A Comprehensive Evaluation of Minimally Invasive Achilles Tendon Reconstruction with Hamstring Graft Indicates Satisfactory Long-Term Outcomes.

Background and objectives: The Achilles tendon, the largest tendon in the body, is vulnerable to injury because of its limited blood supply and the combination of forces to which it is subjected. Given the relevance of the Achilles tendon in the proper function of the foot and ankle, the primary goal of the present study was to use a holistic approach for a comprehensive evaluation of Achilles tendon reconstruction results on multiple levels. Materials and Methods: The study was designed in the following way: 30 patients with partial or total Achilles tendon tears were subjected to the minimally invasive Achilles tendon reconstruction. Patients were then subjected to the clinical, functional and isokinetic tests 12 and 24 months after the treatment. The clinical evaluation included calf circumference measurements and subjective patient-reported tests: ATRS, EQ-5D-5L and VAS scales. The functional evaluation was based on three tests: the weight-bearing lunge test, the heel rise test and single leg hop. Isometric and isokinetic evaluation was performed using a Biodex 3 dynamometer. Results: The calf circumference of the operated limbs was significantly lower than the non-operated limb 12 months after the surgical procedure, however this improved at the second evaluation. All subjective outcomes improved significantly 24 months after the surgery. Significantly better results in the function of the operated limbs were also obtained 24 months after the surgery. However, most of the muscle strength parameters of the operated limbs were already comparable to non-operated ones 12 months after the surgery and were comparable between two evaluation times. Conclusions: The overall results of this extensive evaluation are highly satisfactory and patients returned to their normal physical activity. From a medical point of view, it is assumed that the healing process is completed 12 months after the surgery, however, importantly, our results indicate that we should consider the healing process and the rehabilitation process separately.

Optimized Modeled Myofascial Release Enhances Wound Healing in 3-Dimensional Bioengineered Tendons: Key Roles for Fibroblast Proliferation and Collagen Remodeling.

OBJECTIVE: The purpose of this study was to evaluate the mechanisms of action of optimized myofascial release (MFR) on wound healing using a 3-dimensional human tissue construct. METHODS: Bioengineered tendons were cultured on a deformable matrix, wounded using a steel cutting tip, then strained in an acyclic manner with a modeled MFR paradigm at 103% magnitude for 5 minutes. Imaging and measurements of the width and wound size were performed daily, and the average tissue width of the entire bioengineered tendon was measured, and wound size and major and minor axes of the elliptical wound were additionally measured. Assessments of actin and collagen were performed by immunofluorescence, and Gomori's trichrome staining and fibroblast nuclei deposition was quantified using the CellProfiler analysis software. RESULTS: Optimized modeled MFR treatment significantly reduced the wound size and increased both collagen density and cell deposition at the wound site. All measures of wound healing improvements required the presence of proliferating fibroblasts. CONCLUSION: Myofascial release-induced cell deposition and collagen density at wound sites required actively proliferating fibroblasts. If clinically translatable, our results support a mechanism by which MFR improves patient wound healing.

Creatine Supplementation Supports the Rehabilitation of Adolescent Fin Swimmers in Tendon Overuse Injury Cases.

Our purpose was to investigate the effect of creatine (Cr) supplementation on regeneration periods in tendon overuse injury rehabilitation of adolescent fin swimmers. The participants of this study were injured adolescent competitive fin swimmers (n = 18). The subjects were randomly assigned the creatine (CR) or placebo (PL) groups with a double-blind research design. The subjects were given Cr supplementation or received the placebo as part of the conservative treatment of the tendinopathy. We measured the segmental lean mass (SLM;kg), the ankle plantar flexion peak torque (PFT;N·m), the pain intensity (NRS;values), prior to immobilization, after immobilization (R2) and after the 2nd (R4) and 4th (R6) weeks of the rehabilitation period of the injured limb. The creatine kinase (CK; U/L) enzyme levels were measured before immobilization, and then every 24 hours for four days. There was a significant decrease in SLM (CR by 5.6% vs. PL by 8.9%; p < 0.03) after two weeks of immobilization in both groups (p < 0.001). After four weeks rehabilitation the SLM significantly increased in both groups (CR by 5.5% vs. PL by 3.8%; p < 0.01). The percent changes in PFT after supplementation in R4 (p < 0.001) and R6 (p < 0.03) were significantly different between groups. There was a significant percent increase measured in the CR group (R4 by 10.4%; p < 0.001; R6 by 16.8%; p < 0.001), whereas significant, but lower growth found in the PL group also took place (R4 by 7.1%; p < 0.001; R6 by 14.7%; p < 0.001) after four weeks of rehabilitation. Significantly faster decrease were found in NRS of CR versus PL group during treatment (p < 0.02). We detected significantly lower CK levels increase at the CR group compared to the PL group. The results of this study indicate that Cr supplementation combined with therapeutic strategy effectively supports the rehabilitation of tendon overuse injury of adolescent fin swimmers.

A novel approach for rehabilitation of a triceps tendon rupture: A case report.

OBJECTIVE: Generate hypotheses and add new perspectives to the literature in the nonsurgical management of large ruptures in the distal part of the triceps tendon. METHODS: The patient was physically active, right handed, with a history of 20 years of resistance training practice and involvement in many activities, mostly combat sports (boxing, karate and mixed martial arts). The exercise program was designed with high repetitions and low rest intervals between sets in order to increase the metabolic stress. The resistance training with focus on tendon rehabilitation was performed in 28 weeks, with a follow-up of 52 weeks. The outcomes were changes in muscle strength and in the morphology of muscle and tendon. RESULTS: The results obtained in the isokinetic tests showed that the functional deficit was more evident during isometric than dynamic actions, and was also higher is slow than fast actions. Dynamic performance was fully recovered at the end of the follow up, while isometric strength did not. CONCLUSIONS: The present case reports a successful rehabilitation program after a near maximum triceps tendon rupture. The novelty was in the use of a simple resistance training program, that demanded low time commitment and was performed in a regular fitness facility.

Platelet rich Plasma in Achilles Tendon Healing 2 (PATH-2) trial: protocol for a multicentre, participant and assessor-blinded, parallel-group randomised clinical trial comparing platelet-rich plasma (PRP) injection versus placebo injection for Achilles tendon rupture.

BACKGROUND: Achilles tendon injuries give rise to substantial long-lasting morbidity and pose considerable challenges for clinicians and patients during the lengthy healing period. Current treatment strategies struggle to curb the burden of this injury on health systems and society due to lengthy rehabilitation, work absence and reinjury risk. Platelet-rich plasma (PRP) is an autologous preparation that has been shown to improve the mechanobiological properties of tendons in laboratory and animal studies. The use of PRP in musculoskeletal injuries is on the increase despite the lack of adequately powered clinical studies. METHODS AND DESIGN: This is a multicentre randomised controlled trial to evaluate the efficacy and mechanism of PRP in patients with acute Achilles tendon rupture (ATR). All adults with acute ATR presenting within 12 days of the injury who are to be treated non-operatively are eligible. A total of 230 consenting patients will be randomly allocated via a remote web-based service to receive PRP injection or placebo injection to the site of the injury. All participants will be blinded to the intervention and will receive standardised rehabilitation to reduce efficacy interference.Participants will be followed up with blinded assessments of muscle-tendon function, quality of life, pain and overall patient's functional goals at 4, 7, 13, 24 weeks and 24 months post-treatment. The primary outcome is the heel-rise endurance test (HRET), which will be supervised by a blinded assessor at 24 weeks. A subgroup of 16 participants in one centre will have needle biopsy under ultrasound guidance at 6 weeks. Blood and PRP will be analysed for cell count, platelet activation and growth factor concentrations. ETHICS AND DISSEMINATION: The protocol has been approved by the Oxfordshire Research Ethics Committee (Oxfordshire Research Ethics Committee A, reference no 14/SC/1333). The trial will be reported in accordance with the CONSORT statement and published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: ISRCTN: 54992179, assigned 12 January 2015. ClinicalTrials.gov: NCT02302664, received 18 November 2014. UK Clinical Research Network Study Portfolio Database: ID 17850.

Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study.

BACKGROUND AND PURPOSE: Both traditional and progressive rotator cuff repair rehabilitation protocols often delay active motion of the shoulder for 6 weeks or more. The early inclusion of a comprehensive aquatic-assisted exercise program presents a unique approach to postoperative management. The purpose of this case study is to describe a comprehensive evidence-based, aquatic-assisted rehabilitation program following arthroscopic rotator cuff repair. CASE DESCRIPTION: A 73-year-old woman with a nonretracted, medium-size, full-thickness tear (2.5 cm) of the supraspinatus tendon underwent arthroscopic rotator cuff repair and was referred for postoperative physical therapy. The rehabilitation program was initiated at 2 weeks postoperatively and consisted of concurrent land- and aquatic-based interventions over 6 weeks for a total of 18 physical therapy visits. OUTCOMES: Improvements were made in all 5 patient-reported outcome measures that were recorded weekly over the course of care. Improvements reached or exceeded minimal detectable change levels for the Shoulder Pain and Disability Index and the Penn Shoulder Score. Her numeric pain rating scale score at rest decreased from 4/10 at the initial evaluation to 2/10 at 8 weeks postoperatively and with activity decreased from 9/10 to 6/10. Shoulder strength and range of motion values also exhibited improvement over the course of care. No adverse events occurred during the case study. DISCUSSION: This case study illustrates the safe inclusion of low-stress aquatic exercises as an early adjunct to traditional land-based rotator cuff repair rehabilitation programs in small- to medium-size repairs. Further studies are needed to determine the long-term effectiveness of adding aquatic therapy to traditional postoperative programs.

[Correct treatment of acute Achilles tendon rupture - the difficult choice]. / Korrekt behandling af akut akillesseneruptur­ det svære valg.

Treatment of acute Achilles tendon rupture in Denmark has changed from being predominantly operative to being non-operative treatment over the past five years. However, no clear evidence is found in the literature in favour of one treatment modality over another. Non-operative treatment leads to an increased risk of re-rupture and operative treatment to an increased risk of other complications such as adhesions, infection and nerve injury. When a non-operative treatment protocol is chosen it is paramount that sufficient expertise is present to guide the treatment and rehabilitation.

Biomechanical and histological effects of augmented soft tissue mobilization therapy on achilles tendinopathy in a rabbit model.

OBJECTIVE: Augmented soft tissue mobilization (ASTM) has been used to treat Achilles tendinopathy and is thought to promote collagen fiber realignment and hasten tendon regeneration. The objective of this study was to evaluate the biomechanical and histological effects of ASTM therapy on rabbit Achilles tendons after enzymatically induced injury. METHODS: This study was a non-human bench controlled research study using a rabbit model. Both Achilles tendons of 12 rabbits were injected with collagenase to produce tendon injury simulating Achilles tendinopathy. One side was then randomly allocated to receive ASTM, while the other received no treatment (control). ASTM was performed on the Achilles tendon on postoperative days 21, 24, 28, 31, 35, and 38. Tendons were harvested 10 days after treatment and examined with dynamic viscoelasticity and light microscopy. RESULTS: Cross-sectional area in the treated tendons was significantly greater than in controls. Storage modulus tended to be lower in the treated tendons but elasticity was not significantly increased. Loss modulus was significantly lower in the treated tendons. There was no significant difference found in tangent delta (loss modulus/storage modulus). Microscopy of control tendons showed that the tendon fibers were wavy and type III collagen was well stained. The tendon fibers of the augmented soft tissue mobilization treated tendons were not wavy and type III collagen was not prevalent. CONCLUSION: Biomechanical and histological findings showed that the Achilles tendons treated with ASTM had better recovery of biomechanical function than did control tendons.

The effect of electroacupuncture on tendon repair in a rat Achilles tendon rupture model.

OBJECTIVE: To examine the effect of electroacupuncture (EA) on early post-rupture tendon repair in a rat model of Achilles tendon rupture using histological and mechanical evaluation. METHODS: An Achilles tendon rupture model was prepared in 90 Wistar rats, which were randomly assigned to EA, manual acupuncture or control groups. Rats in the EA group received EA (pulse width 5 ms; stimulation frequency 50 Hz; stimulation strength 20 µA; stimulation time 20 min) daily from 1 day following model preparation until the day of assessment (either 7 or 10 days after model preparation), when the region of interest was sampled to assess tendon repair using in vitro methods. Total cell count and the number of cells staining positive for transforming growth factor-ß1 (TGF-ß1) and basic fibroblast growth factor (b-FGF) were measured. Tension tests were performed 10 days after model preparation to measure the maximum breaking strength of the repaired tendon. RESULTS: Both the total cell count and the number of cells positive for b-FGF were significantly higher in the EA group (p<0.05). In the EA group only, immunostaining showed strong expression of TGF-ß1 7 days after model preparation (p<0.05). Maximum breaking strength of the repaired tendon 10 days after model preparation was significantly higher in the EA group (p<0.01). CONCLUSIONS: The marked increase in cell count and growth factor expression as well as increased tendon strength in the EA group suggest that EA may be a useful method for promoting tendon repair.

Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short- and long-term evaluations.

We evaluated the factors influencing outcomes of flexor tendon repair in 112 fingers using a six-strand suture with the Yoshizu #1 technique and early postoperative active mobilization in 101 consecutive patients. A total of 32 fingers had injuries in Zone I, 78 in Zone II, and two in Zone III. The mean follow-up period was 6 months; 16 patients (19 fingers) participated in long-term follow-up of 2 to 16 years. The total active motion was 230° SD 29°; it correlated negatively with age. The total active motion was 231° SD 28° after repair of the lacerated flexor digitorum superficialis tendon, and was 205° SD 37° after excision of the flexor digitorum superficialis tendon ends (p = 0.0093). A total of 19 fingers showed no significant increases in total active motion more than 2 years after surgery. The rupture rate was 5.4% in our patients and related to surgeons' level of expertise. Five out of six ruptured tendons were repaired by inexperienced surgeons. Level of Evidence IV.

Unusual clinical presentation of a partial tibialis anterior rupture.

Subcutaneous rupture of the tibialis anterior tendon is rare. Diagnosis is usually clear. The essential clinical symptoms are progressively: footdrop gait, loss of ankle flexion strength, ankle foot pain and claw toes. But the occurrence of an asymptomatic time period between the injury and the onset of clinical signs can make the diagnosis more difficult. MRI is the gold standard examination for tendons injuries and associated bone and joints damages. Surgical exploration confirms MRI findings. It constitutes the treatment of choice for tibialis anterior tendon rupture. Surgical or functional techniques used have an impact on the design of the rehabilitation program, essential step in the care management of these injuries. It avoids postoperative tendon adhesions and their functional consequences. We report here a case of a man presenting with footdrop gait as the only clinical symptom.

Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises.

PURPOSE: To compare range of motion and healing rates between 2 different rehabilitation protocols after arthroscopic single-row repair for full-thickness rotator cuff tear. METHODS: Sixty-four shoulders available for postoperative magnetic resonance imaging (MRI) evaluation after arthroscopic rotator cuff repair were enrolled in this study. Aggressive early passive rehabilitation (manual therapy [2 times per day] and unlimited self-passive stretching exercise) was performed in 30 shoulders (group A) and limited early passive rehabilitation (limited continuous passive motion exercise and limited self-passive exercise) in 34 shoulders (group B). A postoperative MRI scan was performed at a mean of 7.6 months (range, 6 to 12 months) after surgery. RESULTS: Regarding range of motion, group A improved more rapidly in forward flexion, external rotation at the side, internal and external rotation at 90° of abduction, and abduction than group B until 3 months postoperatively with significant differences. However, there were no statistically significant differences between the 2 groups at 1-year follow-up (P = .827 for forward flexion, P = .132 for external rotation at the side, P = .661 for external rotation at 90° of abduction, and P = .252 for abduction), except in internal rotation at 90° of abduction (P = .021). In assessing the repair integrity with postoperative MRI scans, 7 of 30 cases (23.3%) in group A and 3 of 34 cases (8.8%) in group B had retears, but the difference was not statistically significant (P = .106). CONCLUSIONS: Pain, range of motion, muscle strength, and function all significantly improved after arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation protocols. However, aggressive early motion may increase the possibility of anatomic failure at the repaired cuff. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. LEVEL OF EVIDENCE: Level II, randomized controlled trial.

Proloterapia y desgarro parcial del manguito rotador, otra opción terapéutica: a propósito de un caso / Prolotherapy and partial rotator cuff tear, another therapeutic option. A case report

El dolor de hombro es un motivo frecuente de consulta en los servicios de rehabilitación, y puede deberse a un desgarro en el manguito rotador, como en el caso que nos ocupa. Nos encontramos ante una paciente joven afecta de una rotura parcial del tendón del músculo supraespinoso que, tras no responder a múltiples tratamientos, ha sido tratada con proloterapia. Esta es una terapia médica complementaria y alternativa basada en infiltraciones para el tratamiento del dolor osteomuscular crónico. Tras seis sesiones de proloterapia en un periodo de 15 semanas, la paciente mostró una mejoría clínica medida con la escala analógica visual para el dolor y una mejoría ecográfica. Al tratarse de un único caso clínico, no podemos establecer una relación causa-efecto, por lo que sería conveniente seguir investigando sobre esta técnica terapéutica(AU)

Shoulder pain is a frequent reason for consultation in rehabilitation services, which may be due to a rotator cuff tear, as in our case. We are reporting a case of a young female patient affected by a partial tear of the supraspinatus tendon, who was treated with prolotherapy after failing to respond to multiple treatments. Prolotherapy is a complementary and alternative medical therapy based on injections for treatment of chronic musculoskeletal pain. After six sessions of prolotherapy, in a period of 15 weeks, the patient showed clinical improvement measured by visual analogue scale for pain and ultrasonography. As this is a single clinical case, we cannot establish a cause-effect relationship, however, it would be advisable to continue research on this therapeutic technique(AU)

The effects of a closed-chain, eccentric training program on hamstring injuries of a professional football cheerleading team.

OBJECTIVE: Hamstring injuries are a common occurrence among professional football cheerleaders. The purpose of this study is to identify the effects of an eccentric, closed-chain hamstring exercise intervention on hamstring injury-associated pain during the course of the football season among professional football cheerleaders. METHODS: Forty-three female cheerleaders participated in an eccentric, closed-chain hamstring exercise intervention protocol provided by doctors of chiropractic that incorporated loops of elastic-band or Thera-Band Loops (Hygenic Corporation, Akron, OH) during practice and at home during the regular football season. Hamstring injury-related pain was assessed in June, during team selection; in September, at the start of the season; and in December, at the end of season. No intervention was applied between June and September, although the sample participated in 4 hours of practice 2 to 3 times per week. The intervention was applied to the entire sample regardless of hamstring injury-related pain during the regular football season between September and December. The interventions included 2 exercises and were completed bilaterally 2 times per week at each biweekly practice and were encouraged to be done at least 3 additional times per week at home on nonpractice days. RESULTS: Among the subsample who reported hamstring-related injury pain between June and September, the exercise intervention significantly decreased (P < .007) pain between September (6.07 ± 0.58) and December (3.67 ± 0.65). CONCLUSIONS: The eccentric, closed-chain hamstring exercise intervention reduced hamstring injury-related pain among this group of professional football cheerleaders.

Effects of motor imagery on hand function during immobilization after flexor tendon repair.

OBJECTIVE: To determine whether motor imagery during the immobilization period after flexor tendon injury results in a faster recovery of central mechanisms of hand function. DESIGN: Randomized controlled trial. SETTING: Tertiary referral hospital. PARTICIPANTS: Patients (N=28) after surgical flexor tendon repair were assigned to either an intervention group or a control group. INTERVENTION: Kinesthetic motor imagery of finger flexion movements during the postoperative dynamic splinting period. MAIN OUTCOME MEASURES: The central aspects of hand function were measured with a preparation time test of finger flexion in which subjects pressed buttons as fast as possible following a visual stimulus. Additionally, the following hand function modalities were recorded: Michigan Hand Questionnaire, visual analog scale for hand function, kinematic analysis of drawing, active total motion, and strength. RESULTS: After the immobilization period, the motor imagery group demonstrated significantly less increase of preparation time than the control group (P=.024). There was no significant influence of motor imagery on the other tested hand function (P>.05). All tests except kinematic analysis (P=.570) showed a significant improvement across time after the splinting period (P

Enfrentamiento quirúrgico de las lesiones del tendón de biceps distal / Surgical approach in distal biceps tendon lesions

Surgical treatment of distal biceps tendon ruptures is indicated in active patients, and its aim is to recover mainly the supination strength, and flexion secondarily, focusing the controversy on its approach and fixation systems. Objective: To present a patients series results operated on for this injury, with different surgical techniques. Methods: Ten patients were evaluated retrospectively analyzing descriptively: age, evolution time, approach and fixation types, grafts use, functional and satisfaction outcome, and complications. Results: It was considered excellent in all patients, despite the use of different types of fixation and approaches, either in acute or chronic, with few complications. Conclusion: According to our results, and the literature review, it can be obtained excellent functional results, with different approaches and fixation systems, allowing an early rehabilitation.

El tratamiento quirúrgico en las roturas del tendón de bíceps distal se indica en pacientes activos, e intenta recuperar principalmente la fuerza de supinación, y secundariamente de flexión, centrando la controversia en su abordaje y sistemas de fijación. Objetivo: Presentar los resultados en una serie de pacientes operados de esta lesión, con diferentes técnicas quirúrgicas. Métodos: Se evalúan retrospectivamente diez pacientes, analizando descriptivamente edad, tiempo de evolución, tipo de abordaje y fijaciones, uso de injertos, resultados funcionales, grado de satisfacción, y complicaciones. Resultados: Fueron considerados excelentes en todos los pacientes, a pesar del uso de distintos tipos de fijación y abordajes, en roturas agudas y crónicas, con escasas complicaciones. Conclusión: De acuerdo a lo presentado, y acorde a la literatura revisada, se pueden obtener excelentes resultados funcionales, con diferentes abordajes y sistemas de fijación, que permitan una rehabilitación precoz.

Flexores. Avances en fisioterapia / Flexor muscles. Advances in physical therapy

Introducción. A pesar de contradecir técnicasde rehabilitación tradicionales en las que se inicianlos ejercicios pasivos para posteriormente pasara los activos, con este protocolo se pretende inmovilizarselectivamente las articulaciones más proximalespermitiendo una movilización activa de la articulacióndistal.Material y método. Hemos documentado las lesionestendinosas traumáticas tratadas en nuestro centromediante movilización activa inmediata, comparandolos resultados con un grupo control en el que se haefectuado un protocolo de movilización pasivainmediata.Conclusiones. La utilización de esta técnica permitesolucionar tres problemas simultáneamente: a) resolverla debilidad articular y de tejidos blandos; b) cambiar el patrón de movilidad activa haciéndolo más productivo,y c) movilizar el edema crónico. Cuando se intenta disminuir el estrés de una articulación mediante la utilización de ortesis fijas, estamos dando origen a una debilidad que no puede ser tratada mediante movilizaciones pasivas. Sólo se han documentado efectos negativos de la movilización pasiva; además, una mejora del movimiento pasivo no se corresponde con una mejora de la movilidad activa. Los patrones anormales de movimiento originan cambios en la corteza somatosensorial. La recuperación de la movilidad abarca una rehabilitación mecánica y una reeducación de lospatrones normales de movimiento en la corteza.El empleo de esta metodología nos permite crearpatrones de movimiento deseados sin que aparezcanmovimientos compensatorios

Introduction. In spite of contradict techniques oftraditional rehabilitation where passive exercises arebegun in order to go to the active ones later, this protocol is expected to inmobilize selectively the most proximal articulations permiting an active mobilization of the distal articulation.Material and method. we have documented thetendinous injuries treated in our centre by inmediateactive mobilization and we have checked the results witha controlled group followed by immediate passivemobilization.Conclusions. the use of this technique,allows us to solvethree problems simultaneously. a) To solve the articularweakness and soft tissues; b) to change the active mobility pattern becoming more productive, and c) tTo mobilize the chronic oedema. When it is tried to reduce the stress of an articulation through the use of fixed orthosis, we are provoking a weakness of the passive mobilization which cannot be treated with passive mobilizations.Only negative effects have been researched, also a better passive movementwhich does not correspond with a better active mobility.The abnormal patterns of movement provoke changes atthe somesthetic cortex level. The recovery of the mobility cover a mechanic rehabilitation and normal patterns of movement rehabilitation at the cortex level.Using this methodology allows us to create movementpatterns wanted without the appearance of compensatorymovements

Effects of low-voltage microamperage stimulation on tendon healing in rats.

STUDY DESIGN: Randomized controlled prospective experimental study. OBJECTIVES: To examine the effects of transcutaneous low-voltage microamperage stimulation (LVMAS) on the mechanical strength of Achilles tendon repair in rats at 4 weeks after injury. BACKGROUND: Understanding the effect of LVMAS on the healing of injured tendons is hampered by the lack of related experimental studies, especially from the aspect of biomechanical outcome measures. METHODS AND MEASURES: Fourteen 3-month-old male Sprague-Dawley rats received surgical transection to the medial portion of their right Achilles tendon. The rats were divided into a LVMAS group (n = 7) and control group (n = 7). From day 6 postsurgery onwards, the LVMAS group received daily treatment of transcutaneous LVMAS (2.5 V, 100 microA/cm2, 10 pulses per second, positive current) for a total of 22 sessions, while the control group received placebo LVMAS by the same investigator during that period. On day 31, the Achilles tendons were harvested for biomechanical testing for load relaxation, stiffness, and ultimate tensile strength along the longitudinal direction. RESULTS: The normalized Achilles tendon ultimate tensile strength of the LVMAS group (mean +/- SD, 110.5% +/- 25.0%) was higher than that of the control group (75.3% +/- 20.8%) (P = .014), but no significant difference was found in normalized stiffness and load relaxation between the 2 groups (P = .239 and .350, respectively). CONCLUSION: The results of this study suggest that the administration of transcutaneous LVMAS could improve healing and consequently the tensile strength of partially transected Achilles tendons of rats at 4 weeks after injury.