Tendon injury and repair – A perspective on the basic mechanisms of tendon disease and future clinical therapy

Snedeker, Jess G.; Foolen, Jasper

doi:10.1016/j.actbio.2017.08.032

Cited by 260 publications

(254 citation statements)

References 301 publications

(402 reference statements)

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“…This partial tear resulted in an acute on chronic inflammatory response. However, in contrast to the paradigm presented by Snedeker and Foolen,29 our patient reported an increase in tissue function, notably symptomatic function.…”

Section: Discussioncontrasting

confidence: 99%

“…A paradigm has also been presented to elucidate the effect of injury on tendon tissue quality and function, particularly given pre-existing chronic tendinopathic degeneration (figure 5). 29 Within this, mechanical loading has been suggested as a ‘state switch’ between functional remodelling and the progression of chronic disease 29…”

Section: Discussionmentioning

confidence: 99%

“…The effect of tendon injury (tear) on tissue quality and function in healthy tissue, and proposed capacity of injury and its inflammation to promote remodelling and increased function (adapted from Snedeker and Foolen29). …”

Section: Discussionmentioning

confidence: 99%

“…Tendon’s reparative capacity has been discussed as ‘an interplay between an ‘intrinsic compartment’ (fascicles of tendon cells and collagen) and ‘extrinsic compartment’ (synovium-like tissues connecting immune, vascular and nervous systems)’ 29. In our case, it is possible that the tear itself promoted an extrinsic compartment inflammatory reparative response further to the existent localised mid-portion swelling which may have promoted tendon reparation in the specific aspect of the previously pathological AT tissue, leading to decreased symptom reporting from the patient.…”

Section: Discussionmentioning

confidence: 99%

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Partial mid-portion Achilles tear resulting in substantial improvement in pain and function in an amateur long-distance runner

Woyton¹,

Kluzek

Wedatilake

et al. 2018

BMJ Case Reports

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This case presents symptom resolution for a long-distance runner with chronic Achilles tendinopathy (AT), following a partial tear of his Achilles tendon. The patient reported a sudden pain during a morning run, with preserved function. Three hours postinjury, he was reviewed in a musculoskeletal clinic. An ultrasound scan confirmed a partial Achilles tear, associated with significant Doppler activity. His index of AT severity The Victorian Institute of Sports Assessment - Achilles Questionnaire (VISA-A) 4 hours postinjury was markedly higher compared with 2 weeks preinjury, indicating reduced symptom severity. A follow-up scan 4 weeks postinjury showed minimal mid-portion swelling and no signs of the tear. His VISA-A score showed continued symptom improvement. This case represents resolution of tendinopathic symptomatology post partial Achilles tear. While the natural histories of AT and Achilles tears remain unknown, this case may indicate that alongside the known role of loading, inflammation may be a secondary mediator central to the successful resolution of AT pain.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Partial mid-portion Achilles tear resulting in substantial improvement in pain and function in an amateur long-distance runner

Woyton¹,

Kluzek

Wedatilake

et al. 2018

BMJ Case Reports

View full text Add to dashboard Cite

show abstract

“…Lower echogenicity could also be related to increased proteoglycan content, as tendon rupture can increase the presence of proteoglycan‐rich inclusions . Ankle manipulation may further increase proteoglycan expression, possibly as an adaptation to increase tissue hydration to facilitate nutrient and metabolite diffusion …”

Section: Discussionmentioning

confidence: 99%

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Hillin

Fryhofer

Freedman

et al. 2019

Journal Orthopaedic Research

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Conservative (non‐operative) treatment of Achilles tendon ruptures is a common alternative to operative treatment. Following rupture, ankle immobilization in plantarflexion is thought to aid healing by restoring tendon end‐to‐end apposition. However, early activity may improve limb function, challenging the role of immobilization position on tendon healing, as it may affect loading across the injury site. This study investigated the effects of ankle immobilization angle in a rat model of Achilles tendon rupture. We hypothesized that manipulating the ankle from full plantarflexion into a more dorsiflexed position during the immobilization period would result in superior hindlimb function and tendon properties, but that prolonged casting in dorsiflexion would result in inferior outcomes. After Achilles tendon transection, animals were randomized into eight immobilization groups ranging from full plantarflexion (160°) to mid‐point (90°) to full dorsiflexion (20°), with or without angle manipulation. Tendon properties and ankle function were influenced by ankle immobilization position and time. Tendon lengthening occurred after 1 week at 20° compared to more plantarflexed angles, and was associated with loss of propulsion force. Dorsiflexing the ankle during immobilization from 160° to 90° produced a stiffer, more aligned tendon, but did not lead to functional changes compared to immobilization at 160°. Although more dorsiflexed immobilization can enhance tissue properties and function of healing Achilles tendon following rupture, full dorsiflexion creates significant tendon elongation regardless of application time. This study suggests that the use of moderate plantarflexion and earlier return to activity can provide improved clinical outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Anisotropic Hybrid Hydrogels with Superior Mechanical Properties Reminiscent of Tendons or Ligaments

Choi

Kim

2019

Adv Funct Materials

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Mimicking the hierarchically anisotropic structure and excellent mechanical properties of natural tissues, such as tendons and ligaments, using biomaterials is challenging. Despite recent achievements with anisotropic hydrogels, limitations remain because of difficulties in achieving both structural and mechanical characteristics simultaneously. A simple approach for fabricating hybrid hydrogels with a hierarchically anisotropic structure and superior mechanical properties that are reminiscent of tendons or ligaments is proposed. Alginate–polyacrylamide double‐network (DN) hydrogels incorporated with high aspect ratio mesoporous silica microparticles are stretched and fixed via subsequent drying and ionic crosslinking to achieve multiscale structures composed of an anisotropically aligned polymer network embedded with aligned microparticles. The mechanical properties of hydrogels can be further controlled by the degree of stretching, quantities, and functional groups of inorganic microparticles, and types of crosslinking cations. The subsequent reswelling results in a high water content (>80%) similar to that of natural tendons while high strength, modulus, and toughness are maintained. The optimized anisotropic hybrid hydrogel exhibits a tensile modulus of 7.2 MPa, strength of 1.3 MPa, and toughness of 1.4 MJ m−3 even in the swollen state, which is 451‐, 27‐, and 2.2 times higher than that observed in the non‐swollen tough DN hydrogel. This study suggests a new strategy for fabricating anisotropic hydrogels with superior mechanical properties to develop new biomaterials for artificial tendons or ligaments.

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Tendon injury and repair – A perspective on the basic mechanisms of tendon disease and future clinical therapy

Cited by 260 publications

References 301 publications

Partial mid-portion Achilles tear resulting in substantial improvement in pain and function in an amateur long-distance runner

Partial mid-portion Achilles tear resulting in substantial improvement in pain and function in an amateur long-distance runner

Effects of immobilization angle on tendon healing after achilles rupture in a rat model

Anisotropic Hybrid Hydrogels with Superior Mechanical Properties Reminiscent of Tendons or Ligaments

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