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1.
Acta Cir Bras ; 34(11): e201901101, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939594

RESUMO

PURPOSE: To determine the efficacy of norbixin-based poly(hydroxybutyrate) (PHB) membranes for Achilles tendon repair. METHODS: Thirty rats were submitted to total tenotomy surgery of the right Achilles tendon and divided into two groups (control and membrane; n = 15 each), which were further subdivided into three subgroups (days 7, 14, and 21; n = 5 each). Samples were analyzed histologically. RESULTS: Histological analysis showed a significant reduction in inflammatory infiltrates on days 7, 14 (p < 0.0001 for both), and 21 (p = 0.0004) in the membrane group compared to that in the control group. There was also a significant decrease in the number of fibroblasts in the control group on days 7, 14 (p < 0.0001), and 21 (p = 0.0032). Further, an increase in type I collagen deposition was observed in the membrane group compared to that in the control group on days 7 (p = 0.0133) and 14 (p = 0.0107). CONCLUSION: Treatment with norbixin-based PHB membranes reduces the inflammatory response, increases fibroblast proliferation, and improves collagen production in the tendon repair region, especially between days 7 and 14.


Assuntos
Tendão do Calcâneo/efeitos dos fármacos , Tendão do Calcâneo/cirurgia , Carotenoides/farmacologia , Hidroxibutiratos/farmacologia , Poliésteres/farmacologia , Tenotomia/métodos , Tendão do Calcâneo/patologia , Animais , Colágeno Tipo I/análise , Colágeno Tipo I/efeitos dos fármacos , Colágeno Tipo III/análise , Colágeno Tipo III/efeitos dos fármacos , Fibroblastos/efeitos dos fármacos , Humanos , Masculino , Ratos Wistar , Valores de Referência , Regeneração/efeitos dos fármacos , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
2.
J Orthop Res ; 38(1): 59-69, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31478241

RESUMO

The deposition of aggrecan/hyaluronan (HA)-rich matrix within the tendon body and surrounding peritenon impede tendon healing and result in compromised biomechanical properties. Hence, the development of novel strategies to achieve targeted removal of the aggrecan-HA pericellular matrix may be effective in treating tendinopathy. The current study examined the therapeutic potential of a recombinant human hyaluronidase, rHuPH20 (FDA approved for reducing HA accumulation in tumors) for treating murine Achilles tendinopathy. The 12-week-old C57Bl/6 male mice were injected with two doses of rHuTGF-ß1 into the retrocalcaneal bursa (RCB) to induce a combined bursitis and tendinopathy. Twenty-four hours following induction of injury, treatment groups were administered rHuPH20 Hyaluronidase (rHuPH20; Halozyme Therapeutics) into the RCB. At either 6 h (acute), 9 days, or 25 days following hyaluronidase treatment, Achilles tendons were analyzed for gene expression, histology and immunohistochemistry, fluorophore-assisted carbohydrate electrophoresis, and biomechanical properties. The rHuPH20 treatment was effective, particularly at the acute and 9-day time points, in (a) removing HA deposits from the Achilles tendon and surrounding tissues, (b) improving biomechanical properties of the healing tendon, and (c) eliciting targeted increases in expression of specific cell fate, extracellular matrix metabolism, and inflammatory genes. The potential of rHuPH20 to effectively clear the pro-inflammatory, HA-rich matrix within the RCB and tendon strongly supports the future refinement of injectable glycosidase preparations as potential treatments to protect or regenerate tendon tissue by reducing inflammation and scarring in the presence of bursitis or other inducers of damage such as mechanical overuse. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:59-69, 2020.


Assuntos
Tendão do Calcâneo/patologia , Bursite/tratamento farmacológico , Hialuronoglucosaminidase/uso terapêutico , Tendinopatia/tratamento farmacológico , Animais , Fenômenos Biomecânicos , Proteínas da Matriz Extracelular/metabolismo , Humanos , Hialuronoglucosaminidase/administração & dosagem , Injeções , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Proteínas Recombinantes/uso terapêutico , Regeneração , Tendinopatia/metabolismo , Fator de Crescimento Transformador beta1/farmacologia
3.
J Am Podiatr Med Assoc ; 109(4): 327-333, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762310

RESUMO

Tendinopathy in the presence of gouty arthropathy is relatively common, yet the clinical suspicion for gout involvement in acute tendon pain remains low. A 49-year-old man presented with an acute, tender, erythematous mass to the right posterior heel. A computed tomographic scan was obtained, which revealed a septated fluid collection superficial to the Achilles tendon. The patient was taken to the operating room for an incision and drainage with debridement, and the abscess was found to be filled with caseous material. The diagnosis of gout was confirmed with pathology. The calcaneus was submitted to biopsy, and the results were negative for osteomyelitis. The patient was returned to the operating room for repair of the Achilles tendon with flexor hallucis longus tendon transfer. Postoperatively, the patient was nonweightbearing for 6 weeks. Oral colchicine was used perioperatively, and a steroid taper was administered. The patient was started on allopurinol and colchicine for chronic treatment. At 14 months, the patient was walking without pain or recurrence of the mass. Although the relationship between hyperuricemia and tendinopathy is not completely understood, it is apparent that tendon involvement may be a sequela in patients with gout. When a patient presents with acute tendon pain, gout should be considered in the differential diagnosis.


Assuntos
Tendão do Calcâneo/patologia , Gota/patologia , Tendinopatia/patologia , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/cirurgia , Tornozelo/diagnóstico por imagem , Gota/diagnóstico por imagem , Gota/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Tendinopatia/diagnóstico por imagem , Tendinopatia/cirurgia
4.
J Shoulder Elbow Surg ; 28(12): 2379-2385, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31757369

RESUMO

BACKGROUND AND HYPOTHESIS: Heterotopic ossification (HO) is a recognized sequela after trauma and arthroplasty. The purpose of this study was to evaluate the therapeutic effect of celecoxib on HO. We hypothesized that celecoxib may inhibit the progression of initiated HO. METHODS: We performed a retrospective review of 37 patients who underwent elbow joint surgery between January 2014 and June 2018. Seventeen patients were prescribed orally administered celecoxib (200 mg/dose, twice daily) for 2 months after the diagnosis of HO, whereas the remaining 20 patients were administered celecoxib for 1 month starting immediately after surgery. HO progression was evaluated by plain radiographs. By use of an Achilles tendon puncture-induced HO mouse model, the curative effect of celecoxib was illustrated at different HO progression stages. The mice were assigned to 1 of 4 groups: sham group, vehicle group, group receiving celecoxib on day 1, and group receiving celecoxib in week 6. Achilles tendons were analyzed by micro-computed tomography and histochemistry after 12 weeks. RESULTS: Celecoxib did not inhibit the progression of initiated HO in the patients in whom HO was diagnosed, whereas those who received celecoxib after surgery had lower morbidity. Achilles tendon puncture effectively induced typical HO in mice. The ectopic bone volume was significantly reduced in the day 1 celecoxib group compared with the vehicle group; however, the difference was not statistically significant in the week 6 celecoxib group. CONCLUSIONS: Administration of celecoxib starting immediately after surgery can significantly inhibit the formation of HO. Once HO is visible on plain radiographs or micro-computed tomography, celecoxib cannot effectively attenuate further progression of HO in humans and mice.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Celecoxib/uso terapêutico , Progressão da Doença , Ossificação Heterotópica/tratamento farmacológico , Ossificação Heterotópica/prevenção & controle , Complicações Pós-Operatórias/tratamento farmacológico , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/lesões , Tendão do Calcâneo/patologia , Adulto , Idoso , Animais , Modelos Animais de Doenças , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Ossificação Heterotópica/diagnóstico por imagem , Ossificação Heterotópica/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Microtomografia por Raio-X , Adulto Jovem
5.
In Vivo ; 33(5): 1635-1640, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471416

RESUMO

BACKGROUND/AIM: To compare patients affected by ankylosing spondylitis (AS) treated with anti-TNF-α for two years with controls in terms of Achilles tendon stiffness, ultrasound structure and thickness. PATIENTS AND METHODS: B-mode ultrasound evaluation and strain ultrasound elastography were performed in longitudinal and transverse planes on 22 Achilles tendons of 11 AS patients and 26 of 13 controls. RESULTS: There were no significant differences in thickness and stiffness of the Achilles tendon between AS patients and controls, except for an increased thickness in the middle third of the tendon in the AS patients (p=0.04). The Achilles tendon stiffness ratio of AS patients was 1.02±0.36 vs. 1.14±0.38 in the controls (p=0.2). CONCLUSION: AS patients had an Achilles tendon thickness greater than controls at the middle third, but no difference in the stiffness was found among them. Strain ultrasound elastography may be useful to exclude early changes in mechanical properties of tendons.


Assuntos
Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/patologia , Anticorpos Monoclonais/uso terapêutico , Técnicas de Imagem por Elasticidade , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Ultrassonografia , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Estudos de Casos e Controles , Técnicas de Imagem por Elasticidade/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espondilite Anquilosante/metabolismo , Resultado do Tratamento , Ultrassonografia/métodos
6.
Braz J Med Biol Res ; 52(9): e8290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482998

RESUMO

Tendon rupture is a very frequent accident involving average people and high-performance athletes. Clinical studies describe tendon recovery as a painful and slow process involving different biochemical and histological events. Ascorbic acid (AA) is a potent antioxidant as well as an important cofactor for collagen synthesis. In the current study, we evaluated if local treatment with AA is able to promote tendon repair in tenotomized rats. Animals were submitted to Achilles tendon rupture followed by surgical suture. Control and AA groups received in loco injection of saline solution (0.9% NaCl) and 30 mM AA, respectively. Histological and functional recovery of Achilles tendon tissue was evaluated at 7, 14, and 21 days post-surgery. Hematoxylin/eosin staining and collagen fluorescence analysis showed intense disarrangement of tendon tissue in the saline group. Tenotomized animals also showed hypercellularity in tendon tissue compared with non-tenotomized animals. The Achilles functional index (AFI) showed a significant decrease of tendon functionality in tenotomized animals at 7, 14, and 21 days post-surgery. AA accelerated tissue organization and the recovery of function of the Achilles tendons. The beneficial effect of AA treatment was also observed in the organization of the collagen network. Data presented in the current work showed that in loco treatment with AA accelerated the recovery of injured Achilles tendon post-surgery.


Assuntos
Tendão do Calcâneo/efeitos dos fármacos , Ácido Ascórbico/administração & dosagem , Colágeno/efeitos dos fármacos , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/lesões , Tendão do Calcâneo/patologia , Animais , Colágeno/fisiologia , Modelos Animais de Doenças , Masculino , Ratos , Ratos Wistar , Recuperação de Função Fisiológica/efeitos dos fármacos , Tenotomia , Cicatrização/efeitos dos fármacos
7.
Best Pract Res Clin Rheumatol ; 33(1): 122-140, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31431267

RESUMO

Tendinopathy (pain and dysfunction in a tendon) is a prevalent clinical musculoskeletal presentation across the age spectrum, mostly in active and sporting people. Excess load above the tendon's usual capacity is the primary cause of clinical presentation. The propensity towards chronicity and the extended times for recovery and optimal function and the challenge of managing tendinopathy in a sporting competition season make this a difficult condition to treat. Tendinopathy is a heterogeneous condition in terms of its pathology and clinical presentation. Despite ongoing research, there is no consensus on tendon pathoetiology and the complex relationship between tendon pathology, pain and function is incompletely understood. The diagnosis of tendinopathy is primarily clinical, with imaging only useful in special circumstances. There has been a surge of tendinopathy treatments, most of which are poorly supported and warrant further exploration. The evidence supports a slowly progressive loading program, rather than complete rest, with other treatment modalities used as adjuncts mainly targeted at achieving pain relief.


Assuntos
Tendão do Calcâneo/patologia , Manejo da Dor/métodos , Tendinopatia/diagnóstico , Humanos
8.
Curr Sports Med Rep ; 18(6): 192-200, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31385834

RESUMO

Symptomatic tendinopathy can be a disabling condition for athletes. Common sites of tendinopathy in athletes include the rotator cuff (RTC), Achilles, and patellar tendons. Advanced imaging modalities, such as magnetic resonance imaging and ultrasound occasionally identify tendinopathic changes in asymptomatic individuals. Such asymptomatic changes have been documented in the RTC, Achilles, and patellar tendons of athletes. In the RTC, tendinopathy, partial-, and full-thickness tears have been demonstrated in asymptomatic athletes, though only small numbers of these athletes may develop symptoms despite prolonged periods of ongoing, competitive play. In the Achilles and patellar tendons, neovascularization, hypoechogenicity, and tendon thickening are commonly noted findings in asymptomatic athletes, and though all have been associated with tendon pain in the literature, there is some inconsistency as to which are the strongest predictors of future tendon pain. Evidence on how best to address or intervene upon such asymptomatic changes is limited.


Assuntos
Tendão do Calcâneo/patologia , Ligamento Patelar/patologia , Manguito Rotador/patologia , Tendinopatia/diagnóstico por imagem , Doenças Assintomáticas , Atletas , Humanos , Imagem por Ressonância Magnética , Tendinopatia/patologia , Ultrassonografia
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(7): 871-876, 2019 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-31298006

RESUMO

Objective: To explore the effect of platelet-rich plasma (PRP) in treatment of Achilles tendinopathy in rabbits, and provide experimental evidence for the clinical application of PRP in treatment of Achilles tendinopathy. Methods: Forty-eight adult New Zealand white rabbits, weighing 2.5-3.0 kg, male or female, were randomly divided into model group (group A), model control group (group B), model+treatment control group (group C), model+treatment group (group D), with 12 in each group. The rabbits were injected with type Ⅰ collagenase to prepare Achilles tendinopathy models in groups A, C, and D, and with an equal dose of normal saline in group B. The blood from the central artery of rabbit ear was taken to preprare PRP by secondary centrifugation in group D. The results of platelet counts showed that PRP platelets reached 3 to 5 times the whole blood. After the model was prepared, the rabbits in groups C and D were injected with physiological saline and autologous PRP at the molding site respectively, once a week, 0.8 mL each time for 4 weeks. At 1 week after PRP injection, the relative hardness (expressed as HRD%) of Achilles tendon was evaluated by ultrasound elastic quantitative imaging detection technique; the maximum breaking load of Achilles tendon was measured by universal electronic tensile testing machine; the contents of collagen type Ⅰ and Ⅲ were determined by ELISA; and the morphology of Achilles tendon collagen fibers was observed by HE and Masson stainings. Results: All animals survived during the experiment. The results of ultrasound elastic quantitative imaging and mechanical tests showed that the HRD% and the maximum breaking load were significantly lower in group A than in group B ( P<0.05) and in group C than in group D ( P<0.05). The results of ELISA showed that the content of collagen type Ⅰ was significantly lower in group A than in group B ( P<0.05) and in group C than in group D ( P<0.05); the content of collagen type Ⅲ was significantly higher in group A than in group B ( P<0.05) and in group D than in group C ( P<0.05). HE and Masson stainings showed that the Achilles tendon collagen fibers were irregularly curled and the structure was severely damaged in group A; the fibers were parallel and ordered, and the structure was complete in group B; the fibers were irregularly curled and structurally disordered in group C; the fibers were slightly curled and the structure was relatively complete in group D. Conclusion: A rabbit model of Achilles tendinopathy can be reconstructed by type Ⅰ collagenase injection. PRP treatment can increase the Achilles tendon hardness and maximum breaking load, up-regulate the expression level of collagen type Ⅰ and Ⅲ, improve the structure of Achilles tendon collagen fiber, and promote the repair in rabbit Achilles tendinopathy model.


Assuntos
Tendão do Calcâneo , Plasma Rico em Plaquetas , Tendinopatia , Tendão do Calcâneo/patologia , Animais , Colágeno Tipo I/análise , Colágeno Tipo III/análise , Feminino , Masculino , Coelhos , Distribuição Aleatória , Tendinopatia/terapia
10.
Lipids Health Dis ; 18(1): 149, 2019 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-31279347

RESUMO

BACKGROUND: Coronary artery calcium (CAC) is known as a reliable tool for estimating risk of myocardial infarction, coronary death, all-cause mortality and is even used to evaluate suitable asymptomatic patients. We therefore aimed to evaluate whether CAC scoring can be applied in the algorithm for clinical examination of patients with severe hypercholesterolemia (SH). METHODS: During the period of 2016-2017 a total of 213 asymptomatic adults, underwent computed tomography angiography to evaluate their CAC scoring. The sample consisted of 110 patients with SH and 103 age and sex matched controls without dyslipidemia and established cardiovascular disease. RESULTS: In total there were 79 (37.2%) subjects with elevated (≥25th) CAC percentiles. Out of them 47 (59.5%) had SH and 32 (40.5%) did not. CAC score did not differ between groups (SH (+) 140.30 ± 185.72 vs SH (-) 87.84 ± 140.65, p = 0.146), however there was a comparable difference in how the participants of these groups distributed among different percentile groups (p = 0.044). Gender, blood pressure, tabaco use, physical activity, family history of coronary artery disease and diabetes mellitus were not associated with CAC score (p > 0.05). There were no significant correlations between biochemical parameters and CAC percentiles except for increase in lipoprotein(a) (p = 0.038). Achilles tendon pathology, visceral obesity, body mass index and increased waist-hip ratio were not associated with CAC percentiles either (p > 0.05). CONCLUSIONS: CAC score is not associated with presence of SH. CAC score is not an appropriate diagnostic tool in the algorithm for clinical examination of patients with SH. Further larger studies are needed to support our findings.


Assuntos
Cálcio , Vasos Coronários/diagnóstico por imagem , Hipercolesterolemia/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Tendão do Calcâneo/patologia , Adolescente , Adulto , Composição Corporal , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Feminino , Humanos , Hipercolesterolemia/sangue , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Mater Sci Eng C Mater Biol Appl ; 103: 109711, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31349489

RESUMO

Tendon calcification is a common but intractable problem leading to pain and activity limitation when injury or tendinopathy progresses into the late stage. This is because tendon stem/progenitor cells (TSPCs) can undergo aberrant osteogenic differentiation under inflammatory conditions. This study aims to investigate the effect of curcumin, a natural anti-inflammatory agent, on regulating the differentiation of TSPCs in tendon calcification. With inflammatory stimulation, TSPCs showed higher alkaline phosphatase activity and more frequent formation of mineralized nodules which were verified in the culture system; however, curcumin significantly alleviated these pathological changes. In in vivo function analysis, chitosan microsphere-encapsulated curcumin was delivered to injured sites of rat tendon ectopic calcification model. The inflammation in the tendon tissues of the curcumin group was significantly relieved. Controlled-release curcumin partially rescued tendon calcification and enhanced tendon regeneration in animal model. This study demonstrates that controlled-release curcumin can manipulate the fate decision of TSPCs, and that it promotes the tenogenesis and inhibits the osteogenesis of TSPCs in a pathological microenvironment, which provides a possible new therapeutic strategy for tendon disease.


Assuntos
Tendão do Calcâneo/metabolismo , Calcinose/tratamento farmacológico , Diferenciação Celular/efeitos dos fármacos , Curcumina/farmacologia , Células-Tronco/metabolismo , Tendão do Calcâneo/patologia , Animais , Calcinose/metabolismo , Calcinose/patologia , Curcumina/química , Preparações de Ação Retardada/química , Preparações de Ação Retardada/farmacologia , Camundongos , Ratos , Células-Tronco/patologia
12.
J Orthop Surg Res ; 14(1): 172, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182124

RESUMO

BACKGROUND: Increased tendon pain and tendon damage is a significant complication related to hyperlipidemia. Unlike the well-established pathogenesis associated with increased serum concentrations of total cholesterol, triglycerides, and low-density lipoprotein in atherosclerotic cardiovascular disease, the role of hyperlipidemia in promoting tendon damage remains controversial and requires mechanistic clarity. METHODS: In this study, we analyzed the consequences of hypercholesterolemia on the integrity of the collagen-based architecture of the Achilles tendon. The Achilles tendons from rabbits fed with normal-cholesterol (nCH) and high-cholesterol (hCH) diets were analyzed. We studied the morphology of tendons, distribution of lipids within their collagen-rich milieu, the relative amounts of fibrillar collagen I and collagen III, and selected biomechanical parameters of the tendons at the macroscale and the nanoscale. RESULTS: Histological assays of hCH tendons and tenosynovium demonstrated hypercellular areas with increased numbers of macrophages infiltrating the tendon structure as compared to the nCH tendons. While Oil Red staining revealed lipid-rich deposits in the hCH tendons, hybridization of tendon tissue with the collagen hybridizing peptide (CHP) demonstrated damage to the collagen fibers. Fourier-transform infrared (FTIR) spectra showed the presence of distinct peaks consistent with the presence of cholesterol ester. Additionally, the hCH tendons displayed regions of poor collagen content that overlapped with lipid-rich regions. The hCH tendons had a substantial fourfold increase in the collage III to collagen I ratio as compared to the nCH tendons. Tendons from the hCH rabbits showed poor biomechanical characteristics in comparison with control. The biomechanical changes were evident at the macrolevel and the nanolevel of tendon structure. CONCLUSIONS: Our findings support the hypothesis that hypercholesterolemia coincides with the weakening of the tendons. It is likely that the intimate contact between collagen fibrils and cholesterol deposits contributes to the weakening of the fibrillar structure of the tendons.


Assuntos
Tendão do Calcâneo/metabolismo , Tendão do Calcâneo/patologia , Colesterol/metabolismo , Modelos Animais de Doenças , Hipercolesterolemia/metabolismo , Hipercolesterolemia/patologia , Animais , Colágeno/metabolismo , Dieta Hiperlipídica/efeitos adversos , Feminino , Hipercolesterolemia/etiologia , Coelhos
13.
Acta Bioeng Biomech ; 21(1): 103-111, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31197280

RESUMO

PURPOSE: The aim of this study was to verify improved, ensemble-based strategy for inferencing with use of our solution for quantitative assessment of tendons and ligaments healing process and to show possible applications of the method. METHODS: We chose the problem of the Achilles tendon rupture as an example representing a group of common sport traumas. We derived our dataset from 90 individuals and divided it into two subsets: healthy individuals and patients with complete Achilles tendon ruptures. We computed approx. 160 000 2D axial cross-sections from 3D MRI studies and preprocessed them to create a suitable input for artificial intelligence methods. Finally, we compared different training methods for chosen approaches for quantitative assessment of tendon tissue healing with the use of statistical analysis. RESULTS: We showed improvement in inferencing with use of the ensemble technique that results from achieving comparable accuracy of 99% for our previously published method trained on 500 000 samples and for the new ensemble technique trained on 160 000 samples. We also showed real-life applications of our approach that address several clinical problems: (1) automatic classification of healthy and injured tendons, (2) assessment of the healing process, (3) a pathologic tissue localization. CONCLUSIONS: The presented method enables acquiring comparable accuracy with less training samples. The applications of the method presented in the paper as case studies can facilitate evaluation of the healing process and comparing with previous examination of the same patient as well as with other patients. This approach might be probably transferred to other musculoskeletal tissues and joints.


Assuntos
Tendão do Calcâneo/patologia , Inteligência Artificial , Cicatrização , Tendão do Calcâneo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Ruptura/diagnóstico por imagem
14.
Rev Col Bras Cir ; 46(1): e2054, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31017177

RESUMO

The equinus deformity causes changes in the foot contact and may affect more proximal anatomical regions, such as the knee, hip and trunk, potentially leading to gait disorders. The equinus is usually secondary to retraction, shortening and/or spasticity of the triceps surae, and it may require surgical correction. Surgery for the correction of equinus is one of the oldest procedures in Orthopedics, and it was initially performed only at the calcaneus tendon. The technique has evolved, so that it could be customized for each patient, depending on the degree of deformity, the underlying disease, and patient´s profile. The aim is to correct the deformity, with minimal interference in muscle strength, thus reducing the incidence of disabling complications such as crouch gait and calcaneus foot. We conducted a literature search for the most common surgical techniques to correct the equinus deformity using classic books and original articles. Further, we performed a database search for articles published in the last ten years. From the anatomical perspective, the triceps surae presents five anatomical regions that can be approached surgically for the equinus correction. Due to the complexity of the equinus, orthopedic surgeons should be experienced with at least one procedure at each region. In this text, we critically approach and analyze the most important techniques for correction of the equinus, mainly to avoid complications.


Assuntos
Pé Equino/cirurgia , Músculo Esquelético/cirurgia , Nervo Sural/cirurgia , Tendão do Calcâneo/patologia , Tendão do Calcâneo/cirurgia , Pé/cirurgia , Humanos , Nervo Sural/patologia , Tenotomia/métodos
15.
Ugeskr Laeger ; 181(8)2019 Feb 18.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30821237

RESUMO

Tendinopathy is a condition of tendon overuse and is a very common cause of morbidity among recreational and competitive athletes. Chronic overload results in degenerative changes of the tendon, which becomes painful and swollen with impaired function. A reduction in the overloading activity is the mainstay of the treatment. A rehabilitating programme consisting of controlled loading of the affected tendon should follow this. Other modalities, which may facilitate treatment, are: injections with corticosteroid, platelet-rich plasma, and of high volume, as well as shock-wave therapy and surgery.


Assuntos
Tendão do Calcâneo , Plasma Rico em Plaquetas , Tendinopatia , Tendão do Calcâneo/patologia , Atletas , Humanos , Injeções , Dor , Tendinopatia/etiologia , Tendinopatia/terapia
16.
ScientificWorldJournal ; 2019: 6043019, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30853864

RESUMO

The objective of this review was to analyze original articles about the effects of therapy with LED in experimental models of calcaneal tendon lesions of rats. The search was performed in the period from February to May 2018, in the following electronic databases: MEDLINE, SciELO, and LILACS, besides the Google Scholar, using the descriptors "Achilles tendon", "Rats", "LED", "Tendinopathy", and "Low-level Light Therapy", as well as their matching parts in the Portuguese and Spanish languages, related to and in association with the relevant terms to the content sought. From the descriptors used 215 works were found. After application of eligibility criteria 8 works were selected, in which positive results were found after the application of the LED. Regarding the main results found with phototherapy, we observed a significant reduction in inflammation. Only one article mentioned little reduction of inflammation. In relation to the number of sessions, there was wide variation, with an average of approximately 5 sessions every 24 hours. Studies in this review pointed out, therefore, positive results in the repair of the calcaneal tendon after therapy with irradiation LED; however, carrying out more experimental studies that help the standardization of parameters to be used in this therapy for further clinical studies becomes necessary.


Assuntos
Tendão do Calcâneo/patologia , Terapia com Luz de Baixa Intensidade , Traumatismos dos Tendões/radioterapia , Tendão do Calcâneo/efeitos da radiação , Animais , Ratos , Traumatismos dos Tendões/patologia
17.
J Med Syst ; 43(5): 122, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-30915598

RESUMO

The use of conventional immobilization splints can cause a lot of mishaps and discomfort in patients. In addition, it is common the generation of muscle, joint and vascular complications arising from the application of classic restraint devices in this phase of treatment. Currently, it is being observed that these problems could be solved with the use of Advanced Manufacturing techniques based on Additive Manufacturing (AM), industrial digitalization and reverse engineering for the realization of individualized immobilization splints. The present study proposes to give these splints a functional character in their design adapting them to a specific pathology, in this case to the partial rupture of Achilles tendon. It also provides a comparison against the use of conventional plaster splints as an improvement factor for their definitive implementation considering the initial sanitary use for which they were designed. In this way, there have been created therapeutic windows that allow the application of rehabilitation techniques, being the treatment that would be carried out developed in parallel. The designed splint has been made in FilaFlex and Polycarbonate, materials that guarantee comfort and resistance at the same time. In addition, an optimization in terms of material has been executed, lightening the splint and reducing environmental impact and manufacturing costs. As a result of this preliminary study, a prototype on scale printed in PLA has been generated.


Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/patologia , Projeto Auxiliado por Computador , Aparelhos Ortopédicos , Desenho de Equipamento , Humanos , Ortopedia , Cimento de Policarboxilato/química , Contenções
18.
J Orthop Surg Res ; 14(1): 54, 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30777116

RESUMO

BACKGROUND: This pilot study aimed to ascertain whether the local application of ascorbic acid (AA), of T3, and of rat (r) bone marrow mesenchymal stem cells (BMSCs), alone or in all possible combinations, promoted healing after an Achilles tendon injury in a rat model. METHODS: An Achilles tendon defect was produced in 24 6-8-week-old male inbred Lewis rats. The animals were then randomly divided into eight groups of three rats each. The tendon defect was filled with 50 µL of phosphate-buffered saline (PBS) containing (1) 50 µg/mL AA (AA group), (2) 10-7 M T3 (T3 group), (3) 4 × 106 rBMSCs (rBMSC group), (4) 50 µg/mL AA + 10-7 M T3 (AA + T3 group), (5) 4 × 106 rBMSCs + 50 µg/mL AA (rBMSC + AA group), (6) 4 × 106 rBMSCs + 10-7 M T3 (rBMSC + T3 group), (7) 4 × 106 rBMSCS + 50 µg/mL AA + 10-7 M T3 (rBMSC + AA + T3 group), and (8) PBS only (control group: CTRL). All treatments were administered by local injection immediately after the tendons had been damaged; additionally, AA was injected also on the second and fourth day from the first injection (for groups 1, 4, 5, and 7), and T3 was injected again every day for 4 days (for groups 2, 4, 6, and 7). At 30 days from initial treatment, tendon samples were harvested, and the quality of tendon repair was evaluated using histological and histomorphological analysis. The structure and morphology of the injured Achilles tendons were evaluated using the modified Svensson, Soslowsky, and Cook score, and the collagen type I and III ratio was calculated. RESULTS: The group treated with AA combined with T3 displayed the lowest Svensson, Soslowsky, and Cook total score value of all tissue sections at histopathological examination, with fiber structure close to regular orientation, normal-like tendon vasculature, and no cartilage formation. AA + T3 also showed the highest collagen I and the lowest collagen III values compared to all other treatments including the CTRL. CONCLUSION: There are potential benefits using a combination of AA and T3 to accelerate tendon healing.


Assuntos
Tendão do Calcâneo/lesões , Ácido Ascórbico/administração & dosagem , Transplante de Células-Tronco Mesenquimais/métodos , Estudo de Prova de Conceito , Ruptura/terapia , Tri-Iodotironina/administração & dosagem , Tendão do Calcâneo/efeitos dos fármacos , Tendão do Calcâneo/patologia , Animais , Células Cultivadas , Modelos Animais de Doenças , Quimioterapia Combinada , Masculino , Projetos Piloto , Ratos , Ratos Endogâmicos Lew , Ruptura/patologia , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia
19.
Int Immunopharmacol ; 70: 117-124, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30798160

RESUMO

Magnolol is a compound that is extracted from magnolia, is used in Chinese medicine and is a type of lignan. Magnolol has various anti-inflammation, anti-proliferation and pro-autophagy effects. Ossified tendinopathy affects many athletes and people with repetitive tendon injuries. Ossified tendinopathy is a tremendous economic burden, and no effective and safe drugs are available to prevent the pathogenesis of ectopic ossification. In this study, we aimed to study how magnolol affects ossified tendinopathy by evaluating its effects on osteogenic differentiation of tendon-derived stem cells (TDSCs). Our data suggested that magnolol attenuated ectopic ossification in the Achilles tendon caused by Achilles tenotomy. Magnolol inhibited PGE2-induced ALP activity and prevented calcium deposits in TDSCs in vitro. Magnolol also exerted inhibitory effects on expression of osteogenic factors, such as Runx2, OCN, and BMP2 in vivo. Further investigation revealed the underlying mechanism by which magnolol prevents PGE2-induced ectopic ossification. Specifically, magnolol inhibits PGE2-induced PI3K/AKT/ß-catenin pathway activation in TDSCs. Our findings demonstrated that magnolol inhibited ossified tendinopathy through preventing osteogenic differentiation of TDSCs via downregulation PGE2-induced PI3K/AKT/ß-catenin pathways.


Assuntos
Tendão do Calcâneo/patologia , Anti-Inflamatórios/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Lignanas/uso terapêutico , Osteogênese/efeitos dos fármacos , Tendinopatia/tratamento farmacológico , Animais , Diferenciação Celular , Células Cultivadas , Dinoprostona/metabolismo , Humanos , Masculino , Medicina Tradicional Chinesa , Fosfatidilinositol 3-Quinases/metabolismo , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Tenotomia , beta Catenina/metabolismo
20.
Ann Chir Plast Esthet ; 64(2): 208-214, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-30745022

RESUMO

INTRODUCTION: Management of the combined loss of Achilles tendon and skin is difficult. However, these are not exceptional situations after Achilles tendon surgery. Data from the literature are extensive and there is currently no consensus on the technique of tendon reconstruction. CASE REPORTS: We report four cases of purulent necrosis of the Achilles tendon complicating longitudinal incision or suturing of a tendon rupture. After debridement of necrotic tissue, the defect was covered either by a fasciocutaneous perforating flap or a thin skin graft without reconstruction of the underlying tendon. DISCUSSION AND CONCLUSION: The functional results are very satisfactory with good joint mobilities and a resumption of walking without lameness for all patients. Fibrosis can reconstitute a true neo-tendon confirmed on MRI. The advantages are many compared to other methods: a single operating time is necessary, the postoperative management is simple and it avoids certain technical difficulties related to tendon reconstruction. A larger series would be needed to support these results.


Assuntos
Tendão do Calcâneo/lesões , Retalhos Cirúrgicos/transplante , Tendão do Calcâneo/patologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/cirurgia , Fotografação , Procedimentos Cirúrgicos Reconstrutivos , Ruptura/cirurgia , Supuração
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