 0.37 +/- 0.15 to 0.75 +/- 0.36, P = 0.02), and by 15-fold in the quadriceps femoris muscle (from 0.31 +/- 0.11 to 4.5 +/- 1.7, P = 0.005). The exercise-induced increase in the glucose uptake in neither tendon correlated with the increase in glucose uptake in the quadriceps muscle (r = -0.10, P = 0.87 for the patellar tendon and r = -0.30, P = 0.62 for the quadriceps tendon). These results show that tendon glucose uptake is increased during exercise. However, the increase in tendon glucose uptake is less pronounced than in muscle and the increases are uncorrelated. Thus tendon glucose uptake is likely to be regulated by mechanisms independently of those regulating skeletal muscle glucose uptake.

Adult↗
PubMed2006

Ultrastructural collagen fibril alterations in the patellar tendon 6 years after harvesting its central third.

BACKGROUND: Clinically, donor site problems are common, even in the long term after anterior cruciate ligament reconstruction using patellar tendon autograft. However, there is a lack of knowledge in terms of the mid- and long-term ultrastructural appearance of the previously harvested tendon in humans. HYPOTHESIS: The patellar tendon does not regain normal ultrastructure 6 years after harvesting its central third and leaving the defect open. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Thirteen patients were included in the study. Biopsy specimens were obtained from the central and lateral thirds of the patellar tendon under ultrasound guidance 71 months (range, 68-73 months) after the reconstruction. Ten biopsy specimens from other subjects with asymptomatic patellar tendons served as controls. The sections were evaluated using transmission electron microscopy. Longitudinal sections were used for morphological evaluation, and the fibril diameter was measured on the transverse sections and grouped into 5 diameter classes. RESULTS: All control specimens were found to have a compact extracellular matrix with regularly oriented collagen fibrils. Specimens from the lateral part of the harvested tendons displayed a more heterogeneous extracellular matrix. In 3 specimens, the extracellular matrix was different from that of the control specimens. Specimens from the central part of the harvested tendons displayed an even more heterogeneous extracellular matrix, with 8 specimens judged as heterogeneous. The fibril diameter in control specimens displayed the most heterogeneous pattern, and all 5 fibril classes were present. All fibril classes were found in the lateral biopsy specimens from the previously harvested tendons, but the 2 smallest fibril classes (0-30 and 31-60 nm) were significantly more dominant compared with control specimens (P < .0001). In the central specimens from the previously harvested tendons, only the 3 smallest size classes were found (P < .0001 vs controls). CONCLUSION: Six years after harvesting its central third and leaving the defect open, the patellar tendon revealed a "more heterogeneous matrix" with changes in ultrastructural morphology and relative fibril diameter distribution compared with normal control tendon.

Adolescent↗
PubMedDate not supplied

Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review.

The authors conducted a systematic review to assess the effectiveness of extracorporeal shock wave therapy (ESWT) for the treatment of calcific and noncalcific tendonitis of the rotator cuff. Conservative treatment for rotator cuff tendonitis includes physiotherapy, nonsteroidal antiinflammatory drugs, and corticosteroid injections. If symptoms persist with conservative treatment, surgery is often considered. Extracorporeal shock wave therapy has been suggested as a treatment alternative for chronic rotator cuff tendonitis, which may decrease the need for surgery. Articles for this review were identified by electronically searching Medline, EMBASE, Cumulative Index to Nursing & Allied Health Literature (CINAHL), and Evidence Based Medicine (EBM) and hand-screening references. Two reviewers selected the trials that met the inclusion criteria, extracted the data, and assessed the methodological quality of the selected trials. Finally, the strength of scientific evidence was appraised. Evidence was classified as strong, moderate, limited, or conflicting. Sixteen trials met the inclusion criteria. There were only five randomized, controlled trials and all involved chronic (>/=3 months) conditions, three for calcific tendonitis and two for noncalcific tendonitis. For randomized, controlled trials, two (40%) were of high quality, one (33%) for calcific tendonitis and one (50%) for noncalcific tendonitis. The 11 nonrandomized trials included nine that involved calcific tendonitis and two that involved both calcific and noncalcific tendonitis. Common problem areas were sample size, randomization, blinding, treatment provider bias, and outcome measures. There is moderate evidence that high-energy ESWT is effective in treating chronic calcific rotator cuff tendonitis when the shock waves are focused at the calcified deposit. There is moderate evidence that low-energy ESWT is not effective for treating chronic noncalcific rotator cuff tendonitis, although this conclusion is based on only one high-quality study, which was underpowered. High-quality randomized, controlled trials are needed with larger sample sizes, better randomization and blinding, and better outcome measures.

Calcinosis↗