| 1. |
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| 2. |
- Fridén, Thomas, et al.
(författare)
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Function after anterior cruciate ligament injuries. Influence of visual control and proprioception
- 1998
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 69:6, s. 590-594
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Tidskriftsartikel (refereegranskat)abstract
- Information about limb positions and movements consists of input from visual, vestibular, cutaneous, muscular, tendinous and joint receptors, but the relative contribution from each type and location of receptors is not known. The aim of this study was: a) to measure the contribution from visual control on extremity function, as measured with a one-leg hop test in healthy persons, in patients with an asymptomatic ACL injury, after non-operative treatment and in patients with a stable knee after an ACL reconstruction, b) to investigate if there was any relation between proprioception from the extremity, as measured with the threshold for detecting passive motion of the knee, and the one-leg hop test with a gradual decrease in visual control. There was a decrease in hop-length when the subjects were deprived of visual control that was significant when the dominant eye or both eyes were blinded, both in the 2 patient groups and the reference population. The magnitude of the length reduction did not differ between the groups or between injured and healthy limbs. In all 4 threshold tests performed as a measure of peripheral proprioception, a stronger relation to hop-length was recorded for the blinded hop than with full visual control in the patients with nonoperated ACL injuries. The coefficients of correlation between hop-length and the proprioceptive recordings in the injured limb were of the same magnitude as on the healthy side.
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| 3. |
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| 7. |
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| 8. |
- Froberg, A, et al.
(författare)
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Force in the achilles tendon during walking with ankle foot orthosis
- 2009
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 37:6, s. 1200-1207
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Tidskriftsartikel (refereegranskat)abstract
- Ankle foot orthoses are used for postoperative treatment of Achilles tendon ruptures and decrease calf muscle electromyography activity during walking. Hypothesis Achilles tendon load decreases with increased restriction of dorsiflexion and is associated with decreased triceps surae activity. Study Design Controlled laboratory study. Methods In 8 subjects, the maximum force and rate of force development in the Achilles tendon were measured with an optic fiber technique, and the activity of the gastrocnemius, soleus, and tibialis anterior muscles was recorded using electromyography. Trial conditions were walking barefoot and wearing an ankle-foot orthoses set in 3 different positions: (1) locked at 20° of plantar flexion and with free plantar flexion but restricted dorsiflexion to (2) 10° plantar flexion and (3) 10° dorsiflexion, respectively. The design of the ankle foot orthoses did not provide heel support when fixed in a plantarflexed position. Results Maximum Achilles tendon force was highest at the ankle-foot orthoses setting of 20° plantar flexion (3.1 times body weight) and decreased to 2.1 times body weight during barefoot walking ( P < .01). The rate of Achilles tendon force showed an increasing trend with less-restricted dorsiflexion. Soleus activity was 52% of mean barefoot walking activity at 3 20° plantar flexion ( P < .001) and then increased as dorsiflexion was less restricted. Conclusion Weightbearing in ankle-foot orthoses when dorsiflexion is restricted beyond neutral may result in increased forces in the Achilles tendon compared with barefoot walking, despite reduced electromyography activity in the triceps surae and decreased rate of force development. Clinical Relevance If patients bear full weight in an ankle-foot orthoses locked at 20° plantar flexion without heel support, the maximum force in the tendon may exceed that encountered during barefoot walking.
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| 9. |
- Gardin, A, et al.
(författare)
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Magnetic resonance signal, rather than tendon volume, correlates to pain and functional impairment in chronic Achilles tendinopathy
- 2006
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 47:7, s. 718-724
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To depict abnormal tendon matrix composition using magnetic resonance imaging (MRI) in chronic Achilles tendinopathy, and correlate intratendinous signal alterations to pain and functional impairment. Material and Methods: MRI of the Achilles tendon was performed on 25 patients with chronic Achilles tendinopathy (median age 50, range 37–71 years). All patients suffered from pain in the mid-portion of the Achilles tendon. Intratendinous signal was calculated from five different sagittal sequences, using a computerized 3D seed-growing technique. Pain and functional impairment were evaluated using a questionnaire completed by patients. Results: Severity of pain and functional impairment correlated to increased mean intratendinous signal in the painful tendon in all MR sequences ( P<0.05, median r = 0.38, range 0.28–0.43 for pain; P<0.05, median r = 0.48, range 0.29–0.49 for functional impairment). However, tendon volume did not correlate to pain or functional impairment ( P>0.05). Difference in mean intratendinous signal between symptomatic and contralateral asymptomatic tendons was highly significant in all sequences ( P<0.05) except on T2-weighted images ( P = 0.6). Conclusion: Severity of pain and disability correlated to increased MR signal rather than to tendon volume in patients with unilateral mid-portion chronic Achilles tendinopathy.
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| 10. |
- Ibrahim, Mustafa, et al.
(författare)
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Histological and ultrastructural degenerative findings in the gluteus medius tendon after hip arthroplasty
- 2021
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Ingår i: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Despite gluteus medius (GMED) tendinosis being relatively common, its presence in association with hip osteoarthritis (OA) or total hip arthroplasty (THA) is not well studied. It was hypothesized that more tendon degeneration would be found in patients with OA of the hip and in those that had undergone THA than that in a control group. Methods One hundred patients were included between 2016 and 2019 and were included into 4 groups; the patients were undergoing revision surgery in two groups and primary THA in the other two groups; 22 patients had previously undergone primary THA through a direct lateral approach (involving sectioning of the GMED tendon), 24 patients had previously undergone primary THA through a posterior approach (leaving the GMED tendon intact), 29 patients had primary hip OA, and 25 patients who suffered a femoral neck fracture served as controls. Biopsies from the GMED tendon were obtained at the time of the primary THA or the hip revision surgery. The tendon biopsies were examined ultrastructurally and histologically. Results Ultrastructurally, the direct lateral and posterior revision groups had statistically significantly more collagen fibrils with smaller diameters compared with the fracture and primary THA groups. Moreover, the direct lateral revision group had more collagen fibrils with smaller diameters compared with the posterior revision group. Histologically, the direct lateral revision group had a higher total degeneration score (TDS) compared with the primary hip OA group. Conclusions The GMED tendon shows more ultrastructural degeneration in patients who undergo hip revision arthroplasty than in patients with primary OA of the hip and control patients, who had suffered a femoral neck fracture. Furthermore, patients who had previously undergone primary THA through a direct lateral approach revealed more histological GMED tendon degeneration than patients who suffer primary hip OA.
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| 11. |
- Kader, D, et al.
(författare)
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Achilles tendinopathy: some aspects of basic science and clinical management
- 2002
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Ingår i: British journal of sports medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 36:4, s. 239-249
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Tidskriftsartikel (refereegranskat)abstract
- Achilles tendinopathy is prevalent and potentially incapacitating in athletes involved in running sports. It is a degenerative, not an inflammatory, condition. Most patients respond to conservative measures if the condition is recognised early. Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.
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| 12. |
- Kartus, J, et al.
(författare)
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A radiographic and histologic evaluation of the patellar tendon after harvesting its central third
- 2000
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 28:2, s. 218-226
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Tidskriftsartikel (refereegranskat)abstract
- Nineteen consecutive patients undergoing anterior cruciate ligament reconstruction using the central third of the ipsilateral patellar tendon were included in the study. Serial magnetic resonance images revealed that the donor-site gap in the tendon decreased with time (mean follow-up, 26 months). The thickness was significantly increased compared with the intact contralateral patellar tendon, regardless of when the magnetic resonance imaging was performed. Ultrasonography showed the same findings at a mean follow-up of 26 months. Histologic evaluation of the repair tissue in the central part of the tendon, as well as the tissue in the peripheral part of the patellar tendon at the donor site, revealed a significant increase in cellularity and vascularity as compared with normal control tendons. Thus, 2 years after the harvesting procedure, the patellar tendon displayed significant radiographic and histologic abnormalities. On the basis of these findings, reharvest of the patellar tendon, at least up to 2 years after primary harvest, cannot be recommended.
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| 13. |
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| 15. |
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| 16. |
- Liden, M, et al.
(författare)
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A histological and ultrastructural evaluation of the patellar tendon 10 years after reharvesting its central third
- 2008
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 36:4, s. 781-788
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Tidskriftsartikel (refereegranskat)abstract
- This study was undertaken to evaluate the histologic and ultrastructural characteristics of the patellar tendon 10 years after reharvesting its central third. Hypothesis In the long term, after its central third is reharvested, the patellar tendon does not regain a normal histological and ultrastructural appearance. Study Design Case-control study; Level of evidence, 3. Methods Twelve consecutive patients (4 women, 8 men) who underwent anterior cruciate ligament revision surgery using reharvested ipsilateral patellar tendon autografts were included in the study. Percutaneous biopsy samples were obtained from the central and lateral parts of the patellar tendon under ultrasonographic guidance at a median of 116 months (range, 102–127 months) after the revision procedure. Eleven biopsy specimens from asymptomatic patellar tendons obtained from open anterior cruciate ligament reconstructions served as controls. The histologic characteristics and the presence of glycosaminoglycans were assessed using a light microscope, and the ultrastructure was assessed using a transmission electron microscope. Results The histological evaluation revealed deterioration in fiber structure, increased cellularity, and increased vascularity in both the central and peripheral parts of the reharvested patellar tendon specimens compared with normal tendon specimens. No difference in the amount of glycosaminoglycans was seen in specimens from either part of the reharvested patellar tendons and the control specimens. The ultrastructural evaluation revealed that all the control specimens had a normal morphologic appearance and a compact extracellular matrix with regularly oriented collagen fibrils. Furthermore, in the control specimens, the fibril diameter was heterogeneous, with all fibril size classes present. Specimens from the central and the lateral part of the reharvested tendon displayed pathological cell appearance and a more heterogeneous extracellular matrix. The lateral specimens from the reharvested tendons also displayed all fibril size classes but with a more homogeneous distribution. In the central specimens, the largest fibril size class was absent. Conclusion Ten years after its central third was reharvested for anterior cruciate ligament revision surgery, the patellar tendon had not normalized in terms of its histological and ultrastructural appearance.
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| 17. |
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| 18. |
- Movin, T, et al.
(författare)
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Acute rupture of the Achilles tendon
- 2005
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Ingår i: Foot and ankle clinics. - : Elsevier BV. - 1083-7515. ; 10:2, s. 331-56
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Tidskriftsartikel (refereegranskat)
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| 19. |
- Movin, T, et al.
(författare)
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Intratendinous alterations as imaged by ultrasound and contrast medium-enhanced magnetic resonance in chronic achillodynia
- 1998
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Ingår i: Foot & ankle international. - : SAGE Publications. - 1071-1007 .- 1944-7876. ; 19:5, s. 311-317
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We performed a comparative study of ultrasonography and gadolinium imaging contrast-enhanced T1-weighted magnetic resonance to evaluate tendon pathology in chronic Achilles tendon disorder. Another main issue was to evaluate the structural basis as defined by histopathology from hypoechoic compared with normoechic areas within the same tendon. Materials and Methods: Twenty patients (16 male, 4 females, median age 40 years) with chronic achillodynia participated in the study. Clinical examination revealed swelling and tenderness localized to the midportion of the Achilles tendon. Contrast medium-enhanced magnetic resonance imaging (CME-MRI) was performed in all patients. Ultrasonography-guided core biopsies were taken from regions with a clear widening of the tendon and a pathologic low-echo signal as well as from normoechoic areas. The specimens were analyzed with a standardized protocol giving a total tendon score (0–24), and a stereologic method for quantification of glycosaminoglycan (GAG)-rich areas. Results: The volume of the intratendinous abnormality was larger in 13 of 20 when imaged by CME-MR ( P < 0.05), whereas the shape and enlargement of the tendon per se were similarly imaged by ultrasound (US) and CME-MR. Tendon pathology as imaged by US was graded as severe from hypoechoic regions and moderate from normoechoic regions. The corresponding quantification of GAGs was 0.36 compared with 0.17, respectively ( P < 0.001). Conclusion: CME-MR imaging revealed greater sensitivity in demonstrating intratendinous pathology than the ultrasound; this was documented by the larger size of the corresponding lesion and the fact that the pathology was occurring in areas that were considered normal by ultrasonography. US hypoechoic areas showed a markedly abnormal tendon structure including an increased amount of GAG-rich areas. However, moderate pathology was also found in the neighboring normoechogenous areas within the same tendon, indicating a more generalized disorder than depicted by echogenic properties.
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| 20. |
- Movin, T, et al.
(författare)
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MR imaging in chronic Achilles tendon disorder
- 1998
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 39:2, s. 126-132
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: the primary objective was to compare 4 imaging sequences (T1-weighted, T2-weighted, proton density, and T1-weighted with gadolinium contrast agent enhancement) with regard to intratendinous signal abnormality in patients with achillodynia. the secondary objective was to relate the images to the clinical symptoms and histopathological findings Material and Methods: Twenty patients (16 men, 4 women, median age 40 years) with chronic achillodynia participated in the study. the symptoms prohibited activity and clinical examination revealed swelling and tenderness 1.5–6 cm proximal to the Achilles tendon insertion. of the 20 patients: 5 had bilateral achillodynia, 4 had had previous contralateral Achilles tendon disorder, and 11 had never had symptoms in the contralateral tendon region. These 11 tendons served as controls for comparison MR imaging was performed on a superconductive 1.5 T unit. Both Achilles tendons were examined (n=40) at the same time, and multiple sagittal and transversal images were obtained. the corresponding sections on these images were visually graded according to both extension and level of MR signal intensity. Tissue was obtained for microscopic examination from the most symptomatic side in all patients (n=20) Results: T1-weighted images following gadolinium contrast medium enhancement proved to be the best method by which to visualize intratendinous signal abnormality. This sequence revealed signal abnormality in 24/25 symptomatic tendons and in 1/11 control tendons ( p>0.001). Histopathological examination showed an increased noncollagenous extracellular matrix and altered fiber structure in the lesions corresponding to the contrast-enhanced areas Conclusion: Gadolinium enhancement improved the imaging of intratendinous signal abnormality on T1-weighted images. There was a high level of extracellular glycosaminoglycans, which are highly-fixed negatively-charged macromolecules with extreme water-retaining capacity and which may have contributed to the enhancement by the gadolinium contrast agent
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| 21. |
- Movin, T, et al.
(författare)
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Pathology of the Achilles tendon in association with ciprofloxacin treatment
- 1997
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Ingår i: Foot & ankle international. - : SAGE Publications. - 1071-1007 .- 1944-7876. ; 18:5, s. 297-299
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Tidskriftsartikel (refereegranskat)abstract
- Achilles tendon pain or rupture after fluoroquionolone treatment has been described as an uncommon adverse effect. We report two patients with ciprofloxacin-associated Achilles tendon disease, one with histopathological examination. Microscopic evaluation showed irregular collagen fiber arrangement, hypercellularity, and increased interfibrillar glycosaminoglycans. These pathological features are also seen in tendon overuse injuries in athletes.
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| 22. |
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| 23. |
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| 24. |
- Movin, T
(författare)
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Tendon tissue sampling
- 2000
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Ingår i: Scandinavian journal of medicine & science in sports. - : Wiley. - 0905-7188. ; 10:6, s. 368-371
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Tidskriftsartikel (refereegranskat)
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| 25. |
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| 26. |
- Möller, Michael, 1957, et al.
(författare)
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Acute rupture of tendon Achillis. A prospective randomised study of comparison between surgical and non-surgical treatment.
- 2001
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Ingår i: The Journal of bone and joint surgery. British volume. - 0301-620X. ; 83:6, s. 843-8
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Tidskriftsartikel (refereegranskat)abstract
- In a prospective, randomised, multicentre study, 112 patients (99 men and 13 women, aged between 21 and 63 years) with acute, complete rupture of tendo Achillis were allocated either to surgical treatment followed by early functional rehabilitation, using a brace, or to non-surgical treatment, with plaster splintage for eight weeks. The period of follow-up was for two years. Evaluation was undertaken by independent observers and comprised interviews, clinical measurements, isokinetic muscle performance tests, heel-raise tests and an overall outcome score. The rate of rerupture was 20.8% after non-surgical and 1.7% after surgical treatment (p < 0.001). Surgical and non-surgical treatment produced equally good functional results if complications were avoided. However, the rate of rerupture after non-surgical treatment was unacceptably high.
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| 27. |
- Möller, Michael, 1957, et al.
(författare)
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Calf muscle function after Achilles tendon rupture. A prospective, randomised study comparing surgical and non-surgical treatment.
- 2002
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Ingår i: Scandinavian journal of medicine & science in sports. - : Wiley. - 0905-7188. ; 12:1, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- In a prospective, randomised, multicentre study, 112 patients with Achilles tendon rupture (ATR) were allocated to surgical treatment (n=59), followed by early functional rehabilitation using a brace, and non-surgical treatment (n=53), i.e. eight weeks of plaster treatment. In this study, the results of the isokinetic muscle strength evaluation are presented for contractions in both the concentric and the eccentric mode, plantar flexion and dorsiflexion, two angular velocities and three different positions of the subject. The heel-raise test for endurance, maximum calf circumference and tendon width were also evaluated. The re-rupture rate was 20.8% in the non-surgically-treated group and 1.7% in the surgically-treated group. No significant differences were found between the treatment groups in terms of the isokinetic strength measurements and the endurance test among the patients who did not sustain a re-rupture. If a re-rupture is avoided, both surgical and non-surgical treatment for ATR produce good functional outcome; however, the muscle function was not restored after two years in either group.
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| 28. |
- Nestorson, J, et al.
(författare)
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Function after Achilles tendon rupture in the elderly: 25 patients older than 65 years followed for 3 years.
- 2000
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Ingår i: Acta orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 71:1, s. 64-8
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Tidskriftsartikel (refereegranskat)abstract
- We retrospectively analyzed the function after Achilles tendon rupture in 25 patients older than 65 years, 3 (1-5) years after the initial treatment. The patients' median age at the time of injury was 71 (65-86) years. The initial management was surgical in 14 patients and non-surgical (8-week immobilization) in 10, 1 patient was not treated. The ratio of the number of heel-raises on the injured to the uninjured side was median 0.64 (0-1.14), showing a reduction in performance. However, in both surgically- and non-surgically-treated patients, the subjective impairment was mild, and the patients were able to perform most walking activities. Only 9 patients reached their previous activity level. Co-morbidity was frequent: 17 patients had other diseases that affected their performance. 14 complications occurred in 11 patients. 5 patients sustained a rerupture (4 following initial closed treatment with plaster), 1 a deep venous thrombosis and 4 had superficial infections requiring antibiotic treatment. 1 patient sustained a fibular nerve injury following compression by the plaster cast and another a sural nerve injury during the operation. 2 patients had symptoms due to adhesions between the tendon and the skin. We conclude that Achilles tendon rupture in patients older than 65 years reduces lower limb function and that complications are common following surgical and non-surgical treatment.
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| 29. |
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| 30. |
- Rolf, C, et al.
(författare)
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Etiology, histopathology, and outcome of surgery in achillodynia
- 1997
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Ingår i: Foot & ankle international. - : SAGE Publications. - 1071-1007 .- 1944-7876. ; 18:9, s. 565-569
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Tidskriftsartikel (refereegranskat)abstract
- Fifty-eight patients suffering from achillodynia for a median of 12 months (range, 4–240 months) were analyzed using history, clinical findings, ultrasound findings, histopathology, and surgical outcome. Surgical criteria were daily pain or inability to perform sports activity and failure of nonoperative treatment. There were 34 men and 24 women, 31% (18 of 58 patients) of whom had no direct association with sports or vigorous physical activity. Ultrasonography was performed in all cases and showed low echogenous areas (N = 48), increased tendon diameter (N = 40), and/or peritendinous fluid (N = 11). Histopathological evaluation of tendon biopsies, obtained from regions showing pathology at surgery (N = 35), revealed altered fiber structure and arrangement, focal variations in cellularity, extracellular glycosaminoglycans, neovascularization, and/or hyalinization. In no case was inflammatory cell infiltration observed. At a median clinical follow-up of 25 months after surgery, symptoms were decreased in 86% of patients, and 76% had reached a higher activity level compared with the level before surgery. Complications occurred in 13% of operations.In conclusion, achillodynia is not always associated with excessive physical activity. Macroscopic pathologic tendons showed marked histopathologic changes, correlating well with ultrasound findings. Surgical treatment was beneficial in most cases, despite a relatively high complication rate. The etiology and reason for the lack of healing response to rest and nonoperative treatment are unclear.
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| 31. |
- Shalabi, A, et al.
(författare)
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Dynamic contrast-enhanced mr imaging and histopathology in chronic achilles tendinosis. A longitudinal MR study of 15 patients
- 2002
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 43:2, s. 198-206
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the value of dynamic contrast-enhanced MR imaging (DEMRI) and its correlation to symptoms and histopathology in chronic Achilles tendinosis. Material and Methods: Fifteen patients with severe symptoms underwent DEMRI preoperatively and 2 years postoperatively. US-guided core biopsies of tendinosis tissue were obtained preoperatively and the specimens were analyzed using a semiquantitative protocol. DEMRI was evaluated by calculating the area under curve (AUC) of signal alteration and the static MR by a semiquantitative grading scale. A questionnaire and clinical examination evaluated the clinical outcome. Results: Early contrast enhancement (first 72 s) was seen in DEMRI at tendon lesions of the symptomatic Achilles tendons with a significant difference to asymptomatic contralateral tendon that revealed no or mild enhancement. Increased severity of tendon pathology (including fiber structure abnormality, increased vascularity, rounding of nuclei and increased amount of glycosaminoglycans) was correlated to both dynamic and static signal enhancement. Two years following surgical treatment, the signal alterations showed regression of early contrast enhancement (AUC decreased from 9 preoperatively to 2 postoperatively). The clinical outcome was as follows: 8 patients excellent, 4 good, 2 fair and 1 poor. Conclusion: Patients with chronic painful achillodynia showed an early contrast-agent enhancement corresponding to the tendon lesion. Increased enhancement correlated to increased severity of tendon histopathology and patient symptoms. Two years after surgical treatment the contrast-agent enhancement decreased.
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| 32. |
- Shalabi, A, et al.
(författare)
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Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI
- 2004
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Ingår i: The American journal of sports medicine. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 32:5, s. 1286-1296
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Tidskriftsartikel (refereegranskat)abstract
- Satisfactory treatment results have been reported after eccentric calf muscle strength training in patients with chronic Achilles tendinopathy. Hypothesis Magnetic resonance imaging may be a useful adjunct in the evaluation of the effect of 3 months of eccentric calf muscle strength training. Study Design Prospective cohort study. Methods Using magnetic resonance imaging, the Achilles tendons were investigated in 25 patients (16 men and 9 women) ranging in age from 28 to 70 years (median, 51 years) before and after training. Five different magnetic resonance imaging sequences were used. Tendon volume and mean intratendinous signal were calculated using a new seed-growing technique showing 99.3% and 96.6% intraobserver reliability, respectively. The clinical outcome was categorized according to pain level and performance using a questionnaire completed by the patient. Results The eccentric training resulted in a 14% (mean) decrease of tendon volume measured on T1-weighted images, from 6.6 ± 3.1 cm3 to 5.8 ± 2.3 cm3 (P < .05). The intratendinous signal in the symptomatic Achilles tendon measured on proton density-weighted images decreased 23% (mean), from 227 ± 77 signal units to 170 ± 83 signal units (P < .05). The gadolinium contrast agent-enhanced images did not add further value compared with other sequences. Clinical Outcome The clinical outcome was categorized as excellent in 10, good in 3, fair in 5, and poor in 8 patients. The [. Delta]signal correlated significantly with the pain level (P < .05). Conclusions Eccentric training resulted in decreased tendon volume and intratendinous signal and was correlated with an improved clinical outcome. Magnetic resonance imaging techniques can be used as an adjunct to clinical evaluation by monitoring morphologic effects in clinical treatment studies of Achilles tendinopathy.
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| 33. |
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| 34. |
- Shalabi, A, et al.
(författare)
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MR evaluation of chronic Achilles tendinosis. A longitudinal study of 15 patients preoperatively and two years postoperatively
- 2001
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Ingår i: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 42:3, s. 269-276
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate surgically treated patients with chronic Achilles tendinosis by MR. Material and Methods: Gd-contrast-enhanced (CME) T1-, precontrast T1-, PD- and T2-weighted images were obtained preoperatively and 2 years following surgical treatment on 15 middle-aged patients with severe symptoms of chronic Achilles tendinosis. MR evaluation included the depiction of intratendinous signal alterations and their volume, and also measurement of tendon diameter. A questionnaire and clinical examination evaluated the clinical outcome. Results: The most sensitive sequence to depict an intratendinous lesion was the CME T1-WI. There was marked regress of the estimated volume of the intratendinous signal alteration from a median of 1.2 cm3 preoperatively to 0.0 cm3 postoperatively on CME T1-WI. CME T1-WI showed a regress in intratendinous signal abnormality from 13 out of 15 patients preoperatively to 4 of 15 patients 2 years postoperatively. The a.p. dimension was 9 mm at both MR occasions. The clinical outcome was excellent in 8, good in 5, fair in 1 and poor in 1 patient. Conclusion: Surgical treatment of chronic Achilles tendinosis and its healing resulted in a decrease or elimination of the intratendinous signal alteration correlating to an improved clinical outcome 2 years postoperatively.
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| 35. |
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| 36. |
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| 37. |
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| 38. |
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| 39. |
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| 40. |
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| 41. |
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| 42. |
- Svensson, M., et al.
(författare)
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A long-term serial histological evaluation of the patellar tendon in humans after harvesting its central third
- 2005
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 13:5, s. 398-404
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Tidskriftsartikel (refereegranskat)abstract
- It is previously known that the patellar tendon does not normalise histologically in the short term after harvesting its central third. The aim of the study was to obtain long-term serial biopsies from the central and peripheral parts of the patellar tendon after the harvesting procedure. Our hypothesis was that in the long term after harvesting its central third, the patellar tendon does not regain normal histological appearance. Seventeen consecutive patients, who had undergone anterior cruciate ligament reconstruction using patellar tendon autografts, were included. Percutaneous biopsies were obtained under ultrasonographic guidance 27 (24-29) months and 71 (68-73) months after the index procedure, respectively. The sections were stained with haematoxylin and eosin. The biopsies were evaluated using light microscope. Both at 27 months and 71 months, the fibre structure was deteriorated and the vascularity and cellularity were increased compared with normal tendon. This was seen in both the central and peripheral parts of the tendon. In conclusion, nearly 6 years after harvesting its central third, the patellar tendon had still not normalised histologically, neither in the central nor peripheral parts of the tendon.
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| 43. |
- Svensson, Michael, 1964, et al.
(författare)
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Ultrastructural collagen fibril alterations in the patellar tendon 6 years after harvesting its central third
- 2007
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Ingår i: Am J Sports Med. - : SAGE Publications. - 0363-5465 .- 1552-3365. ; 35:2, s. 301-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Clinically, donor site problems are common, even in the long term after anterior cruciate ligament reconstruction using patellar tendon autograft. However, there is a lack of knowledge in terms of the mid- and long-term ultrastructural appearance of the previously harvested tendon in humans. HYPOTHESIS: The patellar tendon does not regain normal ultrastructure 6 years after harvesting its central third and leaving the defect open. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Thirteen patients were included in the study. Biopsy specimens were obtained from the central and lateral thirds of the patellar tendon under ultrasound guidance 71 months (range, 68-73 months) after the reconstruction. Ten biopsy specimens from other subjects with asymptomatic patellar tendons served as controls. The sections were evaluated using transmission electron microscopy. Longitudinal sections were used for morphological evaluation, and the fibril diameter was measured on the transverse sections and grouped into 5 diameter classes. RESULTS: All control specimens were found to have a compact extracellular matrix with regularly oriented collagen fibrils. Specimens from the lateral part of the harvested tendons displayed a more heterogeneous extracellular matrix. In 3 specimens, the extracellular matrix was different from that of the control specimens. Specimens from the central part of the harvested tendons displayed an even more heterogeneous extracellular matrix, with 8 specimens judged as heterogeneous. The fibril diameter in control specimens displayed the most heterogeneous pattern, and all 5 fibril classes were present. All fibril classes were found in the lateral biopsy specimens from the previously harvested tendons, but the 2 smallest fibril classes (0-30 and 31-60 nm) were significantly more dominant compared with control specimens (P < .0001). In the central specimens from the previously harvested tendons, only the 3 smallest size classes were found (P < .0001 vs controls). CONCLUSION: Six years after harvesting its central third and leaving the defect open, the patellar tendon revealed a "more heterogeneous matrix" with changes in ultrastructural morphology and relative fibril diameter distribution compared with normal control tendon.
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- Åhlén, Martina, et al.
(författare)
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Histological evaluation of regenerated semitendinosus tendon a minimum of 6 years after harvest for anterior cruciate ligament reconstruction.
- 2014
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Ingår i: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Semitendinosus (ST) and/or gracilis (G) autografts are the most used grafts for anterior cruciate ligament (ACL) surgery. The tendons have been shown to be able to regenerate but with focal areas of scar tissue in the short term. There are no long-term histological studies of the regenerated tendons. Hypothesis: In the long term, the regenerated ST tendon normalizes and has a similar histology as the contralateral nonharvested tendon. Study Design: Case-control study; Level of evidence, 3. Methods: Eighteen patients (8 female, 10 male) who underwent ACL surgery using ipsilateral ST/G tendon autografts were included in this study. Percutaneous specimens were obtained from the regenerated ST tendon and the contralateral nonharvested ST tendon under ultrasonographic guidance at a median of 8.4 years (100.5 months; range, 77-129 months) after the harvest procedure. Specimens from the nonoperated side served as controls. The histology and presence of glycosaminoglycans (GAGs) were assessed using a light microscope and a semiquantitative grading system. Results: Thirty-six biopsies were obtained (2 biopsies from each patient). In 5 biopsies, the amount of tissue was too small to analyze in the light microscope, and 1 patient had been operated on bilaterally and was therefore excluded. In total, 24 biopsies were included in the histological analysis. In overall terms, there were no significant differences between the regenerated and nonharvested ST tendon in terms of fiber structure, cellularity, vascularity, and level of GAGs a minimum 6 years after harvest of the ST tendon. However, 3 of the regenerated tendons displayed a loss of fiber structure. Conclusion: The ST tendon regenerates and may regain a histological appearance similar to that of the nonharvested contralateral tendon, as seen in this study a median of 8.4 years after harvesting. However, in some tendons, loss of fiber structure was found.
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