Tendinopatia ścięgna głowy długiej mięśnia dwugłowego ramienia – konfrontacja badania przedmiotowego z wynikami artroskopii barku

Tendinoapthy is a common medical problem and its aetiopathology is multifactorial. Biceps tendon is more vulnerable to injurie due to anatomic and biomechanical conditions. The aim of the study was to present results of the physical examination and shoulder arthroscopy findings among patients suffering from biceps tendon tendinopathy.The research was divided into two phases: preoperative and arthroscopic. First phase consisted of clinical examination- five clinical tests, level of pain assessment by use of VAS scale and analysis of the history of disease. Second phase presented  25 patients who underwent shoulder arthroscopy assisted biceps tendon tenotomy or tenodesis.Clinical examination showed that the most accurate test for biceps tendon tendinopathy was tenderness in the bicipital groove. Mean VAS score was: 7.8. History of subjects tendinopathy was half traumatic and half overuse aetiology. Shoulder arthroscopy revealed other injuries and the most frequent accompanying lesions were rotator cuff tears.The association between biceps tendon tendinopathy and other shoulder pathologies and problems with accuracy of clinical test have been noted by many authors. Due to  so many accompanying lesions, diagnosis of biceps tendon tendinopathy needs to be supported by other diagnostic methods and shoulder arthroscopy is widely accepted as a gold standard to identify biceps tendon pathologyTendinopatia jest powszechnym problemem medycznym o wieloczynnikowej etiologii. Ścięgno głowy długiej mięśnia dwugłowego ramienia jest podatne na urazy z powodu uwarunkowań anatomicznych oraz biomechanicznych.Celem badania było przedstawienie wyników badania przedmiotowego oraz wyników artroskopii barku u pacjen-tów z tendinopatią ścięgna bicepsa.Badanie podzielono na dwie fazy:przedoperacyjną oraz artroskopową. Pierwsza faza składała się z pięciu testów klinicznych,oceny poziomu bólu za pomocą skali VAS oraz analizy historii schorzenia.Druga faza polegała na artroskopii barku z wykonaniem tenotomii lub tenodezy ścięgna bicepsa.Badanie przedmiotowe wykazało, że najbardziej precy-zyjnym testem do oceny tendinopatii ścięgna bicepsa była tkliwość w bruździe międzyguzkowej. Średni wynik w opar-ciu o skalę VAS to 7,8. Wywiad schorzenia był w połowie urazowy, a w połowie o przeciążeniowej etiologii. Artro-skopia barku ujawniła inne schorzenia w stawach ramien-nych, a najczęstszą zmianą były uszkodzenia stożka rotato-rów.Wielu autorów podkreśla związek pomiędzy tendinopatią bicepsa a innymi uszkodzeniami barku oraz problematykę precyzji testów klinicznych w diagnostyce tendinopatii. W obliczu licznych zmian towarzyszących tendinopatii bicepsa diagnostyka powinna być poszerzona o inne badania obrazo-we oraz artroskopię barku uznawaną jako złoty standard

Therapeutic Advances in Tendinopathy Quantified Microscopically Using Bonar Score, with a Special Reference to PRP Therapy—A Systematic Review of Experimental Studies

(1) Background: The Bonar scoring system serves in the microscopic evaluation of tendon pathology. However, it can be easily adapted to investigate decreasing degeneration after treatment and quantify the healing progress. We believe that there is an actual need for a connection between clinical observations and tissue alterations arising during the treatment process, to gain superior functional outcomes. Herein, we perform a systematic review of the Bonar score’s application in the histopathological assessment of therapeutic advances in tendinopathy, with special reference to PRP therapy. (2) Methods: A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The searching strategy was conducted across major databases: PubMed, Cochrane Central, ScienceDirect, SciELO, and Web of Science. The risk-of-bias assessment was made using the Cochrane Collaboration’s Risk of Bias Tool and SYRCLE. (3) Results: The searching strategy produced 807 articles, and after selection, 22 studies were included. We collected 21 animal studies (n = 472) and 1 human study (n = 45). Three types of tendons were taken into account: 14 Achilles tendons, 7 supraspinatus tendons (SST), and in 1 case, Achilles and patellar tendons simultaneously. A variety of therapeutic methods were used—from intra-tendinous substance injections to surgical procedures or mechanical stimuli—but platelet-rich plasma (PRP) therapy dominated among them and was present in six studies. Most of the collected studies included an assessment of the tendons’ histopathology based on the classical Bonar score (with four variables and one observer). The staining protocol was based on the hematoxylin and eosin technique. An evaluation of therapeutic effects showed 15 positive results, 6 negative results, and 1 neutral result of treatments. (4) Conclusions: To understand the tendinopathy phenomenon, a link between histopathology and clinical observations in chronic tendon disorders is required due to the possibility of functional outcome improvements. The Bonar scoring system is well established in tendon pathology assessment and could also be adopted to assess therapeutic results in tendon disorders. Studies that included the PRP application showed Bonar-scoring-system-based evidence of superior tendinous tissue healing related to improved clinical results

The Role of TRPM2 in Endothelial Function and Dysfunction

The transient receptor potential (TRP) melastatin-like subfamily member 2 (TRPM2) is a non-selective calcium-permeable cation channel. It is expressed by many mammalian tissues, including bone marrow, spleen, lungs, heart, liver, neutrophils, and endothelial cells. The best-known mechanism of TRPM2 activation is related to the binding of ADP-ribose to the nudix-box sequence motif (NUDT9-H) in the C-terminal domain of the channel. In cells, the production of ADP-ribose is a result of increased oxidative stress. In the context of endothelial function, TRPM2-dependent calcium influx seems to be particularly interesting as it participates in the regulation of barrier function, cell death, cell migration, and angiogenesis. Any impairments of these functions may result in endothelial dysfunction observed in such conditions as atherosclerosis or hypertension. Thus, TRPM2 seems to be an attractive therapeutic target for the conditions connected with the increased production of reactive oxygen species. However, before the application of TRPM2 inhibitors will be possible, some issues need to be resolved. The main issues are the lack of specificity, poor membrane permeabilization, and low stability in in vivo conditions. The article aims to summarize the latest findings on a role of TRPM2 in endothelial cells. We also show some future perspectives for the application of TRPM2 inhibitors in cardiovascular system diseases

Intra-Articular Injection of Platelet-Rich Plasma Is More Effective than Hyaluronic Acid or Steroid Injection in the Treatment of Mild to Moderate Knee Osteoarthritis: A Prospective, Randomized, Triple-Parallel Clinical Trial

Purpose: To prospectively compare the efficacy and safety of intra-articular injections of platelet-rich plasma (PRP) with hyaluronic acid (HA) and glucocorticosteroid (CS) control groups for knee osteoarthritis (KOA) in a randomized, triple-parallel, single-center clinical trial. Methods: A total of 75 patients were randomly assigned to one of three groups receiving a single injection of either leukocyte-poor platelet-rich plasma (25 knees), hyaluronic acid (25 knees), or glucocorticosteroid (25 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was collected at baseline and 6, 12, and 26 weeks after treatment. Results: After 6 weeks of PRP administration, a decrease in the mean WOMAC value was observed in all three study groups. Three months after administration, the greatest decrease in the mean WOMAC value was obtained in the PRP group. The results in the HA and CS groups were similar (p = 0.681). In the one-way analysis of variance and post hoc analysis using the HSD Tukey test, a significantly greater improvement was shown by comparing the PRP and CS groups (p = 0.001), and the PRP and HA groups (p = 0.010). After intra-articular injection of CS, the reduction in pain was greatest 6 weeks after administration, and the mean value was the lowest among all groups. During subsequent visits, the value of the pain subscale increased, and after 6 months, it was the highest among the studied groups. Using the Wilcoxon paired test, no PRP effect was found to reduce stiffness at the 6-month follow-up (p = 0.908). Functional improvement was achieved in all groups, i.e., a decrease in the value of this subscale 6 months after administration. The largest decrease was seen in the group that received PRP (p < 0.001) and then in the HA group. The smallest decrease among the investigated methods was shown in the CS group. Conclusions: Intra-articular injections of PRP can provide clinically significant functional improvement for at least 6 months in patients with mild to moderate KOA which is superior to HA or CS injections

Cyclic AMP but Not Calmodulin as a Potential Wasoconstrictor in Simulated Reperfusion

The phenomena of ischemia and reperfusion are associated with the pathological background of cardiovascular diseases. Ischemia is initiated by ischemia reperfusion injury (IRI), which involves disruption of intracellular signaling pathways and causes cell death. The aim of this study was to assess the reactivity of vascular smooth muscle cells in the conditions of induced ischemia and reperfusion, and to determine the mechanisms leading to contractility disorders. This study was conducted using classical pharmacometric methods on an isolated model of the rat caudal artery. The experiment consisted of the analysis of the final and initial perfusate pressure measurements after induction of arterial contraction with phenylephrine in the presence of forskolin and A7 hydrochloride, two ligands modifying the contractility of vascular smooth muscle cells (VSMC). The pharmacometric analysis showed that in simulated reperfusion, cyclic nucleotides have a vasoconstrictive effect, and calmodulin has a vasodilating effect. The responsiveness of vascular smooth muscle cells to the vasopressor effects of α1-adrenomimetics during reperfusion may change uncontrollably, and the effects of secondary messengers may be counter physiological. Further studies are needed to evaluate the function of other second messengers on VSMCs in the process of ischemia and reperfusion

Genetics in Cartilage Lesions: Basic Science and Therapy Approaches

Cartilage lesions have a multifactorial nature, and genetic factors are their strongest determinants. As biochemical and genetic studies have dramatically progressed over the past decade, the molecular basis of cartilage pathologies has become clearer. Several homeostasis abnormalities within cartilaginous tissue have been found, including various structural changes, differential gene expression patterns, as well as altered epigenetic regulation. However, the efficient treatment of cartilage pathologies represents a substantial challenge. Understanding the complex genetic background pertaining to cartilage pathologies is useful primarily in the context of seeking new pathways leading to disease progression as well as in developing new targeted therapies. A technology utilizing gene transfer to deliver therapeutic genes to the site of injury is quickly becoming an emerging approach in cartilage renewal. The goal of this work is to provide an overview of the genetic basis of chondral lesions and the different approaches of the most recent systems exploiting therapeutic gene transfer in cartilage repair. The integration of tissue engineering with viral gene vectors is a novel and active area of research. However, despite promising preclinical data, this therapeutic concept needs to be supported by the growing body of clinical trials

The Comparison of Clinical Result between Primary Repair of the Anterior Cruciate Ligament with Additional Internal Bracing and Anatomic Single Bundle Reconstruction—A Retrospective Study

Background: The current standard of treatment of anterior cruciate ligament (ACL) is reconstruction (ACLR). This technique has some disadvantages: poor proprioception, donor site morbidity and the inability to restore joint kinematics. ACL repair could be an alternative treatment. The purpose of the study was to compare the stability and the function after ACL primary repair versus single-bundle ACLR. Methods: In a retrospective study, 12 patients underwent primary ACL repair with internal bracing, 15 patients underwent standard ACLR. Follow-up examinations were evaluated at up to 2 years postoperatively. One patient in the ACL repair group was lost to follow-up due to re-rupture. The absolute value of anterior tibial translation (ATT) and the side-to-side difference in the same patient (ΔATT) were evaluated using the GNRB arthrometer. The Lysholm knee scoring was obtained. Re-ruptures and other complications were recorded. Results: Anterior tibial translation (ATT) was significantly decreased in the ACL repair group compared with the ACLR group (5.31 mm vs. 7.18 mm, respectively; p = 0.0137). Arthrometric measurements demonstrated a mean side-to-side difference (ΔATT) 1.87 (range 0.2 to 4.9) mm significantly decreased compared to ACLR 3.36 (range 1.2–5.6 mm; p = 0.0107). The mean Lysholm score was 85.3 points in the ACL repair group and 89.9 in ACLR group. No significant differences between ACL repair and ACLR were found for the Lysholm score. There was no association between AP laxity and clinical outcomes. There were two complications in the internal bracing group: one patient had re-rupture and was treated by ACLR, another had limited extension and had arthroscopic debridement. Conclusions: Anterior tibial translation was significantly decreased after ACL repair. Additionally, the functional results after ACL repair with internal bracing were comparable with those after ACLR. It should be noted that the two complications occurred. The current study supports further development of ACL repair techniques

The Effect of Platelet-Rich Plasma on the Intra-Articular Microenvironment in Knee Osteoarthritis

Knee osteoarthritis (KOA) represents a clinical challenge due to poor potential for spontaneous healing of cartilage lesions. Several treatment options are available for KOA, including oral nonsteroidal anti-inflammatory drugs, physical therapy, braces, activity modification, and finally operative treatment. Intra-articular (IA) injections are usually used when the non-operative treatment is not effective, and when the surgery is not yet indicated. More and more studies suggesting that IA injections are as or even more efficient and safe than NSAIDs. Recently, research to improve intra-articular homeostasis has focused on biologic adjuncts, such as platelet-rich plasma (PRP). The catabolic and inflammatory intra-articular processes that exists in knee osteoarthritis (KOA) may be influenced by the administration of PRP and its derivatives. PRP can induce a regenerative response and lead to the improvement of metabolic functions of damaged structures. However, the positive effect on chondrogenesis and proliferation of mesenchymal stem cells (MSC) is still highly controversial. Recommendations from in vitro and animal research often lead to different clinical outcomes because it is difficult to translate non-clinical study outcomes and methodology recommendations to human clinical treatment protocols. In recent years, significant progress has been made in understanding the mechanism of PRP action. In this review, we will discuss mechanisms related to inflammation and chondrogenesis in cartilage repair and regenerative processes after PRP administration in in vitro and animal studies. Furthermore, we review clinical trials of PRP efficiency in changing the OA biomarkers in knee joint

Intra-articular injection of platelet-rich plasma is more effective than hyaluronic acid or steroid injection in the treatment of mild to moderate knee osteoarthritis:a prospective, randomized, triple-parallel clinical trial

Abstract Purpose: To prospectively compare the efficacy and safety of intra-articular injections of platelet-rich plasma (PRP) with hyaluronic acid (HA) and glucocorticosteroid (CS) control groups for knee osteoarthritis (KOA) in a randomized, triple-parallel, single-center clinical trial. Methods: A total of 75 patients were randomly assigned to one of three groups receiving a single injection of either leukocyte-poor platelet-rich plasma (25 knees), hyaluronic acid (25 knees), or glucocorticosteroid (25 knees). The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was collected at baseline and 6, 12, and 26 weeks after treatment. Results: After 6 weeks of PRP administration, a decrease in the mean WOMAC value was observed in all three study groups. Three months after administration, the greatest decrease in the mean WOMAC value was obtained in the PRP group. The results in the HA and CS groups were similar (p = 0.681). In the one-way analysis of variance and post hoc analysis using the HSD Tukey test, a significantly greater improvement was shown by comparing the PRP and CS groups (p = 0.001), and the PRP and HA groups (p = 0.010). After intra-articular injection of CS, the reduction in pain was greatest 6 weeks after administration, and the mean value was the lowest among all groups. During subsequent visits, the value of the pain subscale increased, and after 6 months, it was the highest among the studied groups. Using the Wilcoxon paired test, no PRP effect was found to reduce stiffness at the 6-month follow-up (p = 0.908). Functional improvement was achieved in all groups, i.e., a decrease in the value of this subscale 6 months after administration. The largest decrease was seen in the group that received PRP (p < 0.001) and then in the HA group. The smallest decrease among the investigated methods was shown in the CS group. Conclusions: Intra-articular injections of PRP can provide clinically significant functional improvement for at least 6 months in patients with mild to moderate KOA which is superior to HA or CS injections