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1.
BMJ ; 370: m3027, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-33315586

RESUMO

OBJECTIVE: To study whether a high volume injection without corticosteroids improves clinical outcome in addition to usual care for adults with chronic midportion Achilles tendinopathy. DESIGN: Patient and assessor blinded, placebo controlled randomised clinical trial. SETTING: Sports medicine department of a large district general hospital, the Netherlands. PARTICIPANTS: 80 adults (aged 18-70 years) with clinically diagnosed chronic midportion Achilles tendinopathy and neovascularisation on ultrasonography. 39 were randomised to a high volume injection without corticosteroids and 41 to placebo. INTERVENTIONS: Participants were instructed to perform an exercise programme for 24 weeks (usual care) combined with one 50 mL high volume injection of saline and lidocaine (intervention group) or one 2 mL placebo injection of saline and lidocaine (placebo group) at baseline. MAIN OUTCOME MEASURES: Primary outcome was pain and function assessed using the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at 24 weeks (analysed using a generalised estimation equations model). Secondary outcomes were patient satisfaction, return to sport, degree of ultrasonographic Doppler flow, visual analogue scale on 10 hop test, power and flexibility of the gastrocnemius and soleus muscles, pain detect questionnaire for neuropathic pain, and pain coping inventory. Participants were evaluated at baseline and at 2, 6, 12, and 24 weeks. RESULTS: Only one participant (1%) was lost to follow-up. The estimated mean VISA-A score improved significantly, from 40.4 (95% confidence interval 32.0 to 48.7) at baseline to 59.1 (50.4 to 67.8) at 24 weeks in the high volume injection group and from 36.9 (27.1 to 46.8) to 58.5 (47.9 to 69.1) in the placebo group. The VISA-A score over time did not differ between the groups (adjusted between group difference at 24 weeks 0.5 points, 95% confidence interval -17.8 to 18.8). No significant between group differences were found for patient satisfaction (21/37 (57%) v 19/39 (49%) patients, P=0.50) and return to desired sport (15/29 (52%) v 19/31 (61%) patients active in sports, P=0.65) at 24 weeks. None of the other secondary outcomes differed between the two groups. CONCLUSIONS: A high volume injection without corticosteroids in addition to usual care is not effective for symptom reduction in patients with chronic midportion Achilles tendinopathy. On the basis of our findings, we cannot recommend the use of a high volume injection in this patient group. TRIAL REGISTRATION: ClinicalTrials.gov NCT02996409.


Assuntos
Tendão do Calcâneo , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Solução Salina/administração & dosagem , Tendinopatia/tratamento farmacológico , Adolescente , Adulto , Idoso , Anestésicos Locais/uso terapêutico , Doença Crônica , Terapia Combinada , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Terapia por Exercício , Feminino , Seguimentos , Humanos , Injeções , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Solução Salina/uso terapêutico , Tendinopatia/diagnóstico , Tendinopatia/terapia , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 99(46): e23201, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181700

RESUMO

OBJECTIVES: Prolotherapy or proliferative therapy is a treatment option for damaged connective tissues involving the injection of a solution (proliferant) which theoretically causes an initial cell injury and a subsequent "proliferant" process of wound healing via modulation of the inflammatory process. Nonetheless, the benefits of dextrose prolotherapy have not been adequately evaluated. Therefore, the present study assesses the effectiveness and superiority of prolotherapy separately in treating dense fibrous connective tissue injuries. METHODS: PubMed, Scopus, and Embase were searched from the earliest record to February 18, 2019. This study included randomized controlled trials whichBoth analysis at individual studies level and pooled meta-analysis were performed. RESULTS: Ten trials involving 358 participants were included for review. At study level, the majority of comparisons did not reveal significant differences between dextrose prolotherapy and no treatment (or placebo) regarding pain control. The meta-analysis showed dextrose prolotherapy was effective in improving activity only at immediate follow-up (i.e., 0-1 month) (standardized mean difference [SMD]: 0.98; 95% confidence interval [CI]: 0.40-1.50; I = 0%); and superior to corticosteroid injections only in pain reduction at short-term follow-up (i.e., 1-3 month) (SMD: 0.70; 95% CI: 0.14-1.27; I = 51%). No other significant SMDs were found in this analysis. CONCLUSIONS: There is insufficient evidence to support the clinical benefits of dextrose prolotherapy in managing dense fibrous tissue injuries. More high-quality randomized controlled trials are warranted to establish the benefits of dextrose prolotherapy. REVIEW REGISTRATION: PROSPERO (CRD42019129044).


Assuntos
Fáscia/efeitos dos fármacos , Glucose/uso terapêutico , Ligamentos/efeitos dos fármacos , Proloterapia/métodos , Tendinopatia/tratamento farmacológico , Fáscia/lesões , Glucose/administração & dosagem , Humanos , Ligamentos/lesões , Metanálise como Assunto , Proloterapia/instrumentação , Revisões Sistemáticas como Assunto
3.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 33-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856437

RESUMO

Aim of the present pilot study was to verify, for the first time ever, the effects of collagen injections in patients with chronic supraspinatus tendinopathy. Eighteen patients with chronic supraspinatus tendinopathy were treated with a series of 4 type I porcine collagen ultrasound-guided injections, at weekly intervals. The effects were verified at 2-week, 1-month and 3-month follow-up by means of shoulder scoring systems and sonography. A very strong evidence (p<0.001) of a statistically significant main effect amongst the multiple clinical observation was found. Ultrasound imaging highlighted improvement in the structural integrity of the tendon. Compared to other injection therapies, collagen injections proved to be at least equally effective, faster acting and safer.


Assuntos
Lesões do Manguito Rotador , Tendinopatia , Colágeno , Humanos , Projetos Piloto , Manguito Rotador , Dor de Ombro , Tendinopatia/diagnóstico por imagem , Tendinopatia/tratamento farmacológico , Ultrassonografia de Intervenção
4.
Expert Opin Pharmacother ; 21(12): 1467-1477, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32511031

RESUMO

INTRODUCTION: Tendinopathies are common in elite and recreational athletes: traditionally considered overuse injuries, they involve excessive tensile loading and subsequent breakdown of the loaded tendon. Many pharmacological treatments have been proposed for the management of tendinopathy, with no agreement regarding the overall best option available both for Achilles and patellar tendinopathy. AREAS COVERED: The present article reports the best scientific evidence regarding the efficacy and safety of different pharmacological treatments in different types of tendinopathy, focusing on Achilles and patellar tendinopathy, the conditions on which more studies have been published. EXPERT OPINION: No univocal evidence exists regarding the best non-operative management, which includes non-steroidal anti-inflammatory drugs, platelet-rich plasma, high volume image-guided injections, hyaluronic acid, and prolotherapy, for tendinopathy (in particular Achilles and patellar tendinopathies) as a suitable alternative to the commonly used eccentric loading rehabilitation regimen. It is unclear whether the combination of pharmacological substances with physical therapy would produce better results than physical therapy alone. There is an overall lack of published well-performed randomized controlled trials comparing the various options available for the management of tendinopathy, studying large cohorts of patients for adequately long follow-up periods and with well-validated standardized scores and scales.


Assuntos
Tendão do Calcâneo/efeitos dos fármacos , Ligamento Patelar/efeitos dos fármacos , Modalidades de Fisioterapia , Tendinopatia/tratamento farmacológico , Tendão do Calcâneo/lesões , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Ensaios Clínicos como Assunto , Terapia Combinada , Humanos , Ligamento Patelar/lesões , Plasma Rico em Plaquetas , Polidocanol/administração & dosagem , Polidocanol/uso terapêutico , Tendinopatia/terapia , Resultado do Tratamento
5.
PLoS One ; 15(4): e0231619, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294117

RESUMO

BACKGROUND: Tendinopathy is a common musculoskeletal disorder and current treatment options show limited success. Genipin is an effective collagen crosslinker with low cytotoxicity and a promising therapeutic strategy for stabilizing an intratendinous lesion. PURPOSE: This study examined the mechanical effect and delivery of intratendinous genipin injection in healthy and degenerated tendons. STUDY DESIGN: Controlled laboratory study. METHODS: Bovine superficial digital flexor tendons were randomized into four groups: Healthy control (N = 25), healthy genipin (N = 25), degenerated control (N = 45) and degenerated genipin (N = 45). Degeneration was induced by Collagenase D injection. After 24h, degenerated tendons were subsequently injected with either 0.2ml of 80mM genipin or buffer only. 24h post-treatment, samples were cyclically loaded for 500 cycles and then ramp loaded to failure. Fluorescence and absorption assays were performed to analyze genipin crosslink distribution and estimate tissue concentration after injection. RESULTS: Compared to controls, genipin treatment increased ultimate force by 19% in degenerated tendons (median control 530 N vs. 633 N; p = 0.0078). No significant differences in mechanical properties were observed in healthy tendons, while degenerated tendons showed a significant difference in ultimate stress (+23%, p = 0.049), stiffness (+27%, p = 0.037), work to failure (+42%, p = 0.009), and relative stress relaxation (-11%, p < 0.001) after genipin injection. Fluorescence and absorption were significantly higher in genipin treated tendons compared to control groups. A higher degree of crosslinking (+45%, p < 0.001) and a more localized distribution were observed in the treated healthy compared to degenerated tendons, with higher genipin tissue concentrations in healthy (7.9 mM) than in degenerated tissue (2.3 mM). CONCLUSION: Using an ex-vivo tendinopathy model, intratendinous genipin injections recovered mechanical strength to the level of healthy tendons. Measured by genipin tissue distribution, injection is an effective method for local delivery. CLINICAL RELEVANCE: This study provides a proof of concept for the use of intratendinous genipin injection in the treatment of tendinopathy. The results demonstrate that a degenerated tendon can be mechanically augmented by a clinically viable method of local genipin delivery. This warrants further in vivo studies towards the development of a clinically applicable treatment based on genipin.


Assuntos
Adesivos/administração & dosagem , Colágeno/efeitos dos fármacos , Iridoides/administração & dosagem , Tendinopatia/tratamento farmacológico , Tendões/efeitos dos fármacos , Animais , Bovinos , Colágeno/metabolismo , Humanos , Injeções Intralesionais , Tendinopatia/patologia , Tendões/patologia , Resistência à Tração
6.
Biochem Pharmacol ; 175: 113919, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32194057

RESUMO

Achilles tendinopathy has a high re-injury rate and poor prognosis. Development of effective therapy for Achilles tendinopathy is important. Excessive accumulation of ROS and resulting oxidative stress are believed to cause tendinopathy. Overproduction of hydrogen peroxide (H2O2), the most common ROS, could lead to the tendinopathy by causing oxidative damage, activation of endoplasmic reticulum (ER) stress and apoptotic death of tenocytes. Activation of mitochondrial aldehyde dehydrogenase 2 (ALDH2) is expected to alleviate oxidative stress and ER stress. Alda-1 is a selective and potent activator of ALDH2. In this study, we examined the cytoprotective benefit of Alda-1, an activator of ALDH2, on H2O2-induced Achilles tendinopathy in cellular and mouse models. We prepared cellular and mouse models of Achilles tendinopathy by treating cultured Achilles tenocytes and Achilles tendons with oxidative stressor H2O2. Subsequently, we studied the protective benefit of Alda-1 on H2O2-induced Achilles tendinopathy. Alda-1 pretreatment attenuated H2O2-induced cell death of cultured Achilles tenocytes. Treatment of Alda-1 prevented H2O2-induced oxidative stress and depolarization of mitochondrial membrane potential in tenocytes. Application of Alda-1 attenuated H2O2-triggered mitochondria- and ER stress-mediated apoptotic cascades in cultured tenocytes. Alda-1 treatment ameliorated the severity of H2O2-induced Achilles tendinopathy in vivo by preventing H2O2-induced pathological histological features of Achilles tendons, apoptotic death of Achilles tenocytes and upregulated expression of inflammatory cytokines IL-1ß and TNF-α. Our results provide the evidence that ALDH2 activator Alda-1 ameliorates H2O2-induced Achilles tendinopathy. Alda-1 could be used for preventing and treating Achilles tendinopathy.


Assuntos
Tendão do Calcâneo/metabolismo , Aldeído-Desidrogenase Mitocondrial/metabolismo , Benzamidas/uso terapêutico , Benzodioxóis/uso terapêutico , Modelos Animais de Doenças , Tendinopatia/tratamento farmacológico , Tendinopatia/metabolismo , Tendão do Calcâneo/efeitos dos fármacos , Tendão do Calcâneo/patologia , Animais , Benzamidas/farmacologia , Benzodioxóis/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência Celular/fisiologia , Células Cultivadas , Relação Dose-Resposta a Droga , Peróxido de Hidrogênio/toxicidade , Camundongos , Camundongos Endogâmicos C57BL , Tendinopatia/patologia , Tenócitos/efeitos dos fármacos , Tenócitos/metabolismo , Tenócitos/patologia
7.
Biomed Res Int ; 2020: 5052028, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32090096

RESUMO

Achilles tendinitis caused by overuse, aging, or gradual wear induces pain, swelling, and stiffness of Achilles tendon and leads to tendon rupture. This study was performed to investigate the suppression of inflammation responses in interleukin-1ß- (IL-1ß-) stimulated tenocytes in vitro and the suppression of the progression of Achilles tendinitis-induced rat models in vivo using dexamethasone-containing porous microspheres (DEX/PMSs) for a sustained intratendinous DEX delivery. DEX from DEX/PMSs showed the sustained release of DEX. Treatment of IL-1ß-stimulated tenocytes with DEX/PMSs suppressed the mRNA levels for COX-2, IL-1ß, IL-6, and TNF-α. The intratendinous injection of DEX/PMSs into Achilles tendinitis rats both decreased the mRNA levels for these cytokines and increased mRNA levels for anti-inflammatory cytokines IL-4 and IL-10 in tendon tissues. Furthermore, DEX/PMSs effectively prevented tendon degeneration by enhancing the collagen content and biomechanical properties. Our findings suggest that DEX/PMSs show great potential as a sustained intratendinous delivery system for ameliorating inflammation responses as well as tendon degeneration in Achilles tendinitis.


Assuntos
Tendão do Calcâneo/patologia , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Inflamação/tratamento farmacológico , Microesferas , Tendinopatia/tratamento farmacológico , Tendão do Calcâneo/efeitos dos fármacos , Animais , Anti-Inflamatórios/farmacologia , Anti-Inflamatórios/uso terapêutico , Morte Celular/efeitos dos fármacos , Citocinas/genética , Citocinas/metabolismo , Dexametasona/farmacologia , Modelos Animais de Doenças , Liberação Controlada de Fármacos , Hidroxiprolina/metabolismo , Inflamação/complicações , Mediadores da Inflamação/metabolismo , Masculino , Porosidade , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Sprague-Dawley , Suínos , Tendinopatia/complicações , Resistência à Tração , Resultado do Tratamento
9.
s.l; RedARETS; feb. 2020.
Não convencional em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-1095215

RESUMO

TECNOLOGÍA EVALUADA: Inyección peritendinosa de ácido hialurônico. GUIAS DE PRÁCTICA CLÍNICA: No se encontraron guias de práctica clínica que evalúen la recomendación incluida en la pregunta de investigación. BUSQUEDA BIBLIOGRÁFICA: Terminología: Medical Subject Headings (MeSH). Estrategia en Medline. Estrategia epistemonikos. Estrategia Cochrane library. RESULTADOS: Desenlace: Reducción del dolor 3 a 6 semanas. Desenlace: mejoría funcional a las 6 semanas. I2 mayor al 90%. Diferencias en intervenciones y pacientes. Evaluado para lesiones tendinosas sin ruptura en general del manguito de los rotadores. Ausencia de estudios pequeños con resultados negativos. Estudios registrados en clinical trials. gov no publicados.


Assuntos
Humanos , Tendinopatia/tratamento farmacológico , Ácido Hialurônico/uso terapêutico , Avaliação da Tecnologia Biomédica , Análise Custo-Benefício
10.
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
11.
Medicina (Kaunas) ; 55(8)2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31394838

RESUMO

Tendinopathies are very common in general population and a huge number of tendon-related procedures take place annually worldwide, with significant socio-economic repercussions. Numerous treatment options are commonly used for tendon disorders. Besides pharmacological and physical therapy, nutrition could represent an additional tool for preventing and treating this complex pathology that deserve a multidisciplinary approach. In recent years, nutraceutical products are growing up in popularity since these seem to favor the prevention and the healing processes of tendon injuries. This narrative literature review aims to summarize current understanding and the areas of ongoing research about the management of tendinopathies with the help of oral supplementation.


Assuntos
Suplementos Nutricionais/normas , Tendinopatia/tratamento farmacológico , Tendinopatia/fisiopatologia , Tendinopatia/terapia , Suplementos Nutricionais/efeitos adversos , Humanos , Tendões/efeitos dos fármacos , Tendões/fisiopatologia
12.
Foot Ankle Clin ; 24(3): 471-493, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31370998

RESUMO

Regenerative medicine is gaining more and more space for the treatment of Achilles pathologic conditions. Biologics could play a role in the management of midportion Achilles tendinopathy as a step between conservative and surgical treatment or as an augmentation. Higher-level studies are needed before determining a level of treatment recommendation for biologic strategies for insertional Achilles tendinopathy. Combining imaging with patient's functional requests could be the way to reach a protocol for the use of biologics for the treatment of midportion Achilles tendinopathy and, for this perspective, the authors describe the Foot and Ankle Reconstruction Group algorithm of treatment.


Assuntos
Tendão do Calcâneo , Produtos Biológicos/uso terapêutico , Tendinopatia/tratamento farmacológico , Algoritmos , Humanos , Imagem por Ressonância Magnética , Plasma Rico em Plaquetas , Transplante de Células-Tronco , Tendinopatia/diagnóstico por imagem
13.
IUBMB Life ; 71(12): 1986-1993, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31408279

RESUMO

Several studies have identified potential roles for MFG-E8 in promoting tissue repair. However, the effects of MFG-E8 on tendon repair have not yet been investigated. Therefore, we explored the role of MFG-E8 on tendon repair using a rat model of patellar tendon injury. The patellar tendons of Sprague Dawley rats (n = 24/group) received window defects and, after modeling, three groups were randomly assigned: (a) recombinant MFG-E8 (rMFG-E8) group, implantation with MFG-E8 and fibrin glue (400 ng in 10 µl); (b) fibrin group, implantation with fibrin only; and (c) control group, without any treatment. Histopathology, immunohistochemistry, and gene expression analyses were performed at 2 and 4 weeks after healing. Administration of rMFG-E8 in injury sites significantly improved tendon healing histologically at 4 weeks after injury. In addition, numbers of M1 macrophages and M1-stimulator genes, including IFNG, Il-1B, and Il-6, were reduced in the repair sites at 2 weeks by rMFG-E8 administration. In parallel, rMFG-E8 significantly increased the number of M2 macrophages and expression of anti-inflammatory IL-10 and IL-4 at 2 weeks after injury. Treatment with rMFG-E8 markedly decreased tendon cell apoptosis. Moreover, rMFG-E8 significantly enhanced the expression of genes related to tendon matrix formation at 2 weeks after injury, including Col1a1and tenascin-C. We conclude that MFG-E8 could regulate inflammatory responses and apoptotic cell accumulation in tendon repair, and promote the healing process of injured tendon tissue. Thus, exogenous application of MFG-E8 might have therapeutic potential for repair of tendon injuries.


Assuntos
Antígenos de Superfície/farmacologia , Proteínas do Leite/farmacologia , Traumatismos dos Tendões/tratamento farmacológico , Traumatismos dos Tendões/patologia , Animais , Apoptose/efeitos dos fármacos , Apoptose/fisiologia , Regulação da Expressão Gênica/efeitos dos fármacos , Interleucina-10/genética , Interleucina-4/genética , Macrófagos/efeitos dos fármacos , Masculino , Ratos Sprague-Dawley , Proteínas Recombinantes/farmacologia , Tendinopatia/tratamento farmacológico , Tendinopatia/patologia
15.
Foot Ankle Int ; 40(8): 888-894, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31068007

RESUMO

BACKGROUND: The treatment of symptomatic peroneal tendinopathy and tears traditionally begins with nonsteroidal anti-inflammatory drugs, activity modification, physical therapy, and immobilization, with surgery typically reserved for those failing nonoperative treatment. Ultrasound-(US)-guided peroneal tendon sheath (PTS) corticosteroid injection is an additional nonoperative modality, but limited data exist on its safety and efficacy. The purpose of this study was to assess clinical outcomes following US-guided PTS corticosteroid injection for chronic tendinopathy or tears. METHODS: We retrospectively identified patients who had undergone US-guided PTS corticosteroid injection for pain due to peroneal tendinopathy, tears, or subluxation at our institution from 2012 to 2018. Underlying diagnosis was based on clinical examination, magnetic resonance imaging (MRI) results, and/or intraoperative findings, when available. Medical record data were supplemented by e-mail or telephone follow-up. Collected information included patient age, sex, body mass index (BMI), smoking status, workers' compensation status, prior surgeries about the foot and ankle, duration of symptoms prior to injection, perceived improvement in pain following injection and its duration, number of injections, progression to surgery, and any adverse outcomes of injection. We identified 96 patients (109 injections). Thirty-seven (38.5%) had previous foot and ankle surgery, with 17 (17.7%) having surgery specifically on the peroneal tendons. RESULTS: Twenty-four of 96 (25%) progressed to have surgery on their peroneal tendons following injection. Following injection, 38/87 (43.7%) of patients reported 0-1 weeks of pain relief, 11/87 (12.6%) 2-6 weeks, 6/87 (6.9%) 7-12 weeks, and 32/87 (36.8%) greater than 12 weeks. Preinjection duration of symptoms was associated with postinjection duration of pain relief (P=.036). There were 2 reported complications (1.8%): 1 case of self-limited sural nerve irritation and 1 of peroneus longus tear progression. CONCLUSION: Our study demonstrates US-guided PTS corticosteroid injection was safe and relatively effective in patients with symptomatic peroneal tendon tears or tendinopathy, including those who had undergone prior surgery, and may be considered in a comprehensive protocol of nonoperative management. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Corticosteroides/uso terapêutico , Traumatismos do Tornozelo/tratamento farmacológico , Injeções/métodos , Tendinopatia/tratamento farmacológico , Traumatismos dos Tendões/tratamento farmacológico , Ultrassonografia de Intervenção , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Adulto Jovem
16.
J Orthop Res ; 37(8): 1838-1847, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31042324

RESUMO

Platelet-rich plasma (PRP) and broad-spectrum matrix metalloproteinase inhibitors (MMPIs) have been used as therapeutic options for tendinopathy. However, mixed results have been reported regarding their efficacy. We posited that the combination of these two treatment strategies would be more beneficial for healing tendons than each treatment alone. Rat tail tendons were harvested and cultured without mechanical stress for 0, 4, or 10 days. Single and combination treatment with PRP and MMPIs with either broad- or narrow-spectrum (MMP-13 selective), was administered to 4-day stress-deprived (SD) tendons, an ex vivo model for moderate tendinopathy. This treatment was applied to the damaged tendons over 6 days. At the end of their culture time, the tendons were subjected to traction testing and pathohistology, immunohistochemistry, and viability assays. The results showed better histological features for the PRP + narrow-spectrum MMPI group compared with all individual treatment modalities. Moreover, higher fiber density, more elongated nucleus shape, smaller space between fibers, and a trend toward higher mechanical strength were noted for PRP + narrow-spectrum MMPI group compared with 10-day SD tendons. This study shows that the combination of PRP + narrow-spectrum MMPI is a potentially effective treatment approach for tendinopathy. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1838-1847, 2019.


Assuntos
Inibidores de Metaloproteinases de Matriz/administração & dosagem , Plasma Rico em Plaquetas , Tendinopatia/tratamento farmacológico , Tendões/efeitos dos fármacos , Tendões/patologia , Animais , Sobrevivência Celular , Imuno-Histoquímica , Técnicas In Vitro , Masculino , Metaloproteinase 13 da Matriz/metabolismo , Ratos , Ratos Sprague-Dawley , Estresse Mecânico
17.
Agri ; 31(2): 107-110, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30995330

RESUMO

Rotator cuff calcific tendinitis is a common shoulder disorder that usually subsides spontaneously. Some patients, however, do not show any improvement in the pain after conservative treatment for an extended period of time. The aim of this report was to demonstrate the improvement in a patient with calcific tendinitis of infraspinatus following treatment with platelet-rich plasma (PRP). Although the efficacy of PRP therapy in this condition is uncertain, it can be an effective treatment option in refractory cases.


Assuntos
Osteoartrite/tratamento farmacológico , Plasma Rico em Plaquetas , Manguito Rotador , Dor de Ombro/tratamento farmacológico , Tendinopatia/tratamento farmacológico , Feminino , Humanos , Injeções Intra-Articulares , Pessoa de Meia-Idade , Medição da Dor
19.
Exp Cell Res ; 378(2): 119-123, 2019 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-30849310

RESUMO

Tendinopathy is a common and disabling condition that is difficult to treat. The pathomolecular events behind tendinopathy remain uncertain. Micro-RNAs (miRNAs, miRs) are short non-coding RNAs that regulate gene expression and may play a role in tendinopathy development. Tenocytes were obtained from human patellar tendons in patients undergoing anterior cruciate ligament (ACL) reconstruction. Micro-RNA mimics and antagomirs for miR-30d, 26a, and 29a were separately transfected into tenocyte culture. Gene expression for scleraxis, collagen 1 alpha 1 (COL1A1), collagen 3 alpha 1 (COL3A1), interleukin-1-beta (IL-1ß), interleukin-6 (IL-6), bone morphogenic protein 2 (BMP2), bone morphogenic protein 12 (BMP12), and osteocalcin was determined for each miRNA mimic and antagomir transfection using real-time quantitative PCR (qPCR). The results showed that exogenous miR-29a downregulated BMP2 and BMP12, while miR-26a and miR-30d did not have a significant effect on tenocyte gene expression. These findings suggest miR-29a contributes to tendon homeostasis and can serve as a potential therapeutic target in treating tendinopathy.


Assuntos
Antagomirs/farmacologia , MicroRNAs/farmacologia , Osteogênese/genética , Tendinopatia/tratamento farmacológico , Tenócitos/efeitos dos fármacos , Adulto , Reconstrução do Ligamento Cruzado Anterior , Proteínas Morfogenéticas Ósseas/genética , Proteínas Morfogenéticas Ósseas/metabolismo , Células Cultivadas , Expressão Gênica/efeitos dos fármacos , Humanos , MicroRNAs/genética , Osteogênese/efeitos dos fármacos , Tendinopatia/genética , Tenócitos/metabolismo , Transfecção
20.
Discov Med ; 27(147): 63-77, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30825883

RESUMO

Rotator cuff tendinopathy is one of the leading causes of shoulder pain. However, the mechanisms involved in the development of rotator cuff tendinopathy pain are not fully understood. In this study, we first examined the histological features of subacromial bursa from patients with rotator cuff tendinopathy who had symptoms of pain, and investigated the expression of pain mediators, proinflammatory cytokines, metalloproteinases, growth factors, and alarmins in diseased tendon and bursa tissue by real-time PCR, western blot, and/or immunohistochemistry/immunofluorescence staining. Then we investigated whether epigallocatechin-3-gallate (EGCG) could reduce the expression of pain mediators and proinflammatory cytokines in human primary bursa cells and explored the paracrine effect of these EGCG-treated bursa cells on tenocytes in vitro. Neovascularization and infiltration of immune cells including monocytes/macrophages and mast cells were observed in diseased bursa tissue. Bursa from patients with pain had higher mRNA expression of pain mediators and proinflammatory cytokines, compared to the rotator cuff tendon of the same patients, as well as the bursa from asymptomatic patients. EGCG treatment significantly suppressed the interleukin 1 beta (IL-1ß)-induced elevation of mRNA expression of pain mediators, proinflammatory cytokines, and matrix metalloproteinases (MMPs) in bursa cells in vitro; conditioned medium from EGCG-treated bursa cells significantly reduced IL-1ß-induced expression in human primary tenocytes. Our study suggests that the subacromial bursa might serve as a local source of pain mediators and proinflammatory cytokines in rotator cuff tendinopathy. Moreover, EGCG treatment by primarily targeting the subacromial bursa may be a potential strategy to relieve rotator cuff tendinopathy-related pain and symptoms.


Assuntos
Bolsa Sinovial/metabolismo , Catequina/análogos & derivados , Mediadores da Inflamação/metabolismo , Dor , Manguito Rotador/metabolismo , Tendinopatia , Idoso , Bolsa Sinovial/patologia , Catequina/farmacologia , Citocinas/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/tratamento farmacológico , Dor/metabolismo , Dor/patologia , Manguito Rotador/patologia , Tendinopatia/tratamento farmacológico , Tendinopatia/metabolismo , Tendinopatia/patologia
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