摘要:

Summary:Collagen in tendons is arranged in parallel primary, secondary, and tertiary bundles, so as to distribute muscular tensions equally to all parts of the insertions, at whatever position of the joint. The outer surface of each fascicle is covered by a uniform layer of collagen: this coating permits individual fascicles to move independently of each other. A normal tendon is able to bear a load of 50 to 100 N/m2and can be stretched to approximately 4% of its total length before microscopic evidence of rupture of some collagen fibers. Tendons have a low metabolic rate and a low vascularity, which may explain their poor healing capability. Tendons have an intrinsic and an extrinsic capacity to heal, and the relative contribution of each depends on the type of injury, the site of the injury, and the method of management of the injury. Much research is now concentrating on rehabilitation, planning more aggressive rehabilitation programs, especially in young athletes, and on the role of growth factors in tendon healing. Gene transfer could improve the management of tendon injuries, particularly when used as the vehicle for the targeted delivery of growth factors. It is likely that genes encoding the structural proteins of the matrix could be delivered directly to the tendon and enhance its healing in a programmed manner. However, their introduction in routine clinical practice is not imminent.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:The biochemical mechanisms underlying exercise‐related tendon damage and predisposition to repetitive injury are obscure, and there is little information available within the current literature. However, exercise is associated with elevated production of reactive oxygen species. Such species are traditionally viewed as inducers of cellular or tissue damage, but it is now apparent that reactive oxygen (in cooperation or antagonism with reactive nitrogen species) at sublethal levels mediates processes as diverse as proliferation, differentiation, and adaptation. We review evidence to suggest that tendons are subject to reactive oxygen generated both within the vicinity of the tendon and also from the tenocytes themselves, the latter, possibly, as a response to hyperthermia and during repetitive ischemia or reperfusion. We subsequently extend an hypothesis of how such species may influence the development of tendinopathies.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Failure to appreciate how pain arises in tendinopathies may be limiting medical progress. It is assumed that tendon overuse causes inflammation, and thus pain. We critically review the inflammatory model of pain in tendinopathy and find that it does not withstand scrutiny. The generally proposed alternative model is that of mechanical discontinuity of collagen fibers, but this as well is inconsistent with numerous surgical observations. We review data suggesting that pain of tendinopathy may be largely due to yet unidentified biochemical factors activating peritendinous nociceptors when they are exposed to the environs as a result of tendon overuse injury. The noxious agent could include matrix substances and minor collagens. Glutamate can mediate pain, and this is present in higher concentrations in subjects with Achilles tendinopathy than in controls. Chondroitin sulphate is another candidate. Examining alternative models of pain, particularly a mixed biochemical‐mechanical model, may allow significant progress in management of these troublesome conditions.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:The growing importance of sport and recreational activity at all levels in modern society has created a worldwide need to accurately diagnose and better manage an ever‐rising incidence of tendon disorders. Concurrent with this clinical need over the past two decades there has been tremendous growth in the technology of medical imaging. New diagnostic modalities such as ultrasound and magnetic resonance imaging have begun to change the previously accepted approach to clinical work‐up. This article reviews the current status of tendon imaging with an emphasis on ultrasound and magnetic resonance imaging.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Rotator cuff tendinopathy is a degenerative disease characterized by regressive changes at the insertion of the cuff into bone. Although all three major cuff tendons are equally affected by degeneration, tearing always starts at the insertion of the supraspinatus. This points to the importance of additional pathogenetic factors. The articular half of the cuff tendon is always more affected by degeneration than the bursal half. The etiology of degeneration is still open to debate. Among the diagnostic tests, sonography is the method of choice. If in doubt, magnetic resonance imaging can be performed. When surgical repair of a complete tear is indicated, an anterior acromioplasty should only by performed to ensure unimpeded gliding. The same applies to bursectomy, as the bursa is an important source of cells and vessels for healing after a successful repair. Cutting back of the medial stump to bleeding tissue is not indicated, because the tendon proper contributes little to the healing process.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:During the past 20 years clinicians have developed a better understanding of the underlying pathology of upper limb tendinopathies. This knowledge coupled with a better understanding of the exact location of the pathology has enabled surgeons to rationalize the use of existing nonsurgical and surgical treatments and to consider future therapeutic options. Not only has this approach improved the overall success of treatment, but it has also reduced patient morbidity. Research has also clarified the pathology and clinical presentation of a variety of disorders involving neighboring structures that can mimic symptoms commonly attributed to tendinopathies. In the future these findings should reduce diagnostic error and help to identify causes of refractory symptoms. However, despite the advances that have been made, the treatment of a significant proportion of patients with tendinopathies around the elbow, wrist, and hand remains a clinical challenge.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:“Groin pain” is an umbrella term for a pain syndrome that, although manifesting in the groin, may originate from several structures. In this article, we attempt to classify groin pain in a more organic manner, since its cause and origin are becoming better defined. Therefore, we draw a distinction between three main groups, namely insertion tendinopathy, derangement of the abdominal wall, and all causes of pain that do not involve the adductor and the abdominal muscles disorders, nor abdominal wall abnormalities, and we stress the different etiopathogeneses. Diagnosis is based on accurate history taking and physical examination, and imaging can be used to confirm physical findings. Nonoperative management is the initial approach. In case of failure, surgery should be considered, with operative management tailored to the lesion diagnosed.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Patellar tendon injuries constitute a significant problem in a wide variety of sports. Despite the morbidity associated with patellar tendinopathy, its management is often anecdotal, with no evidence‐based protocols available. This article summarizes the clinical features, describes recent advances in investigation of this condition, and outlines conservative and surgical treatment options.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Achilles tendinopathy is one of the most common overuse problems in running athletes. When conservative management is unsuccessful, surgery is indicated to increase the likelihood that the patient will return to high levels of sporting activity. Circulatory, metabolic, and mechanical factors are involved in the pathogenesis of the tendinopathy. In surgery for chronic paratendinopathy, we use different techniques depending on the extension of the adhesions and the thickening of the paratenon, removing the fibrotic rinds of the fascia and the hypertrophic parts of the paratenon, taking care not to disturb the mesotendon. In paratendinopathy associated with tendinopathy of the main body of the tendon and in isolated tendinopathy of the main body of the tendon, we free the tendon from fibrotic adhesions and remove the degenerated nodules. Longitudinal tenotomies are performed to try to re‐establish tendon nutrition, or at least to cause tendon scarring. Moreover, to improve the blood supply in tendons with extensive degeneration, we have started to place a bundle of soleus muscle within the tendon itself. In insertional tendinopathy, the pre‐Achilles bursa is removed, together with the lateral and medial outgrowth of bone and cartilage of the posterior border of the calcaneus, as is done with Haglund deformity, thus preventing further impingement of the tendon insertion.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Summary:Nonoperative functional treatment of Achilles tendon rupture is traced from its equinus cast origins through its evolution from the functional aftercare programs after surgical repair. Review of the recent literature reflects comparable results to surgical repair for middle‐aged recreational athletes and for non‐athletes of any age.

ISSN:1062-8592    

出版商:OVID    

年代:2000

数据来源: OVID