Leukocyte-Poor Platelet-Rich Plasma as a Treatment for Patellar Tendinopathy A Multicenter, Randomized Controlled Trial.

PURPOSE: The purpose of this study was to compare regimens of eccentric exercise and dry-needling, with and without an ultrasound-guided leukocyte-poor platelet-rich plasma (LP-PRP) injection, in patients with patellar tendinopathy. METHODS: Patients with symptomatic patellar tendinopathy based on physical examination and magnetic resonance imaging and who had failed at least 6 weeks of nonoperative treatment were enrolled and randomized at two centers to receive ultrasound-guided dry-needling (DN) alone or in addition to an injection of LP-PRP coupled with standardized eccentric strengthening exercises. Participants completed patient-reported outcome surveys at baseline and at 3, 6, 9, 12, and 26 weeks post-treatment. The primary outcome measure was the Victorian Institute of Sports Assessment (VISA) score for patellar tendinopathy (VISA-P) at 12 weeks, and secondary measures included the visual analog scale (VAS) for pain, Tegner activity scale, Lysholm knee scale (Lysholm), and Veterans Rand 12-Item Health Survey (VR12) questionnaire at 12 and 26 weeks. RESULTS: Thirty-one subjects were enrolled in the study (15 DN, 16 LP-PRP). Twenty-three patients were available for follow-up at all time points. There were no statistically significant differences between the two groups at baseline. At 12 weeks post-treatment, both the LP-PRP and DN groups demonstrated statistically significant (p < 0.05) improvements from baseline with respect to Lysholm score (34.5 ± 15.1 and 31.7 ± 18.4), VAS pain scale (-1.58 ± 2.1 and -2.8 ± 1.9, respectively), and VISA score (19.2 ± 15.9 and 28.4 ± 19.4, respectively). At 26 weeks post-treatment both groups demonstrated statistically significant (p < 0.05) improvements in Lysholm score (23.6 ± 23.1 and 24.5 ± 17.3, respectively) and VAS pain score (-1.67 ± 2.3 and -2.18 ± 2.9, respectively). The LP-PRP group failed to show significance for VISA-P score from 0 to 26 weeks, though the DN group did (22.0 ± 14.6). There were no statistically significant differences between the two groups in mean VISA, VAS, Lysholm, or the Short Form Health Survey (SF-12) scores at either the 12 week or 26-week follow-up time points. CONCLUSION: The results of the current study demonstrate that both DN and DN plus LP-PRP are effective treatment options in the management of symptomatic patellar tendinopathy, however, LP-PRP did not add any additional improvement over DN alone.

Anatomical medial patellofemoral ligament reconstruction improves sport participation and activity levels in adolescents with recurrent patellar dislocation.

OBJECTIVES: This study aims to evaluate the clinical outcomes of an anatomical medial patellofemoral ligament (MPFL) reconstruction and the effects of concomitant patellofemoral joint injuries and radiological findings on outcomes in adolescents with recurrent patellar dislocation (RPD). PATIENTS AND METHODS: Between January 2011 and January 2020, a total of 34 patients (19 males, 15 females; median age: 15.6 years; range, 13 to 17 years) with RPD who underwent anatomic MPFL reconstruction were retrospectively analyzed. Lateral release was performed as indicated. Clinical outcomes were evaluated preoperatively and at the final follow-up using the Visual Analog Scale (VAS), Lysholm, Kujala, and Tegner activity rating scales. Magnetic resonance imaging was performed to detect concomitant injuries such as bone, cartilage, and soft tissue injuries. RESULTS: The mean follow-up was 5±2 years. All postoperative knee functions and activity levels were statistically significantly improved without re-dislocation (p<0.001). There was no statistically significant relationship between the presence and location of cartilage lesions and clinical outcomes (p>0.05). Patients with cartilage lesions had a significantly higher CatonDeschamps index and a higher incidence of bone edema in both the patella and femur than patients without. CONCLUSION: Anatomic MPFL reconstruction with meticulous physical therapy has successful clinical outcomes, prevents re-dislocation, and increases participation in sports and activity levels in adolescent patients with RPD. Although cartilage injuries are common after RPD, it has no adverse effect on clinical outcomes in the mid-term.

Location of Measurement Matters: Unveiling Regional Dynamics and Sex Differences in Patellar Tendon Strain In Vivo.

Patellar tendinopathy is more prevalent in males versus female athletes and commonly presents in the medial region of the tendon. Separate measures of patellar tendon strain in the medial, central, and lateral regions of the tendon, however, have not been quantified. The purpose was to investigate the differences in tendon strain between the medial, lateral, and central regions of the patellar tendon in healthy men and women. Strain in the medial and lateral regions of the patellar tendon in healthy participants (10 males, 10 females) was evaluated using ultrasound during isometric quadriceps contractions at 20%, 40%, 60%, 80%, and 100% of maximum voluntary contraction (MVIC) in 60° and 90° of knee flexion. Central strain was also measured at 60% MVIC in 90° of knee flexion. Mixed models were used to determine strain between tendon regions and sex at 60% MVIC in 90° of knee flexion. Sequential modeling was used to fit region, sex, %MVIC, and angle to predict strain. The central region had less strain compared with both medial and lateral regions. The lateral region had higher strain compared with the medial region regardless of sex. Females had higher strain compared with males, regardless of region. Knee position did not influence tendon strain. Patellar tendon strain differs by region and sex. The varying prevalence between sex and in location of patellar tendinopathy may in part be explained by the unbalanced strains. Differential assessment of regional patellar tendon strain may be of importance for understanding injury risk and recovery with exercise.

Muscle and tendon morphology of a world strongman and deadlift champion.

This study compared the muscle and tendon morphology of an extraordinarily strong individual, a World's Strongest Man and deadlift champion (WSM), with that of various other athletic, trained, and untrained populations. The WSM completed the following: 1) 3.0-T MRI scans, to determine the volume of 22 individual lower limb muscles, 5 functional muscle groups, patellar tendon (PT) cross-sectional area (CSA), and PT moment arm; and 2) countermovement jumps (CMJ) and isometric midthigh pull (IMTP) contractions. The WSM was compared with previously assessed groups from our laboratory (muscle and tendon) and the wider research literature (CMJ and IMTP). The WSM's CMJ peak power (9,866 W) and gross (9,171 N) and net (7,480 N) IMTP peak forces were higher than any previously published values. The WSM's overall measured leg muscle volume was approximately twice that of untrained controls (+96%) but with pronounced anatomical variability in the extent of muscular development. The plantar flexor group (+120%) and the guy rope muscles (sartorius, gracilis, and semitendinosus: +140% to +202%), which stabilize the pelvis and femur, demonstrated the largest differences relative to that of untrained controls. The WSM's pronounced quadriceps size (greater than or equal to twofold vs. untrained) was accompanied by modest PT moment arm differences and, notably, was not matched by an equivalent difference in PT CSA (+30%). These results provide novel insight into the musculotendinous characteristics of an extraordinarily strong individual, which may be toward the upper limit of human variation, such that the WSM's very pronounced lower limb muscularity also exhibited distinct anatomical variability and with muscle size largely uncoupled from tendon size.NEW & NOTEWORTHY Lower-body muscle size of an extraordinarily strong individual, a World's Strongest Man and deadlift champion (WSM), was approximately twice that of controls but was underpinned by pronounced anatomical variability in the extent of muscular development (+23-202%): the plantar flexor group and guy rope muscles demonstrating the largest differences. The WSM's quadriceps size (more than or equal to twice that of controls) contrasted with modest differences in patella tendon moment arm (+18%) and was uncoupled from patellar tendon size (+30%).

Comparison of a handheld ultrasound device with cart-based ultrasound for the assessment of gout lesions in people with established gout.

OBJECTIVES: Use of handheld portable ultrasound is increasing and would improve access for people with rheumatic disease when conventional, cart-based ultrasound is unavailable. This study compared handheld and cart-based ultrasound for the assessment of gout lesions in people with gout. METHODS: The lower limbs of 21 participants with gout were independently scanned at six sites (1st and 2nd metatarsophalangeal joints, knee, patellar ligament, Achilles tendon, and peroneal tendons) using cart-based (LOGIQ P9) and handheld (Vscan Air™) ultrasound by two rheumatologists. One rheumatologist was randomized to scan the right or left leg first with the cart-based or handheld ultrasound. The other rheumatologist scanned the legs in the opposite order with the imaging devices reversed. Images were saved and blinded images scored for double contour, tophus, erosion and aggregates using OMERACT definitions by two rheumatologists experienced in gout ultrasound. RESULTS: On handheld ultrasound, 90% of participants had at least one site with double contour, tophus and erosions, and 100% had at least one site with aggregates. There were similar findings using cart-based ultrasound. However, site-level inter-device analysis showed only fair-good agreement: kappa (percentage agreement) for double contour 0.22 (67%), tophus 0.46 (77%), erosion 0.63 (83%) and aggregates 0.37 (75%). There were more aggregates detected by cart-based ultrasound in joints and more tophi detected by handheld ultrasound in ligaments and tendons. CONCLUSIONS: Handheld ultrasound can detect gout lesions in people with established gout. However, concordance between cart-based and handheld ultrasound in detection of some gout lesions is low, particularly double contour and aggregates.

Arthroscopic medial patellofemoral ligament reconstruction with polyethylene suture combined with medial retinaculum plication for the treatment of acute patellar dislocation in young and middle-aged patients with a follow-up of at least 2 years.

PURPOSE: The purpose of this study was to propose a surgical technique for arthroscopic medial patellofemoral ligament (MPFL) reconstruction with polyethylene suture combined with medial retinaculum plication and to evaluate the efficacy of this surgical technique in the treatment of acute patellar dislocation. METHODS: Clinical data of patients with acute patellar dislocations treated with arthroscopic MPFL reconstruction with polyethylene tape (FiberTape) combined with medial support band compression were analyzed retrospectively from January 2018 to January 2021. The mean age of the patients was 25.15 ± 4.66 years; the mean follow-up time was 27.5 (24-36) months. Clinical evaluation consisted of apprehension test results, patellar extrapolation test results, Lysholm score, Kujala score, and IKDC score, the Patellar lateral shift distance and patellar tilt angle (PTA) measured by CT scan. RESULTS: All patients had no recurrent patellar dislocation or subluxation after surgery, and the apprehension test was negative. In all patients, the Kujala score (36.0 ± 9.9 vs. 98.2 ± 3.1), the IKDC score (48.6 ± 7.0 vs. 90.6 ± 4.4) and the Lysholm score (32.8 ± 10.4 vs. 96.7 ± 3.1) had improved at the 24-month follow up (P < 0.05). In addition, PTA was significantly lower at the 12-month follow-up and 24-giving-month follow-up compared to the preoperative period (P < 0.05, Table 2). The patellar lateral shift distance decreased from 14.94 ± 6.11 mm preoperatively to 3.00 ± 1.40 mm (12-month follow up) and 3.26 ± 1.37 mm (24-month follow up), respectively. CONCLUSION: Arthroscopic MPFL reconstruction with polyethylene suture combined with medial retinaculum plication is a safe and reliable surgical technique for the treatment of acute patellar dislocation in young and middle-aged patients. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Discipline-specific Torque-Velocity Profiles and Musculotendinous Morphology in Athletes.

OBJECTIVES: The aim of this study was to compare torque-velocity profiles, muscle architecture, tendon dimensions, and bilateral-symmetry between competitive cyclists (CY), competitive runners (RN), ice-hockey players (IH), basketball players (BP), and physically-active individuals (CN) (n=10 for each group). METHODS: Vastus lateralis (VL) muscle and patellar tendon (PT) structures were determined with B-mode ultrasonography, and maximal knee extensor isokinetic torque was assessed at three different velocities. RESULTS: Optimal torque and velocity were lower in runners than CY, BP and IH (p<0.05). Maximal power was similar between the athlete groups but greater than CN (p<0.05). Furthermore, RN and BP reached their peak-torque at longer muscle lengths compared to IH and CY (p<0.05). RN had the lowest VL muscle thickness and the greatest fascicle length, while CY had the greatest pennation angle (p<0.05). CY had the greatest PT thickness, particularly at the proximal and medial sites, while BP at the distal point (p<0.05), with similar trends observed for PT cross-sectional-area. CONCLUSIONS: Our findings show that even if power generating capacity is similar between athletic disciplines, there are discipline-specific muscle adaptations, where particularly runners appear to have muscles adapted for speed rather than torque development, while in cyclists, velocity is sacrificed for torque development.

Tibial Tubercle Osteotomy With and Without Medial Patellofemoral Ligament Reconstruction in Adolescent Patients Leads to Decrease in Patellar Height and Patella Tendon Length.

OBJECTIVE: Patellar height changes after tibial tubercle osteotomy (TTO) have not yet been described. We aimed to evaluate whether TTO ± medial patellofemoral ligament reconstruction (MPFL-R) influences patellar height and tendon length, hypothesizing that TTO would decrease patellar height and tendon length. METHODS: A retrospective review was performed of skeletally mature adolescents (<18 y) receiving primary anteromedialization or medialization TTO ± MPFL-R. Patients with at least 6 months of radiographic follow-up were included in the study. Pre and postoperative patellar heights were assessed on lateral, weight-bearing, and flexion (30 to 70 degrees) radiographs using the Blackburne-Peel Index (BPI), Caton-Deschamps Index (CDI), and Insall-Salvati Ratio (ISR). Subgroup analyses were performed to compare patellar height changes in patients with preoperative patella alta, norma, and baja, as well as between patients undergoing medialization and anteromedialization TTO. Data were analyzed for normality using a Shapiro-Wilk test, and paired-sample t tests were performed. RESULTS: Forty-nine knees were included (mean age: 15 y; range: 12 to 17). A significant decrease in mean patellar height after TTO ± MPFL-R was observed across all measures: BPI (0.12, P = 0.000783), CDI (0.08, P = 0.01062), and ISR (0.15, P = 0.00000075). Patellar tendon length decreased by 2.26 mm ( P = 0.001272). Subgroup analyses demonstrated a decrease in mean patellar height across all 3 measurements ( P < 0.001; BPI, CDI, and ISR) for patients with preoperative patella alta but not patella norma or baja. Additional subgroup analysis showed a patellar height decrease using BPI (0.15, P = 0.004583) and ISR (0.14, P = 0.0002806) for patients receiving medialization TTO but not anteromedialization. The anteromedialization cohort did not demonstrate patellar height change using BPI and CDI; ISR demonstrated a decrease (0.10, P = 0.00917). CONCLUSIONS: Mean patellar height and tendon length decreases after TTO ± MPFL-R in skeletally mature, adolescent patients. Subgroup analyses suggest these changes occur in patients with preoperative patella alta and/or patients who undergo medialization TTO. These data suggest that some distalization in patellar positioning may be achieved without formal distalization osteotomy.

Unveiling Metabolic Similarities of Entheses in Patients with Psoriasis and Psoriatic Arthritis Using Noninvasive In Vivo Molecular Imaging: Results From a Cross-sectional Exploratory Study.

OBJECTIVE: We assessed and compared molecular tissue changes at the entheses in patients with psoriasis (PsO) and psoriatic arthritis (PsA) and in healthy controls (HCs) in vivo using multispectral optoacoustic tomography (MSOT) and described their relationship with clinical and ultrasound findings of enthesitis. METHODS: A cross-sectional study (MSOT and Arthrosonography in PsA) in biologic disease-modifying antirheumatic drug-naïve patients with PsA and PsO and HCs was performed. Participants underwent clinical, ultrasonographic, and MSOT examination of six entheses (lateral humeral epicondyle, distal patellar tendon attachment, and Achilles tendon attachment). MSOT-measured hemoglobin (Hb), oxygen saturation (SO2), collagen, and lipid levels were quantified, and mean differences between groups were calculated using linear mixed effects models. MSOT-measured analytes were compared between entheses with and without clinical and ultrasound anomalies. RESULTS: Ninety participants were included (30 PsO, 30 PsA, and 30 HCs), 540 entheses were clinically assessed, and 540 ultrasound and 830 MSOT scans were obtained. Patients with PsA and PsO showed increased oxygenated Hb (PsA: P = 0.003; PsO: P = 0.054) and SO2 (PsA: P < 0.001; PsO: P = 0.001) levels and decreased collagen signals (PsA: P < 0.001; PsO: P < 0.001) compared with HCs, with more pronounced changes in PsA. Significantly lower collagen levels (P = 0.01) and increased lipids (P = 0.03) were recorded in tender entheses compared with nontender ones. Erosions and enthesophytes on ultrasound were associated with significant differences in SO2 (P = 0.014) and lipid signals (P = 0.020), respectively. CONCLUSION: Patients with PsA and PsO exhibit an analogous metabolic pattern at the entheses that is exacerbated in the presence of inflammation. These findings support the notion of a psoriatic disease spectrum characterized by common immunometabolic tissue changes.

Reconstruction of medial meniscus posterior portion deficiency in pigs with an autologous patellar tendon graft: an experimental study.

OBJECTIVE: This study was performed to investigate the effectiveness of two surgical procedures, autologous patellar tendon graft reconstruction and trans-tibial plateau pull-out repair, using a pig model. The primary focus was to assess the repair capability of medial meniscus posterior portion (MMPP) deficiency, the overall structural integrity of the meniscus, and protection of the femoral and tibial cartilage between the two surgical groups. The overall aim was to provide experimental guidelines for clinical research using these findings. METHODS: Twelve pigs were selected to establish a model of injury to the MMPP 10 mm from the insertion point of the tibial plateau. They were randomly divided into three groups of four animals each: reconstruction (autologous tendon graft reconstruction of the MMPP), pull-out repair (suture repair of the MMPP via a trans-tibial plateau bone tunnel), and control (use of a normal medial meniscus as the negative control). The animals were euthanized 12 weeks postoperatively for evaluation of the meniscus, assessment of tendon bone healing, and gross observation of knee joint cartilage. The tibial and femoral cartilage injuries were evaluated using the International Society for Cartilage Repair (ICRS) grade and Mankin score. Histological and immunohistochemical staining was conducted on the meniscus-tendon junction area, primary meniscus, and tendons. The Ishida score was used to evaluate the regenerated meniscus in the reconstruction group. Magnetic resonance imaging (MRI) was used to evaluate meniscal healing. RESULTS: All 12 pigs recovered well after surgery; all incisions healed without infection, and no obvious complications occurred. Gross observation revealed superior results in the reconstruction and pull-out repair groups compared with the control group. In the tibial cartilage, the reconstruction group had ICRS grade I injury whereas the pull-out repair and control groups had ICRS grade II and III injury, respectively. The Mankin score was significantly different between the reconstruction and control groups; histological staining showed that the structure of the regenerated meniscus in the reconstruction group was similar to that of the original meniscus. Immunohistochemical staining showed that the degree of type I and II collagen staining was similar between the regenerated meniscus and the original meniscus in the reconstruction group. The Ishida score was not significantly different between the regenerated meniscus and the normal primary meniscus in the reconstruction group. MRI showed that the MMPP in the reconstruction and pull-out repair groups had fully healed, whereas that in the control group had not healed. CONCLUSION: Autologous patellar tendon graft reconstruction of the MMPP can generate a fibrocartilage-like regenerative meniscus. Both reconstruction and pull-out repair can preserve the structural integrity of the meniscus, promote healing of the MMPP, delay meniscal degeneration, and protect the knee cartilage.

Acute Patellar Tendon Ruptures: An Update on Management.

Patellar tendon ruptures can be debilitating injuries. When incomplete, partial tears can be managed nonsurgically with immobilization and progressive rehabilitation. Although complete ruptures remain a relatively uncommon injury, they portend a high level of morbidity. Ruptures typically result from an acute mechanical overload to the extensor mechanism, such as with forced quadriceps contraction and knee flexion. However, chronically degenerated tendons are also predisposed to failure from low-energy injuries. Diagnosis can often be made clinically with recognition of a palpable defect to the tendon, localized patellar tendon tenderness, and inability to actively extend the knee. Diagnosis and surgical planning can be established with radiograph, ultrasonography, or magnetic resonance imaging. Surgical repair is the mainstay of treatment, and there have been many recent advances in repair technique, optimal reconstruction strategies, and supplemental fixation. Time to surgery for complete tears remains the most important prognosticator for success. Direct primary repair can be completed with transosseous tunnels, suture anchor repair, or end-to-end repair. Tendon reconstruction can be achieved with or without mechanical or biologic augments. Rehabilitation programs vary in specifics, but return to sport can be expected by 6 months postoperatively.

Structure and function of Achilles and patellar tendons following moderate slow resistance training in young and old men.

The aim of this study was to investigate the effect of aging and resistance training with a moderate load on the size and mechanical properties of the patellar (PT) and Achilles tendon (AT) and their associated aponeuroses; medial gastrocnemius (MG) and vastus lateralis (VL). Young (Y55; 24.8 ± 3.8 yrs, n = 11) and old men (O55; 70.0 ± 4.6 yrs, n = 13) were assigned to undergo a training program (12 weeks; 3 times/week) of moderate slow resistance training [55% of one repetition maximum (RM)] of the triceps surae and quadriceps muscles. Tendon dimensions were assessed using 1.5 T magnetic resonance imaging before and after 12 weeks. AT and PT cross sectional area (CSA) were determined every 10% of tendon length. Mechanical properties of the free AT, MG aponeurosis, PT, and VL aponeurosis were assessed using ultrasonography (deformation) and tendon force measurements. CSA of the AT but not PT was greater in O55 compared with Y55. At baseline, mechanical properties were generally lower in O55 than Y55 for AT, MG aponeurosis and VL aponeurosis (Young's modulus) but not for PT. CSA of the AT and PT increased equally in both groups following training. Further, for a given force, stiffness and Young's modulus also increased equally for VL aponeurosis and AT, for boths groups. The present study highlights that except for the PT, older men have lower tendon (AT, MG aponeurosis, and VL aponeurosis) mechanical properties than young men and 12-weeks of moderate slow resistance training appears sufficient to improve tendon size and mechanical adaptations in both young and older men. New and Noteworthy: These novel findings suggest that short-term moderate slow resistance training induces equal improvements in tendon size and mechanics regardless of age.

Medial patellar ligament reconstruction in combination with derotational distal femoral osteotomy for treating recurrent patellar dislocation in the presence of increased femoral anteversion: a systematic review.

BACKGROUND: Medial patellar ligament reconstruction (MPFL-R) in combination with derotational distal femoral osteotomy (DDFO) for treating recurrent patellar dislocation (RPD) in the presence of increased femoral anteversion is one of the most commonly used surgical techniques in the current clinical practice. However, there are limited studies on the clinical outcomes of MPFL-R in combination with DDFO to treat RPD in the presence of increased femoral anteversion. PURPOSE: To study the role of MPFL-R in combination with DDFO in the treatment of RPD in the presence of increased femoral anteversion. METHODS: A systematic review was performed according to the PRISMA guidelines by searching the Medline, Embase, Web of Science, and Cochrane Library databases through June 1, 2023. Studies of patients who received MPFL-R in combination with DDFO after presenting with RPD and increased femoral anteversion were included. Methodological quality was assessed using the MINORS (Methodological Index for Nonrandomized Studies) score. Each study's basic characteristics, including characteristic information, radiological parameters, surgical techniques, patient-reported outcomes, and complications, were recorded and analyzed. RESULTS: A total of 6 studies with 231 patients (236 knees) were included. Sample sizes ranged from 12 to 162 patients, and the majority of the patients were female (range, 67-100%). The mean age and follow-up ranges were 18 to 24 years and 16 to 49 months, respectively. The mean femoral anteversion decreased significantly from 34° preoperatively to 12° postoperatively. In studies reporting preoperative and postoperative outcomes, significant improvements were found in the Lysholm score, Kujala score, International Knee Documentation Committee score, and visual analog scale for pain. Postoperative complications were reported in all studies, with an overall reported complication rate of 4.7%, but no redislocations occurred during the follow-up period. CONCLUSION: For RPD with increased femoral anteversion, MPFL-R in combination with DDFO leads to a good clinical outcome and a low redislocation rate. However, there was no consensus among researchers on the indications for MPFL-R combined with DDFO in the treatment of RPD.

Determination of differences in ultrasound parameters for patellar tendons in males with unilateral patellar tendinopathy-An ancillary analysis of data from two randomized controlled trials.

PURPOSE: To investigate power Doppler (PD) activity and tendon structure (between the injured and contralateral limb) in patients with unilateral patellar tendinopathy (PT) using ultrasonography (US). Secondly, the aim was to determine the intra-rater reliability of the PD activity and tendon structure. METHODS: This study analyzed US baseline data from 57 male participants with symptomatic unilateral PT who had been enrolled in one of two randomized clinical trials. Data were analyzed to examine if systematic differences existed between injured and contralateral limbs using Fiji ImageJ. RESULTS: The PD activity of the symptomatic tendon was larger 25.6 (Q1 = 14.9; Q3 = 41.6) mm2 than the asymptomatic 0 (Q1 = 0.0; Q3 = 0.0) mm2 (p < 0.001). There was a significantly greater tendon thickness at the proximal (2.5 mm 95% CI [2.0; 3.0]), mid (0.8 mm 95% CI [0.5; 1.1]), and distal (0.2 mm 95% CI [0.1; 0.4]) part of the tendon for the symptomatic compared to the asymptomatic tendon. Intra-rater reliability for PD activity and tendon structure ranged from moderate-to-excellent (0.74; 0.99). CONCLUSION: These results provide mean estimates for tendon thickness of symptomatic and asymptomatic tendons, that can be used for clinicians to reliably estimate pathological tendon thickness.

Patellar tendon biomechanical and morphologic properties and their relationship to serum clinical variables in persons with prediabetes and type 2 diabetes.

Tendon biomechanical properties and fibril organization are altered in patients with diabetes compared to healthy individuals, yet few biomarkers have been associated with in vivo tendon properties. We investigated the relationships between in vivo imaging-based tendon properties, serum variables, and patient characteristics across healthy controls (n = 14, age: 45 ± 5 years, body mass index [BMI]: 24 ± 1, hemoglobin A1c [HbA1c]: 5.3 ± 0.1%), prediabetes (n = 14, age: 54 ± 5 years, BMI: 29 ± 2; HbA1c: 5.7 ± 0.1), and type 2 diabetes (n = 13, age: 55 ± 3 years, BMI: 33 ± 2, HbA1c: 6.7 ± 0.3). We used ultrasound speckle-tracking and measurements from magnetic resonance imaging (MRI) to estimate the patellar tendon in vivo tangent modulus. Analysis of plasma c-peptide, interleukin-1ß (IL-1ß), IL-6, IL-8, tumor necrosis factor-α (TNF-α), adiponectin, leptin, insulin-like growth factor 1 (IGF-1), and C-reactive protein (CRP) was completed. We built regression models incorporating statistically significant covariates and indicators for the clinically defined groups. We found that tendon cross-sectional area normalized to body weight (BWN CSA) and modulus were lower in patients with type 2 diabetes than in healthy controls (p < 0.05). Our regression analysis revealed that a model that included BMI, leptin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), age, and group explained ~70% of the variability in BWN CSA (R2 = 0.70, p < 0.001). For modulus, including the main effects LDL, groups, HbA1c, age, BMI, cholesterol, IGF-1, c-peptide, leptin, and IL-6, accounted for ~54% of the variability in modulus (R2 = 0.54, p < 0.05). While BWN CSA and modulus were lower in those with diabetes, group was a poor predicter of tendon properties when considering the selected covariates. These data highlight the multifactorial nature of tendon changes with diabetes and suggest that blood variables could be reliable predictors of tendon properties.

Comparison of In Vivo Stiffness of Tendons Commonly Used for Anterior Cruciate Ligament Reconstruction - A Shear Wave Elastography Study.

RATIONALE AND OBJECTIVES: There are currently no studies investigating the in vivo stiffness of the most commonly used autografts for anterior cruciate ligament reconstruction (ACLR) using Shear wave elastography (SWE). We hypothesize that there are differences regarding the elastic properties between the three tendons commonly used for ACLR and that they are influenced by patient-related factors. MATERIALS AND METHODS: 80 healthy subjects (25 females, 55 males, age: 25.33 ± 4.76 years, BMI: 23.76 ± 3.14 kg/m2, 40 semiprofessional athletes, athlete group [AG], age: 25.51 [19-29]; 40 healthy controls, control group [CG], age: 25.50 [20-29]) were recruited as participants. In addition to patient reported outcome scores, every participant underwent a standardized multimodal ultrasound protocol consisting of B-mode-ultrasound (B-US), Color Doppler-ultrasound (CD-US) and a SWE examination of the bilateral quadriceps tendon (QT), patellar tendon (PT) and semitendinosus tendon (ST). RESULTS: The highest shear wave velocity (SWV) were observed in ST (4.88 (4.35-5.52) m/s, ST vs QT, p = 0.005; ST vs PT, p < 0.001) followed by QT (4.61 (4.13-5.26) m/s, QT vs PT, p < 0.001) and PT (3.73 (3.30-4.68) m/s). Median QT, PT and ST stiffness was significantly higher in AG compared to CG. Male subjects tend to have stiffer QT and PT than female subjects. Positive correlation with SWV was obtained for age and activity level. CONCLUSION: There are significant differences regarding in vivo tendon stiffness between the most frequently used autograft tendon options for ACLR. The quantitative information obtained by SWE could be of particular interest for graft choice for ACLR.

Morphological characteristics of the patellar tendon in runners, cyclists, triathletes, and physically active individuals.

The objective of the study was to compare measurements of length, thickness, and cross-section area (CSA) of the patellar tendon (PT) among cyclists, runners, triathletes, and physically active individuals (control group). Forty healthy individuals (10 cyclists, 10 runners, 10 triathletes, and 10 physically active individuals) aged between 18 and 45 years (30.3 ± 8.6 years) participated in the study. PT was measured by a B-mode ultrasound system. To measure the length and thickness (in 5, 10, 15, and 20 mm of the PT length) the probe was positioned parallel to the tendon and to measure the CSA the probe was positioned perpendicularly in 25, 50, and 75% of the PT length. PT length data were analyzed using a one-way ANOVA to compare between groups and PT CSA and thickness were analyzed using a two-way ANOVA (group vs. position) to compare the variables among the groups with the post-hoc Tukey test. All statistical analyses were performed considering p < 0.05. We observed a significant difference, where cyclists had smaller PT thickness (regardless of the location measured) compared to the group of triathletes (p = 0.001) and the physically active group (p = 0.043). All other variables (length, thickness, and CSA) and interactions (local and position) were not significant. We concluded that regardless of the position where PT thickness is measured, cyclists have smaller PT thickness compared to triathletes and physically active individuals but similar when compared to runners. And no differences in the length and CSA of the PT between groups.

A Novel Tendon Injury Model, Induced by Collagenase Administration Combined with a Thermo-Responsive Hydrogel in Rats, Reproduces the Pathogenesis of Human Degenerative Tendinopathy.

Patellar tendinopathy is a common clinical problem, but its underlying pathophysiology remains poorly understood, primarily due to the absence of a representative experimental model. The most widely used method to generate such a model is collagenase injection, although this method possesses limitations. We developed an optimized rat model of patellar tendinopathy via the ultrasound-guided injection of collagenase mixed with a thermo-responsive Pluronic hydrogel into the patellar tendon of sixty male Wistar rats. All analyses were carried out at 3, 7, 14, 30, and 60 days post-injury. We confirmed that our rat model reproduced the pathophysiology observed in human patients through analyses of ultrasonography, histology, immunofluorescence, and biomechanical parameters. Tendons that were injured by the injection of the collagenase-Pluronic mixture exhibited a significant increase in the cross-sectional area (p < 0.01), a high degree of tissue disorganization and hypercellularity, significantly strong neovascularization (p < 0.01), important changes in the levels of types I and III collagen expression, and the organization and presence of intra-tendinous calcifications. Decreases in the maximum rupture force and stiffness were also observed. These results demonstrate that our model replicates the key features observed in human patellar tendinopathy. Collagenase is evenly distributed, as the Pluronic hydrogel prevents its leakage and thus, damage to surrounding tissues. Therefore, this model is valuable for testing new treatments for patellar tendinopathy.

Comparative analysis of patellar tendon, achilles tendon and plantar fascia structure in indoor and outdoor football players: a novel cross-sectional pilot study.

Different sport modalities were associate with tendon adaptation or even tendon disturbances, such as volleyball, soccer or basketball. Purpose: the aim of the present study was to determine de difference between indoor and outdoor football players on patellar tendon (PT), Achilles tendon (AT), plantar fascia (FP) and Hoffa's fat pad thickness assessed with ultrasound imaging (USI). A cross-sectional study was developed with a total sample of 30 soccer players divided in two groups: outdoor group (n = 15) and indoor group (n = 15). The thickness of PT, AT, PF and Hoffa's fat pad has been assessed with USI. Hoffa's fat pad reported significant differences for the left side between groups (P = 0.026). The rest of variables did not show any significant difference (P < 0.05). The ultrasonography assessment of the thickness of the PT, AT and PF did not show differences between outdoor and indoor football players. Hoffa's fat pad resulted showed a significant decrease for outdoor soccer players with respect futsal players. Thus, it can be considered that the load stimuli received in both soccer players were not enough to produce structural adaptations in PT, AT and PF tissues.

Examination of knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis.

BACKGROUND: Joint moment arm is a major element that determines joint torque. This study aimed to investigate factors associated with knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis. METHODS: Thirty-six participants with knee osteoarthritis (mean age, 78.1 ± 6.0 years) and 43 healthy controls (mean age, 73.0 ± 6.3 years) were analyzed. Magnetic resonance images (MRI) from the knee joint and thigh were acquired using a 3.0 T MRI scanner. The three-dimensional moment arm was defined as the distance between the contact point of the tibiofemoral joint and the patellar tendon line. The three-dimensional moment arm was decomposed into sagittal and coronal components, which were calculated as knee extensor and valgus moment arms, respectively. Quadriceps muscle volume, epicondylar width, bisect offset, Insall-Salvati ratio, and Kellgren-Lawrence grade were assessed. Multiple regression analyses were performed in the healthy control and knee osteoarthritis groups, with knee extensor and valgus moment arms as dependent variables. FINDINGS: Knee extensor moment arm was significantly associated with epicondylar width and the Insall-Salvati ratio in the healthy control group and with Kellgren-Lawrence grade, epicondylar width, and quadriceps muscle volume in the knee osteoarthritis group. Valgus knee moment arm was significantly associated with bisect offset in both the groups. INTERPRETATION: Knee size, osteoarthritis severity, and quadriceps muscle volume affect the knee extensor moment arm in knee osteoarthritis, whereas lateral patellar displacement affects the valgus knee moment arms in older individuals with and without knee osteoarthritis.