scholarly journals Intrasound Therapy Improves the Mechanical Properties and the Morphology of Tendons in Fluoroquinolone-Induced Achilles Tendinopathy

2021 ◽  
Vol 25 (7) ◽  
pp. 1295-1303
Author(s):  
A.I. Aiyegbusi ◽  
O.A. Ajibola ◽  
T.A. Samuel ◽  
O.J. Balogun ◽  
F.I. Duru
Keyword(s):  
Mechanical Properties ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Tensile Load ◽  
Achilles Tendinopathy ◽  
Ultimate Tensile Stress ◽  
Sprague Dawley ◽  
Hind Limbs ◽  
Level Of Significance ◽  
Group B

Fluoroquinolones (FQs), especially Pefloxacin (PEF) have been reported to increase risk of Achilles tendon rupture. However, prior studies showed that intrasound therapy (ITR) significantly improved the morphology of the healing tendon. This study aimed to compare the effects of 7, 14 and 21 days intrasound treatment on the mechanical properties and morphology of the Achilles tendon in fifty (50) male Sprague-Dawley rats induced with FQ and randomized into three main categories designated as Normal control (A), Experimental control (B) and Treatment groups (C). All animals in groups B and C were orally administered PEF 400mg/kg in a fixed volume of 2.5 ml/kg daily for 6 consecutive days. The Achilles tendon of both hind limbs in group C were treated with the lowest intensity ITR 5 minutes daily for 7, 14 and 21 consecutive days. All the animals were serially sacrificed on days 8, 15 and 22 and the tendons excised and processed. Data were analyzed with RSTUDIO version 4.0.02 and the level of significance set at 0.05. Kruskal Wallis showed no significant differences (p >0.05) in all the biomechanical parameters across all the groups. Compared with group B, ITR 14 days treatment had the best improvement in all biomechanical variables, though insignificant (p>0.05). In the Intrasound groups, there were significant positive correlations of Nitric Oxide Synthase (NOS) with ultimate tensile stress and tensile load (p= 0.005; p=0.003) respectively. Intrasound treatment to the Achilles tendon for 14 days improved the mechanical properties  and morphology of tendons in Fluoroquinolone-induced tendinopathy.

scholarly journals Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Yangjing Lin ◽  
Jin Cao ◽  
Changgui Zhang ◽  
Liu Yang ◽  
Xiaojun Duan
Keyword(s):  
Achilles Tendon ◽  
Recurrence Rate ◽  
Operative Time ◽  
Achilles Tendon Rupture ◽  
Tendon Lengthening ◽  
Group A ◽  
Achilles Tendon Lengthening ◽  
The Mean ◽  
Group B

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.

scholarly journals Tendon Morphology and Mechanical Properties Are Associated With the Recovery of Symptoms and Function in Patients With Achilles Tendinopathy

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091727
Author(s):  
Patrick Corrigan ◽  
Daniel H. Cortes ◽  
Ryan T. Pohlig ◽  
Karin Grävare Silbernagel
Keyword(s):  
Mechanical Properties ◽  
Shear Modulus ◽  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Calf Muscle ◽  
Initial Assessment ◽  
Muscle Endurance ◽  
Patient Reported ◽  
Morphology And Mechanical Properties

Background: Achilles tendinopathy is a debilitating overuse injury characterized by pain, altered Achilles tendon structure, and impaired functional performance. Evaluating tendon structure as part of the physical examination may help establish a well-defined prognosis. However, the usefulness of measuring tendon structure for developing a prognosis has been questioned since structural abnormalities can exist without symptoms. Purpose: To determine whether initial measures of tendon morphology and mechanical properties were associated with patient-reported symptoms and calf muscle endurance at baseline, 6-month follow-up, and 1-year follow-up by prospectively following a cohort of individuals with Achilles tendinopathy. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 59 participants with midportion or insertional Achilles tendinopathy completed an initial assessment and follow-up assessments at 6 months and 1 year. At the initial assessment, patient-reported symptoms, calf muscle endurance, and Achilles tendon thickening were evaluated, and Achilles tendon mechanical properties were estimated. At the 6-month and 1-year follow-up assessments, patient-reported symptoms and calf muscle endurance were reevaluated. Results: Greater Achilles tendon thickening at the initial assessment was consistently associated with worse patient-reported symptoms and calf muscle endurance at each assessment. Changes in symptoms over the year were moderated by the initial shear modulus of the tendon, with a lower shear modulus associated with less improvement in symptoms. Lower viscosity at the initial assessment was also associated with worse calf muscle endurance at each assessment. Conclusion: Measures of tendon morphology and mechanical properties appear to be associated with patient-reported symptoms and calf muscle function for patients with Achilles tendinopathy.

Uphill running improves rat Achilles tendon tissue mechanical properties and alters gene expression without inducing pathological changes

2012 ◽  
Vol 113 (5) ◽  
pp. 827-836 ◽  
Author(s):  
K. M. Heinemeier ◽  
D. Skovgaard ◽  
M. L. Bayer ◽  
K. Qvortrup ◽  
A. Kjaer ◽  
...  
Keyword(s):  
Gene Expression ◽  
Mechanical Properties ◽  
Growth Factor ◽  
Achilles Tendon ◽  
Glucose Uptake ◽  
Transforming Growth Factor ◽  
Achilles Tendinopathy ◽  
Tissue Growth ◽  
Tendon Tissue ◽  
Collagen Iii

Overuse Achilles tendinopathy is a common and challenging problem in sports medicine. Little is known about the etiology of this disorder, and the development of a good animal model for overuse tendinopathy is essential for advancing insight into the disease mechanisms. Our aim was to test a previously proposed rat model for Achilles tendon overuse. Ten adult male Sprague-Dawley rats ran on a treadmill with 10° incline, 1 h/day, 5 days/wk (17–20 m/min) for 12 wk and were compared with 12 control rats. Histological, mechanical, and gene-expression changes were measured on the Achilles tendons after the intervention, and local tendon glucose-uptake was measured before and after the intervention with positron emission tomography. No differences were detected between runners and controls in tissue histology or in glucose uptake, indicating that tendon pathology was not induced. Greater tendon tissue modulus ( P < 0.005) and failure stress/body weight ( P < 0.02) in runners compared with controls further supported that tendons successfully adapted to uphill running. Several genes of interest were regulated after 12 wk of running. Expression of collagen III and insulin-like growth factor I was increased, while collagen I was unchanged, and decreases were seen in noncollagen matrix components (fibromodulin and biglycan), matrix degrading enzymes, transforming growth factor-β1, and connective tissue growth factor. In conclusion, the tested model could not be validated as a model for Achilles tendinopathy, as the rats were able to adapt to 12 wk of uphill running without any signs of tendinopathy. Improved mechanical properties were observed, as well as changes in gene-expression that were distinctly different from what is seen in tendinopathy and in response to short-term tendon loading.

scholarly journals Biomechanical Effects of Δ9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD), the Major Constituents of Cannabis, on Tendon to Tendon Healing in a Sprague Dawley Rat Achilles Tendon Surgical Repair Model

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0039
Author(s):  
Chris Stauch ◽  
Brittany Ammerman ◽  
Michael Aynardi ◽  
Matthew Garner ◽  
Greg Lewis ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Surgical Repair ◽  
Subcutaneous Administration ◽  
Tendon Healing ◽  
Tensile Load ◽  
Control Group ◽  
Sprague Dawley ◽  
Control Groups ◽  
Significant Difference ◽  
Load To Failure

Objectives: Use of Cannabis is common amongst athletes and the U.S. population at large. Use of Cannabinoid Oil is being increasingly utilized for a number of different pathologies, injuries, and ailments due to anecdotal evidence of its efficacy. Due to the current United States Opioid crisis, Δ9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD), the two major constituents of cannabis, are currently being evaluated as potential safer alternatives to narcotic pain medicines. The effects of recreational and/or therapeutic THC and CBD on musculoskeletal injury and healing however remain largely unknown. Our purpose was to evaluate the biomechanical effects of THC and CBD on tendon to tendon healing in a Sprague Dawley Achilles Tendon injury and surgical repair model. Methods: 33 Sprague Dawley rats were randomly assigned into control (1 ml/kg/day of vehicle containing 5% Cremaphor, 5% ethanol, and 0.9% saline n=12), THC (3 mg/kg/day n = 12), or CBD (3 mg/kg/day n=9) treatment groups. Surgical transection and repair of the Achilles tendon was performed and all rats began subcutaneous administration of their respective drug treatment the day of surgery and for 4 subsequent days, followed by sacrifice. Load to failure and stiffness were calculated from load displacement data during tensile load testing on a MTS machine. One-way ANOVA with heterogeneous variance was utilized for evaluation. Means and 95% confidence intervals were also determined. Results: The CBD group demonstrated the highest mean load to failure of 17.5 N (15.1-19.8 N), with the THC group having the second highest mean load to failure at 17.3 N (15.3-19.2 N), and the control group reporting the lowest at 15.2 N (12.1-18.3 N). No statistical difference was observed between CBD/control (p = 0.25), THC/control (p = 0.29), or CBD/THC groups (p = 0.92, Figure 1A). The THC group reported the highest mean stiffness of 3.9 N/mm (2.7-5.1 N/mm). The CBD and control groups demonstrated mean stiffness values of 3.5 N/mm (2.9-4.1 N/mm) and 3.5 N (2.7-4.3 N/mm), respectively. No statistically significant differences were observed between THC/control (p = 0.51), THC/CBD (p = 0.50), or CBD/control groups (p = 0.96) for stiffness (Figure 1B). Conclusion: Our investigation demonstrates that subcutaneous administration of CBD resulted in the highest mean load to failure while THC administration resulted in the highest mean stiffness of the three groups. This did not result however in a statistically significant difference between groups. In our small animal tendon-to-tendon repair model, use of THC or CBD did not result in decreased biomechanical characteristics, and there was a trend toward improved ultimate strength and stiffness as compared to control. Further evaluation with larger numbers of animals, and evaluating the potential synergistic effects of THC and CBD administered together are warranted. [Figure: see text]

Repair of Chronic Achilles Ruptures Has a High Incidence of Venous Thromboembolism

2016 ◽  
Vol 10 (5) ◽  
pp. 415-420 ◽  
Author(s):  
Mark J. Bullock ◽  
William T. DeCarbo ◽  
Mark H. Hofbauer ◽  
Joshua D. Thun
Keyword(s):  
Venous Thromboembolism ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Achilles Tendon Repair ◽  
Elective Repair ◽  
High Incidence ◽  
Tendon Ruptures

Background. Despite the low incidence of deep vein thrombosis (DVT) in foot and ankle surgery, some authors report a high incidence of symptomatic DVT following Achilles tendon rupture. The purpose of this study was to identify DVT risk factors inherent to Achilles tendon repair to determine which patients may benefit from prophylaxis. Methods. One hundred and thirteen patient charts were reviewed following elective and nonelective Achilles tendon repair. For elective repair of insertional or noninsertional Achilles tendinopathy, parameters examined included lateral versus prone positioning and the presence versus absence of a flexor hallucis longus transfer. For nonelective repair, acute Achilles tendon ruptures were compared to chronic Achilles tendon ruptures. Results. Of 113 Achilles tendon repairs, 3 venous thromboembolism (VTE) events (2.65%) occurred including 2 pulmonary emboli (1.77%). Seventeen of these repairs were chronic Achilles tendon ruptures, and all 3 VTE events (17.6%) occurred within this subgroup. Elevated body mass index was associated with VTE in patients with chronic Achilles ruptures although this did not reach significance ( P = .064). No VTE events were reported after repair of 28 acute tendon ruptures or after 68 elective repairs of tendinopathy. Two patients with misdiagnosed partial Achilles tendon tears were excluded because they experienced a VTE event 3 weeks and 5 weeks after injury, prior to surgery. Conclusion. In our retrospective review, chronic Achilles ruptures had a statistically significant higher incidence of VTE compared with acute Achilles ruptures ( P = .048) or elective repair ( P = .0069). Pharmaceutical anticoagulation may be considered for repair of chronic ruptures. Repair of acute ruptures and elective repair may not warrant routine prophylaxis due to a lower incidence of VTE. Levels of Evidence: Prognostic, Level III: Case Control Study

Fluoroquinolone Therapy and Achilles Tendon Rupture

2003 ◽  
Vol 93 (4) ◽  
pp. 333-335 ◽  
Author(s):  
Diane Vanek ◽  
Amol Saxena ◽  
John M. Boggs
Keyword(s):  
Achilles Tendon ◽  
Bacterial Infections ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Achilles Tendinopathy ◽  
The Relationship

Fluoroquinolones have been associated with tendinopathies. The authors present three cases of Achilles tendinopathy in which the patients’ symptoms were preceded by treatment for unrelated bacterial infections with ciprofloxacin. Although the exact mechanism of the relationship is not understood, those who engage in sports or exercise should be advised of the risk of quinolone-induced tendinopathy. (J Am Podiatr Med Assoc 93(4): 333-335, 2003)

scholarly journals Shear wave and strain sonoelastography for the evaluation of the Achilles tendon during isometric contractions

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Alessandro Schneebeli ◽  
Ilaria Fiorina ◽  
Chandra Bortolotto ◽  
Marco Barbero ◽  
Deborah Falla ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Reference Material ◽  
Achilles Tendon ◽  
Shear Wave ◽  
Shear Wave Elastography ◽  
Strain Ratio ◽  
Achilles Tendinopathy ◽  
Isometric Contractions ◽  
Tendon Stiffness ◽  
Healthy Participants

Abstract Objectives Changes in mechanical loading as well as pathology can modify the Achilles tendon mechanical properties and therefore detection of these changes is relevant for the diagnosis and management of Achilles tendinopathy. The aim of this study was to evaluate strain and shear wave sonoelastography for their ability to detect changes in the Achilles tendon mechanical properties during a series of isometric contractions. Methods Longitudinal sonoelastography images of the Achilles tendon were acquired from 20 healthy participants using four different ultrasound devices; two implementing strain sonoelastography technology (SE1, SE2) and two, shear wave elastography technology (SWE1, SWE2). Results SE1 measured a decreasing strain ratio (tendon become harder) during the different contraction levels from 1.51 (0.92) to 0.33 (0.16) whereas SE2 mesaured a decreasing strain ratio from 1.08 (0.76) to 0.50 (0.32). SWE1 measured decreasing tendon stiffness during contractions of increasing intensity from 33.40 (19.61) to 16.19 (2.68) whereas SWE2 revealed increasing tendon stiffness between the first two contraction levels from 428.65 (131.5) kPa to 487.9 (121.5) kPa followed by decreasing stiffness for the higher contraction levels from 459.35 (113.48) kPa to 293.5 (91.18) kPa. Conclusions Strain elastography used with a reference material was able to detect elasticity changes between the different contraction levels whereas shear wave elastography was less able to detect changes in Achilles tendon stiffness when under load. Inconsistent results between the two technologies should be further investigated.

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