The association between retraction of the torn rotator cuff and increasing expression of hypoxia inducible factor 1α and vascular endothelial growth factor expression: an immunohistological study

<p>Abstract</p> <p>Background</p> <p>Differing levels of tendon retraction are found in full-thickness rotator cuff tears. The pathophysiology of tendon degeneration and retraction is unclear. Neoangiogenesis in tendon parenchyma indicates degeneration. Hypoxia inducible factor 1α (HIF) and vascular endothelial growth factor (VEGF) are important inducers of neoangiogenesis. Rotator cuff tendons rupture leads to fatty muscle infiltration (FI) and muscle atrophy (MA). The aim of this study is to clarify the relationship between HIF and VEGF expression, neoangiogenesis, FI, and MA in tendon retraction found in full-thickness rotator cuff tears.</p> <p>Methods</p> <p>Rotator cuff tendon samples of 33 patients with full-thickness medium-sized rotator cuff tears were harvested during reconstructive surgery. The samples were dehydrated and paraffin embedded. For immunohistological determination of VEGF and HIF expression, sample slices were strained with VEGF and HIF antibody dilution. Vessel density and vessel size were determined after Masson-Goldner staining of sample slices. The extent of tendon retraction was determined intraoperatively according to Patte's classification. Patients were assigned to 4 categories based upon Patte tendon retraction grade, including one control group. FI and MA were measured on standardized preoperative shoulder MRI.</p> <p>Results</p> <p>HIF and VEGF expression, FI, and MA were significantly higher in torn cuff samples compared with healthy tissue (p < 0.05). HIF and VEGF expression, and vessel density significantly increased with extent of tendon retraction (p < 0.05). A correlation between HIF/VEGF expression and FI and MA could be found (p < 0.05). There was no significant correlation between HIF/VEGF expression and neovascularity (p > 0.05)</p> <p>Conclusion</p> <p>Tendon retraction in full-thickness medium-sized rotator cuff tears is characterized by neovascularity, increased VEGF/HIF expression, FI, and MA. VEGF expression and neovascularity may be effective monitoring tools to assess tendon degeneration.</p

Auswirkung von Dreifach-Osteotomien nach Tönnis auf die Beinachsen und Wirbelsäulenform

Untersucht wurde im Rahmen einer retrospektiven Nachuntersuchung (follow-up 9 Jahre)die Auswirkung der Dreifach-Beckenosteotomie nach Tönnis auf die Beinachsen und Wirbelsäulenform. Verwendet wurden klinische (Harris-Hip, Lequesne, UCLA-Aktivität) psychometrische (SF-36, WOMAC) und radiologische (Kellgren-Lawrence) Scores. Die vorliegende radiologische Bildgebung wurde befundet (Beinachsenwinkel, CE-, AC-, ACM-, VCA-Winkel), und es wurde eine rasterstereographische Untersuchung der Wirbelsäule durchgeführt. Das OP-Ergebnis zeigte einen guten Erfolg mit Defiziten für die Hüftflexion und -innenrotation. Die Parameter körperlicher Schmerz, Funktion und emotionale Rolle des SF-36-Scores waren defizitär. Es zeigte sich eine Tendenz zur Valgisierung der mechanischen Beinachse (5 mm medial der Traglinie) mit Varisierung des anatomischen medialen distalen Femurachsenwinkels (aLDFA) und Valgisierung des mechanischen lateralen proximalen Tibiaachsenwinkels (mMPTA) ohne höhergradige Gonarthrosen (Grad 1 nach KLS). Die Wirbelsäule zeigte eine signifikant vermehrte LWS-Lordose und BWS-Kyphose. Ipsilateral der OP kam es zu einer Beinverlängerung (5 mm), Beckentorsion nach ventrokaudal und zu einem Beckenhochstand. Die Ergebnisse lassen sich durch die Kippung des acetabulären Blocks nach ventro laterodistal erklären. Dieses führt zu einer Beinverlägerung mit zunächst funktioneller danach struktureller Adduktion des Femur und damit kompensatorisch zur einer Valgisierung der mechanischen Beinachse. Die Defizite erklären sich teilweise durch die Überkorrektur des VCA-Winkels und Unterkorrektur des ACM-Winkels. Insgesamt gesehen ist die vom erfahrenen Operateur suffizient durchgeführte Dreifach-Beckenosteotomie nach Tönnis eine gute Behandlungsmöchlichkeit für die Behandlung der Hüftdysplasie beim Erwachsenen. Die negativen Auswirkungen auf die Beinachse sind vernachlässigbar klein und zeigten in unserer Untersuchung keine besondere klinische Relevanz

Auswirkung von Dreifach-Osteotomien nach Tönnis auf die Beinachsen und Wirbelsäulenform

Untersucht wurde im Rahmen einer retrospektiven Nachuntersuchung (follow-up 9 Jahre)die Auswirkung der Dreifach-Beckenosteotomie nach Tönnis auf die Beinachsen und Wirbelsäulenform. Verwendet wurden klinische (Harris-Hip, Lequesne, UCLA-Aktivität) psychometrische (SF-36, WOMAC) und radiologische (Kellgren-Lawrence) Scores. Die vorliegende radiologische Bildgebung wurde befundet (Beinachsenwinkel, CE-, AC-, ACM-, VCA-Winkel), und es wurde eine rasterstereographische Untersuchung der Wirbelsäule durchgeführt. Das OP-Ergebnis zeigte einen guten Erfolg mit Defiziten für die Hüftflexion und -innenrotation. Die Parameter körperlicher Schmerz, Funktion und emotionale Rolle des SF-36-Scores waren defizitär. Es zeigte sich eine Tendenz zur Valgisierung der mechanischen Beinachse (5 mm medial der Traglinie) mit Varisierung des anatomischen medialen distalen Femurachsenwinkels (aLDFA) und Valgisierung des mechanischen lateralen proximalen Tibiaachsenwinkels (mMPTA) ohne höhergradige Gonarthrosen (Grad 1 nach KLS). Die Wirbelsäule zeigte eine signifikant vermehrte LWS-Lordose und BWS-Kyphose. Ipsilateral der OP kam es zu einer Beinverlängerung (5 mm), Beckentorsion nach ventrokaudal und zu einem Beckenhochstand. Die Ergebnisse lassen sich durch die Kippung des acetabulären Blocks nach ventro laterodistal erklären. Dieses führt zu einer Beinverlägerung mit zunächst funktioneller danach struktureller Adduktion des Femur und damit kompensatorisch zur einer Valgisierung der mechanischen Beinachse. Die Defizite erklären sich teilweise durch die Überkorrektur des VCA-Winkels und Unterkorrektur des ACM-Winkels. Insgesamt gesehen ist die vom erfahrenen Operateur suffizient durchgeführte Dreifach-Beckenosteotomie nach Tönnis eine gute Behandlungsmöchlichkeit für die Behandlung der Hüftdysplasie beim Erwachsenen. Die negativen Auswirkungen auf die Beinachse sind vernachlässigbar klein und zeigten in unserer Untersuchung keine besondere klinische Relevanz

Surgical and nonsurgical treatment of total rupture of the pectoralis major muscle in athletes: update and critical appraisal

J&amp;ouml;rn Kircher, Christoph Ziskoven, Thilo Patzer, Daniela Zaps, Bernd Bittersohl, R&amp;uuml;diger KrauspeUniversity Hospital, Orthopaedic Department, Heinrich-Heine University D&amp;uuml;sseldorf, D&amp;uuml;sseldorf, GermanyAbstract: The complete rupture of the pectoralis major tendon is an uncommon injury but has become increasingly common among athletes in recent years. This may be due to a higher number of individuals taking part in high-impact sports and weightlifting as well as the use of anabolic substances, which can make muscles and tendons vulnerable to injury. In recent literature, there are only few recommendations to rely on conservative treatment alone, but there are a number of reports and case series recommending early surgical intervention. Comparing the results of the two treatment regimens, there is clear evidence for a superior outcome after surgical repair with better cosmesis, better functional results, regaining of muscle power, and return to sports compared with the conservative treatment. In summary, anatomic surgical repair is the treatment of choice for complete acute ruptures of the pectoralis major tendon or muscle in athletes.Keywords: pectoralis major, rupture, athlete, conservative treatment, surgical treatment, steroid, tendon, sports injur

All-Arthroscopic Suprapectoral Long Head of Biceps Tendon Tenodesis With Interference Screw–Like Tendon Fixation After Modified Lasso-Loop Stitch Tendon Securing

Arthroscopic suprapectoral techniques for tenodesis of the long head of the biceps tendon (LHB) are appropriate for the treatment of proximal biceps lesions. Several types of techniques and fixation devices have been described and evaluated in biomechanical studies regarding primary stability. In this technical note, we describe an all-arthroscopic suprapectoral technique using the 6.25-mm Bio-SwiveLock device (Arthrex, Naples, FL) for an interference screw–like bony fixation after having armed the tendon with a lasso-loop stitch. Both the interference screw fixation and securing of the lasso-loop tendon have been well described and approved in biomechanical tests concerning the primary stability. One advantage of this technique performed from the glenohumeral space, in addition to the strong and secure fixation with ingrowth of the tendon in a bony canal, is the avoidance of touching the soft tissue above the bicipital groove, which results in a smooth fitting of the tendon into its natural canal and therefore avoids mechanical irritation of the stump at the rotator interval. In conclusion, the all-arthroscopic suprapectoral LHB tenodesis performed from the glenohumeral space with the modified lasso-loop stitch for securing of the tendon and the 6.25-mm Bio-SwiveLock suture anchor for interference screw–like bony tendon fixation is an appropriate technique for the treatment of LHB-associated lesions

Arthroscopic Autologous Chondrocyte Transplantation for Osteochondritis Dissecans of the Elbow

Osteochondritis dissecans of the humeral capitellum is characterized by separation of a circumscript area of the articular surface and the subchondral bone in juvenile patients. In advanced lesions, arthroscopic fragment refixation or fragment removal with microfracturing or drilling can be successful. The purpose of this technical note is to describe an all-arthroscopic surgical technique for 3-dimensional purely autologous chondrocyte transplantation for osteochondral lesions of the humeral capitellum

Blood supply in the bicipital groove: A histological analysis

The vascular anatomy in the closed bicipital groove with the long head of the biceps brachii muscle tendon (LHBT), its mesotenon and the transverse ligament intact has not been analyzed on a histological level yet. An anatomic dissection and histologic study was conducted by using 24 cadaveric formaldehyde fixated shoulders. The bicipital groove including the LHBT and its intact sheath was cut en-bloc, fixated, sliced in 7 μm sections, Azan stained and the vascular anatomy analyzed under light microscopy. Each sideward branch deriving from the main ascending branches of the anterior humeral circumflex artery (ACHA) in the mesotenon of the LHBT was identified and followed through multiple sections to identify its direction and area of supply. Per specimen, a mean of 2.71±1.85 branches could be identified running through the soft tissue of the mesotenon towards the osseous walls of the groove. Of the total 65 arterial branches in all specimens, 22 (33.8%) were running into the medial wall of the groove and 40 (61.5%) into the lateral wall (P<0.01). The results indicate that branches of the ACHA in the mesotenon of the LHBT provide blood supply not only to the tendon but to the osseous bicipital groove as well and here significantly more to the lateral than to the medial osseous wall. In addition, Pacini-like mechanoreceptors could be identified in the mesotenon in 9 (37.5%) of the specimens which has not been described up to now

Penetration of topical diclofenac sodium 4 % spray gel into the synovial tissue and synovial fluid of the knee : a randomised clinical trial

PURPOSE: The present study was designed to evaluate the penetration of diclofenac sodium 4 % spray gel in synovial tissue, synovial fluid and blood plasma after topical application in subjects with joint effusions and planned total knee arthroplasty (TKA) due to osteoarthritis. METHODS: A total of 39 patients were randomised to two- or three-times daily application of diclofenac sodium 4 % spray gel to knees requiring surgery over a treatment period of 3 days. Within 8 h after the last application, TKA was conducted, and the diclofenac concentrations in synovial tissue, synovial fluid and blood plasma were measured by liquid chromatography. RESULTS: The median diclofenac concentration was approximately 10-20-fold higher in synovial tissue (36.2 and 42.8 ng/g) than in synovial fluid (2.6 and 2.8 ng/mL) or plasma (3.9 and 4.1 ng/mL) in both treatment groups. Dose proportionality for any compartment or treatment groups could not be detected. Treatment-related adverse events were noted in two cases and limited to skin reactions. CONCLUSION: Diclofenac sodium 4 % spray gel was found to penetrate the skin locally in substantial amounts and thus reach the desired target tissue. Concentrations were not dose-dependent, and application was well tolerated by 97.4 % of patients. Topical application of diclofenac should be considered a valuable alternative to systemic NSAID therapy in the initial treatment of osteoarthritis