Cell-Matrix Response in Tendon Injury

Leadbetter, Wayne B.

doi:10.1016/s0278-5919(20)30507-x

Cited by 491 publications

(110 citation statements)

References 49 publications

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“…A mechanism by which the trauma spreads to the remaining intact tendon until the symptoms of tendinopathy are presented has been suggested by a number of in-vitro experiments [ 110 , 116 , 119 , 128 , 133 - 136 ]. These studies have shown that high strains (or long duty cycles) applied by stretching bioreactors can cause tenocytes to produce abnormal levels of matrix metalloproteases (MMPs), which would in turn degrade the collagen and cause degeneration [ 131 , 137 - 144 ].…”

Section: Introductionmentioning

confidence: 99%

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

Jung

Fisher

Woo

2009

BMC Sports Sci Med Rehabil

107

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Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis.The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL) can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL) tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20-25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons.With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to appropriate methodologies used to obtain their biomechanical properties. Specifically, we hope the reader will pay attention to how the properties of these tissues can be altered due to various experimental and biologic factors. Following this background material, we will present how biomechanics can be applied to gain an understanding of the mechanisms as well as clinical management of various ligament and tendon ailments. To conclude, new technology, including imaging and robotics as well as functional tissue engineering, that could form novel treatment strategies to enhance healing of ligament and tendon are presented.

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Section: Introductionmentioning

confidence: 99%

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

Jung

Fisher

Woo

2009

BMC Sports Sci Med Rehabil

107

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“…While the muscle cells have adequate blood supply, they lack the ability to regenerate after injury; on the other hand, tendons are precariously supplied by blood vessels, hence injuries to the musculo-tendinous areas are notorious for inadequate healing and chronicity. 8 9…”

Section: R Ationale For O Rthobiologic mentioning

confidence: 99%

“…These chronic conditions are believed to be a result of overuse, which occurs as a result of multiple micro-traumatic events that cause disruption of the internal structure of the tendon and degeneration of the cells and matrix. This fails to mature into normal tendon and at times, such injuries result in tendinosis, 8 which is often accompanied by what is called as an angiofibroblastic degeneration. 9 This type of injury is seen in lateral epicondylar tendinopathy, rotator cuff injuries, patellar tendinopathy, Achilles tendinopathy and plantar fasciitis; consequently most of the research in the field of orthobiologics is being done in these areas.…”

Section: R Ationale For O Rthobiologic mentioning

confidence: 99%

Orthobiologics and platelet rich plasma

Dhillon

Behera

Patel

et al. 2014

IJOO

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Orthobiologics have evolved to the extent that they significantly influence modern orthopedic surgical practice. A better understanding of the role of various growth factors and cells in the process of tendon healing, ligament repair, cartilage regeneration and bone formation has stimulated focused research in many chronic musculoskeletal ailments. Investigators have published results of laboratory as well as clinical studies, using orthobiologics like platelet rich plasma, stem cells, autologous conditioned serum etc., with variable results. However, a clear consensus over the best orthobiologic substance and the method of preparation and usage of these substances is lacking. Much of the confusion is due to the fact that studies ranging from RCTs to case reports present variable results, and the interpretations are wide-ranging. We have reviewed the available orthobiologics related data with a focus on platelet rich plasma in orthopedic conditions.

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“…The term “tendinosis” is used in histology to describe the pathological features seen in the ECM of the tendon, 8 where there is failure of the matrix to adapt to stresses due to imbalance in synthesis and degeneration of the matrix. 9 – 12 Many clinicians have adopted the term “tendinitis” or “tendonitis” to describe tendon disorders, indicating it is inflammatory in origin. However, with no histological evidence of this, it would be inaccurate to say so.…”

Section: Introductionmentioning

confidence: 99%

A review on the use of cell therapy in the treatment of tendon disease and injuries

Sawadkar

Mudera

2014

J Tissue Eng

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Tendon disease and injuries carry significant morbidity worldwide in both athletic and non-athletic populations. It is estimated that tendon injuries account for 30%−50% of all musculoskeletal injuries globally. Current treatments have been inadequate in providing an accelerated process of repair resulting in high relapse rates. Modern concepts in tissue engineering and regenerative medicine have led to increasing interest in the application of cell therapy for the treatment of tendon disease. This review will explore the use of cell therapy, by bringing together up-to-date evidence from in vivo human and animal studies, and discuss the issues surrounding the safety and efficacy of its use in the treatment of tendon disease.

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Cell-Matrix Response in Tendon Injury

Cited by 491 publications

References 49 publications

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

Orthobiologics and platelet rich plasma

A review on the use of cell therapy in the treatment of tendon disease and injuries

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