Patellar Tendon Structural Adaptations Occur during Pre-Season and First Competitive Cycle in Male Professional Handball Players

Background: While there is evidence that tendon adapts to training load, structural alterations in the patellar tendon in response to training loads are still unclear. The aim of this study is to identify changes in patellar tendon structure throughout pre-season and after finalizing the first competitive cycle. Methods: Nineteen professional handball players participated in the aforesaid cross-sectional study, in which patellar tendon scan and counter movement jump (CMJ) performance were conducted. Measurements were taken on the first and last day of pre-season training, and at the end of the first competitive cycle. Results: The results revealed that variation on the tendon structure occurred, mainly at the end of pre-season training; for injured tendons this occurred at the proximal (Right p = 0.02), distal (Right p = 0.01), and (Left p = 0.02) tendon, while changes in healthy tendons occurred at the mid (Left p = 0.01) and distal tendon (Right p = 0.01). At the end of the first competitive cycle, changes were observed in the distal injured tendon (p = 0.02). Conclusion: Patellar tendon shows greater structural change after completing pre-season training than at the end of the first competitive cycle, from which it may be inferred that gradual loading during pre-season training allows the tendon to adapt and potentially decrease the onset of patellar tendinopathy.

CLINICAL RESULT OF PATIENTS WITH DISTAL BICEPS TENDON RUPTURE WITH ENDOBUTTON

ABSTRACT Objective: To evaluate the results obtained in the repair of distal biceps injury using the single-incision approach with endobutton use; complications; and ability to return to sport. Methods: 14 athletes with rupture of the distal tendon of the biceps brachii submitted to surgical repair using a single route with endobutton were evaluated. The parameters analyzed were: Mayo Elbow Performance Score (MEPS), flexion-extension range of motion and pronation-supination, and the ability to return to sports practice. Results: Most injuries were related to weightlifting (57.1%), vaquejada (35.7%) and judo (7.2%). All operated patients returned to sports activities, maintaining the elbow range of motion. Two cases faced complications due to neuropraxia (one case affecting the posterior interosseous nerve and the other the radial sensitive nerve). However, there was spontaneous resolution in 10 weeks of follow-up. One case - due to the late presentation and presence of fibrotic adhesions - evolved with a deficit of the lateral cutaneous nerve of the forearm and later with osteolysis and heterotopic ossification. Conclusion: Repair of the distal tendon of the biceps by the one-way technique is a safe method, with a low complication rate and a short rehabilitation period. Level of Evidence III, Retrospective comparative study.

Association of the British Athletic Muscle Injury Classification and anatomic location with return to full training and reinjury following hamstring injury in elite football

BackgroundThe relationship between hamstring muscle injuries (HMIs) that involve the intramuscular tendon and prolonged recovery time and increased reinjury rate remains unclear in elite footballers.ObjectiveTo determine the association of time to return to full training (TRFT) and reinjury of HMIs using the British Athletic Muscle Injury Classification (BAMIC) and specific anatomical injury location in elite-level football players.MethodsThe electronic medical records of all players at an English Premier League club were reviewed over eight consecutive seasons. All players who sustained an acute HMI were included. Two experienced musculoskeletal radiologists independently graded each muscle using the BAMIC, categorised each injury location area (proximal vs middle vs distal third and proximal vs distal tendon) and reported second muscle involvement. TRFT and reinjury were recorded.ResultsOut of 61 HMIs, the intramuscular tendon (BAMIC ‘c’) was involved in 13 (21.3%). HMI involving the intramuscular tendon (‘c’) had a mean rank TRFT of 36 days compared with 24 days without involvement (p=0.013). There were 10 (16.4%) reinjuries with a significant difference of 38.5% reinjury rate in the group with intramuscular tendon injury (‘c’) and 12.5% in the group without (p=0.031). TRFT and reinjury involving a second muscle was statistically significantly higher than without. Most of the HMIs to the biceps femoris with reinjury (5 out of 9) were in the distal third section related to the distal tendon site involving both the long and short head.ConclusionTRFT in HMI involving the intramuscular tendon (‘c’) of the Biceps femoris is significantly longer with significantly higher reinjury rate compared with injuries without, in elite football players. The finding that most reinjures of the biceps femoris occurring in the distal third muscle at the distal tendon site, involving both the long and short head, merits further investigation.

Gaining Insight into the Deformation of Achilles Tendon Entheses in Mice

Understanding the biomechanics of tendon entheses is fundamental for surgical repair and tissue engineering, but also relevant in biomimetics and palaeontology. 3D imaging is becoming increasingly important in the examination of soft tissue deformation. But entheses are particularly difficult objects for micro-computed tomography because they exhibit extreme differences in X-ray attenuation. In this article, the ex vivo examination of Achilles tendon entheses from mice using a combination of tensile tests and synchrotron radiation-based micro-computed tomography is reported. Two groups of specimens with different water content are compared with regard to strains and volume changes in the more proximal free tendon and the distal tendon that wraps around the Tuber calcanei. Tomograms of relaxed and deformed entheses are recorded with propagation-based phase contrast. The tissue structure is rendered in sufficient detail to enable manual tracking of patterns along the tendon, as well as 3D optical flow analysis in a suitable pair of tomograms. High water content is found to increase strain and to change the strain distribution among proximal and distal tendon. In both groups, the volume changes are higher in the distal than in the proximal tendon. These results support the existence of a compliant zone near the insertion. They also show that the humidity of the specimen environment has to be controlled. Necessary steps to extend the automatic tracking of tissue displacements to all force steps are discussed.

EFFICIENCY OF SURGICAL TREATMENT OF DISTAL BICEPS TENDON RUPTURE USING A MINIMALLY INVASIVE APPROACH

Treatment of the distal tendon rupture of the biceps brachii is an evolving topic in modern traumatology and orthopedics. The lack of a unified approach towards this rupture treatment and the growing treatment result requirements dictate the need to develop new surgical methods that allow the complete restoration of the limb's function and decrease the duration and cost of the treatment and the subsequent rehabilitation. The aim of this study is to develop a minimally invasive method for the treatment of distal tendon rupture of the biceps and evaluate its effectiveness in a comparative manner. Following the modern principles of surgery and guided by the analysis of individual elements in the existing techniques for the reinsertion of the distal biceps tendon, a conceptual solution for its treatment was formulated, and a new, patented and minimally invasive surgical technique using specialized tools was developed and introduced into clinical practice. The effectiveness analysis of the newly developed surgical technique was carried out in 2 groups that are comparable in terms of the main preoperative indications; 47 patients were operated on using the new technique, and 56 using already established techniques. Statistically significant results were obtained in the following parameters: duration of operation, size of the incision, duration of hospital stay, time before treatment, duration of plaster cast application and time needed for beginning of rehabilitation. In addition, the application of the newly developed technique reduces the cost of treatment by 2583.4 Belarusian Rubles for one patient.

REINSERTION OF THE DISTAL TENDON OF A BICEPS USING ENDOBUTTON FROM A SINGLE INCISION TECHNIQUE

Summary. Surgical treatment of biceps distal tendon ruptures shows better functional results, compared to a conservative treatment. Recently, the one-incision surgical technique is becoming more and more popular. Task of the study: representation of a technique to recover a distal biceps tendon with a single incision and fixation with an Endobutton. Materials and methods: the single-incision technique for a distal biceps tendon recovery comprises of several steps: an incision place and layer-wise access, preparation of the distal biceps tendon, preparation of the radial tuberosity, fixation of the tendon. Results. The knowledge of anatomy and the correct sequence of steps in the single-incision technique with the fixation of a tendon with Endobutton (by ChM) makes the recovery of distal biceps tendon efficient, reliable, and, what is more important, safe.