Achilles tendon imaging

The Achilles tendon is the largest and strongest tendon in the body, yet one of the most commonly injured. Tendon degeneration is a relatively common disorder, predisposing to tears and often associated with paratenonitis. Numerous other diseases involve the Achilles tendon, some with classic imaging appearances, others with non‐specific appearances. The aim of this pictorial essay is to review the radiographic, computed tomographic, ultrasonographic and MR appearances of the normal and diseased Achilles tendon.     

运动康复疗法在跟腱微创修复术后的临床作用分析

目的分析患者跟腱微创修复术后康复疗法对功能影响与临床意义。方法2008年8月至2013年1月，我科收治并获得随访的92例行跟腱微创修复术的患者，术后按照收治顺序的单双数序号随机分为两组：其中运动康复疗法组48例全部获得随访，男46例，女2例，年龄18～50岁，平均34．3岁。左侧30例，右侧18例。术后严格按照我们制定的图文制式运动康复疗法指南进行渐进性康复训练；自然康复组失访4例，获得随访的44例中男42例，女2例，年龄21—52岁，平均35．1岁，左侧26例，右侧18例。术后由医生口头交待术后康复注意事项。随访按照Amer—Lindholm疗效评定标准进行评定，采用SPSS13．0软件将评定结果进行计量数据的统计学分析，从而进行组间差异性比较。结果随访时间8—48个月，平均19．6个月。运动康复疗法组及自然康复组均无感染病例，自然康复组再断裂4例，3例接受再手术，1例选择保守治疗。运动康复疗法组无跟腱再断裂。根据Arner—Lindholm评定法，运动康复疗法组优34例，良13例，差1例，总体优良率97．91％（47／48）；自然康复组优18例，良21例，差5例，总体优良率88．63％（39／44）。组间差异统计分析显示运动康复组功能优良率显著高于自然康复组（P=0．014）。结论本科制定的跟腱微创修复术后运动康复计划高效可靠，对恢复功能和防止再断裂至关重要。是值得推广的跟腱微创修复术后的康复锻炼方法。     

Magnetic resonance imaging of ankle tendons and ligaments: Part I – Anatomy

Magnetic resonance imaging is an excellent technique for imaging the tendons and the ligaments of the ankle. Owing to the advantage of detailed demonstration of soft‐tissue structures and capability for multiplanar demonstration of the ankle ligaments and tendons, MRI has been increasingly used in the evaluation of the ligamentous and the tendon injuries of the ankle. Knowledge of normal anatomy and of MRI appearances are essential to recognize pathological appearances. In this pictorial essay, the first of a three part series, we review the normal MRI appearances of the ankle tendons and ligaments. The anterior, lateral and medial tendon groups, the Achilles tendon and the lateral, the syndesmotic and the medial ligament groups are described and illustrated. Anatomy of the sinus tarsi is also described. Tendon and ligament pathology will be illustrated in the second part of the series, and imaging approach to ankle injuries will be outlined in the final part of this series.     

关节镜下带跟骨异体跟腱单束单隧道重建前交叉韧带

目的 通过与关节镜下单纯采用同种异体肌腱重建前交叉韧带 （anterior cruciate ligament,ACL） 比较,探讨带跟骨异体跟腱重建 ACL 促进腱-骨愈合的作用。方法 选择 2008 年１月至 2009 年 12 月收治并符合纳入标准的 41 例 ACL 损伤患者,随机分为两组,其中 21 例采用带跟骨异体跟腱重建 ACL （试验组）, 20 例采用单纯同种异体肌腱重建 ACL （对照组）。两组患者年龄、性别、损伤原因、病程及术前功能评分等一般资料差异均无统计学意义 （P＞0.05）,具有可比性。两组均采用单束单隧道技术重建 ACL。结果 术后 ２周两组所有患者切口均Ｉ期愈合。两组患者均获随访,试验组随访时间 24～28 个月,平均 26 个月;对照组 24～30 个月,平均 28 个月。术后２年,试验组 Lachman 试验阴性率 71.4％ （15 例）,前抽屉试验阴性率 76.2％ （16 例）;对照组２个试验的阴性率分别为 70.0% （14 例） 和 75.0% （15 例）。术后２年,试验组 Lysholm 评分、国际膝关节文献委员会 （IKDC） 评分与对照组比较,差异均无统计学意义 （P＞0.05）。CT 检查示,术后 ２年两组骨隧道直径均较术后１个月有不同程度增加,但试验组 （4/21,19.0%） 的骨隧道扩大率明显小于对照组 （8/20,40.0%） （P＜0.05）。膝关节松弛度检测显示：试验组关节前向松弛度为 （1.82±0.90） mm,明显小于对照组的 （2.29±0.77） mm。结论 与采用单纯同种异体肌腱重建 ACL 相比,采用带跟骨异体跟腱重建 ACL 可在一定程度上降低骨隧道扩大率,促进腱-骨愈合,近期疗效较好。     

血小板浓缩物在骨关节病和运动损伤疾病中的应用

Platelet concentrate ( PC ) for surgical use is an evolution of the fibrin glue technologies used since many years. The initial concept of these preparations was to concentrate platelets and their growth factors and activate it into a fibrin gel on a surgical site, in order to improve local healing. The platelets contain alpha granules that are rich in several growth factors, such as platelet-derived growth factor, vascular endothelial growth factor, transforming growth factor-β, insulin-like growth factor, and epidermal growth factor, which play the essential roles in tissue healing and regeneration mechanisms. The relative ease of obtaining and preparation, convenience and applicability in the clinical setting, favorable safety profile and possible beneficial outcomes make PCs a new promising therapeutic approach for future regenerative therapy strategy. Numerous techniques of PC have been developed. The most common forms of autologous platelet concentrates: Platelet rich plasma ( PRP ) and platelet rich fibrin ( PRF ) have been introduced into various medical fields, including orthopedic surgery, plastic surgery, sports injury and other areas of regenerative medicine. More recently, developments in research of the regenerative effects of PC in a range of tissue types including bone, cartilage, tendon and muscle, as well as in the tissues of traumatic injury, have attracted interest in fields such as orthopedic and sport medicine. Many clinical studies suggested that the PC therapies may have benefits to osteoarthropathy such as osteoarthritis and necrosis of femoral head, and the conditions such as epicondylitis, ligament and muscle strains, and tears of rotator cuff, anterior cruciate ligament and Achilles tendon, as well as other sport related injuries. However, our understanding of the mechanisms of PCs in tissue repair and healing is still limited in basic research. There are also limited publications that provided convincing evidences of the efficacy of PCs therapy in the treatment of these injuries/disorders in a randomized controlled clinical trial based study. Therefore, in this review, we describe the various factors that proposed to contribute to the biological activity of PCs, and the published pre-clinical and clinical evidences to support the factors. We also review the current developments on the basic research and clinical application of the PC products in osteoarthropathy and sport medicine, and highlight the areas of emerging clinical applications of PCs.     

Oncogene addiction

Cancer cells contain multiple genetic and epigenetic abnormalities. Despite this complexity, their growth and survival can often be impaired by the inactivation of a single oncogene. This phenomenon, called "oncogene addiction," provides a rationale for molecular targeted therapy. The efficacy of this strategy requires novel methods, including integrative genomics and systems biology, to identify the state of oncogene addiction (i.e., the "Achilles heel") in specific cancers. Combination therapy may also be required to prevent the escape of cancers from a given state of oncogene addiction.     

端粒维持机制及肿瘤治疗新策略

端粒是位于真核细胞染色体末端的特殊蛋白结构,对维持线性染色体的稳定性至关重要,如珑何抑制端粒功能成为改进肿瘤治疗的新亮点.基于抑制端粒酶活性的抗肿瘤治疗存在不足,以端粒维持机制和端粒结构为靶点的抗肿瘤新策略已越来越受到重视,是富有前景的研究方向.     

Oncogene addiction in gliomas: Implications for molecular targeted therapy

Oncogene addiction is a phenomenon that the survival of cancer cells depends on an activated oncogene or inactivation of tumor suppressor gene, and is regarded as the ''Achilles heel'' of the successful molecular targeted therapies in cancer. However, the role of oncogene addiction in gliomas has not been elucidated systematically. In this review, we summarize the current experimental and clinical evidence for the concept of oncogene addiction and describe the mechanisms explaining oncogene addiction in gliomas. And the clinical implications for oncogene addiction in molecular targeted therapy are further emphasized. In addition, we discuss future direction for defining complex "oncogene addiction network" through the integrated analysis of multiple platforms in the flow of genetic information in gliomagenesis.     

A prospective study of aromatase inhibitor‐associated musculoskeletal symptoms and abnormalities on serial high‐resolution wrist ultrasonography

BACKGROUND:

Nearly half of women treated with aromatase inhibitors (AI) develop AI‐associated musculoskeletal symptoms (AIMSS) such as arthralgias, but to the authors' knowledge the etiology is unclear. The upper extremities are frequently affected, especially the wrists, hands, and fingers. AI use may also increase the risk of developing carpal tunnel syndrome. Tendon sheath fluid and tenosynovial changes have been demonstrated by imaging symptomatic patients who were treated with AIs. The authors hypothesized that these abnormalities are correlated with AIMSS.

METHODS:

Thirty consecutive patients in whom adjuvant therapy with letrozole or exemestane was initiated on a prospective clinical trial enrolled in a pilot study evaluating tendon and joint abnormalities at baseline and after 3 months of AI therapy. Patients underwent high‐resolution ultrasonography of the wrists bilaterally and completed the Health Assessment Questionnaire (HAQ) and pain Visual Analog Scale (VAS). AIMSS were defined as an increase in the HAQ or VAS score during AI therapy that exceeded a predefined cutoff.

RESULTS:

Twenty‐five patients completed both the baseline and 3‐month assessments. During the first 12 months of AI therapy, 15 patients developed AIMSS, and 13 discontinued therapy because of musculoskeletal symptoms. There was a trend toward an association between the presence of tendon sheath abnormalities on wrist ultrasound at baseline and the development of AIMSS (P = .06).

CONCLUSIONS:

Clinically relevant musculoskeletal symptoms develop in women treated with AIs, leading to treatment discontinuation in a substantial percentage of these patients. However, in the current study, patient‐reported symptoms were not found to be associated with changes visible on wrist ultrasonography. Cancer 2010. © 2010 American Cancer Society.     

Tear of the distal biceps branchii tendon: A new method of ultrasound evaluation

Tear of the distal biceps brachii tendon is an uncommon injury. Ultrasound evaluation of the distal tendon using an anterior approach is often difficult because of technical factors. We describe a new method of ultrasound evaluation of the distal biceps tendon insertion. This involves a posterior approach with the forearm pronated. With pronation of the forearm, the radial tuberosity faces posteriorly, bringing the distal biceps tendon insertion into view. A surgically proven case of distal biceps tendon tear is presented to illustrate our technique.     

Implications of reactive oxygen species on cancer formation and its treatment

Elevated levels of reactive oxygen species (ROS) are a hallmark of cancer. Although increased ROS concentrations play important roles in cancer formation and progression, levels above a cytotoxic threshold cause cancer cell death. Cancer cells adapt to high concentrations of ROS via antioxidant production and reprogrammed cellular metabolism (eg, the Warburg effect). Because some widely used anticancer therapies such as radiation therapy and chemotherapy rely on ROS accumulation as a mechanism to induce cancer cell death, a cancer cell's ability to control ROS levels is a driver of treatment resistance and a critical consideration for successful cancer treatment. The necessity for cancer cells to adapt to elevated levels of ROS to survive may represent an Achilles heel for some malignancies, as therapies designed to interfere with this adaptation would be expected to kill cancer cells. In this review, we provide an overview of the implications of ROS on cancer formation and anticancer treatment strategies, with a focus on treatment-resistant disease.     

Postoperative patellar tendon healing: An ultrasound study

The patellar tendon donor site of 20 patients who underwent anterior cruciate ligament (ACL) reconstruction using the patellar tendon tissue as autograft was examined with high resolution 7.5 MHz ultrasound. The patients were randomly divided into four groups and studied at 3, 6, 9 or 12 months postoperatively. The size of the postoperative tendon defect was measured just distal to the lower pole of the patella. The size of the tendon defect diminished progressively from a mean of 109 mm² at 3 months to a mean of 23 mm² at 12 months. Increasing echogenicity was first noticed 12 months after tendon repair. Seven patients developed clinical features postoperatively of jumper's knee (patellar tendinosis). There were no ultrasound signs that differentiated these patients from asymptomatic patients. It is concluded that ultrasound provides objective evidence of patellar tendon healing after ACL reconstruction: the surgical defect diminished in size and became echogenic after a period of 12 months.     

Magnetic resonance imaging of the supraspinatus tendon: The significance of signal intensity alterations at the‘criticalzone’

A pictorial essay of normal and abnormal appearances of the supraspinatus tendon is presented. An increased signal intensity within the supraspinatus tendon on short TE sequences is not necessarily abnormal. Increased signal seen within the tendon on modern magnetic resonance imaging (MRI) units is often due to a phenomenon known as the‘magic angle’effect. Only when supraspinatus tendon signal intensity is greater than that of muscle on long TE (T2) sequences should it be considered to be abnormal. The physical basis for the magic angle effect is outlined and a pictorial essay demonstrating the practical implications of this effect is presented. A comparison is made to signal intensity changes seen with partial and complete tears of the supraspinatus tendon. Correlation is made with important morphologic features of partial or complete tears.     

Vindesine a clinical trial with special reference to neurological side effects

Summary A good tumoricidal activity of vindesine (VDS) has been reported in a variety of animal tumors and in human leukemias and lymphomas. We treated 22 patients who had received no prior chemotherapy and were suffering from a variety of malignant neoplasms with 0.5 mg/m² to 3.0 mg/m² VDS i. v. once or three times at weekly intervals and recorded the clinical, hematologic, and especially, neurological side effects.Clinically we observed fatigue in nine patients, paresthesias in seven, myalgias in three, vertigo and diarrhea in two, and skin pains, tinnitus, gastric pains, alopecia, and tremor in one patient each. There was no obvious dose-action relationship. Paravenous injection caused cellulitis similar to that seen with vincristine. No side effects were apparent in liver (SGPT) and renal (creatinine) function tests. Hematologically there was a clear trend toward leukopenia with higher doses of DVA and a mean increase in the thrombocyte count by 51x10³/mm³ was found (sign test: P<0.05). The hemoglobin level did not change.Clinical neurological examination and monitoring by electroneurography revealed no changes in tensiometer performance, motor and sensory nerve conduction velocity, motor or sensory nerve action potential amplitudes, or H-reflex responses. There was dose-related diminution of the proprioceptive reflexes, especially in the lower extremities. Even with as little as 2.0 mg/m² VDS i. v. at weekly intervals for 3 weeks Achilles and patellar tendon reflexes were diminished or absent in all patients.     

Giant cell tumor of tendon sheath, tenosynovial giant cell tumor, and pigmented villonodular synovitis: defining the presentation, surgical therapy and recurrence

Giant cell tumor of the tendon sheath (GCTTS), tenosynovial giant cell tumor (TGCT), and pigmented villo-nodular synovitis (PVNS) are the common names for a group of rare proliferative disorders that involve synovial joints and tendon sheaths. Considerable confusion exists about the surgical treatment and diagnosis of these disorders. This review evaluates the presentation, surgical therapy and recurrence of these three proliferative disorders. We retrospectively reviewed the clinical data from all cases of GCTTS, TGCT, and PVNS from 1985 to 1997. A total of 35 patients were identified: GCTTS (n=8), TGCT (n=1), and PVNS (n=26), there were 18 men and 17 women. The median age was 48 years (range 6-84 years). The most common site of involvement was the knee (15), followed by wrist (7), elbow (4), and hip (4). Seven patients had extra-articular involvement, and 19 were found incidentally at operations for other reasons. Among the 4 patients who developed recurrent disease, 2 had extra-articular disease at the time of their original diagnosis. None died, and none required major amputation. One patient was treated with adjuvant radiotherapy following resection of a recurrence. It is important to distinguish between focal and diffuse forms of synovial involvement. If focal, simple surgical excision is appropriate. If diffuse, complete synovectomy is indicated for disease confined to the joint, and resection of all gross disease is indicated for extra-articular disease. Radical resection with negative margins is not necessary in most instances. In rare aggressive cases, local recurrence may necessitate more extensive resection and radiation therapy.     

幼儿重型先天性马蹄内翻足一次性矫正疗效报道

目的 探讨幼儿重型先天性马蹄内翻足一次性矫正的方法及效果。方法 手术行跟腱延长，胫后肌腱延长，拇长及趾长屈肌腱延长，跖筋膜切断，胫前肌腱外置术，使肌力平衡；同时手法扳正，使跟骨、距骨、舟骨及骰骨等压缩，将畸形矫正成轻度外翻状，术后管形石膏固定3个月。结果 本组68例(99足)，随访1～5年，平均27个月，马蹄内翻足完全矫正，效果优占72．7％，良占27．3％，无一例差。结论 后侧肌腱广泛松解、延长及手法矫正，可一次性矫正幼儿重型马蹄内翻足，并具有不损伤关节正常生理结构，远期关节功能良好，无关节僵硬及关节畸形等优点。     

Fibroma of tendon sheath

This report describes a 60-year-old woman with a fibroma of tendon sheath of left hand. Ultrastructural study of the tumor reveals the nature of the tumor cells as fibroblasts, thus distinguishing it from the more common giant cell tumor of tendon sheath believed to be derived from synovial cells.     

Fibroma of tendon sheath

Three cases of fibromas involving tendon sheath of right index finger, left ring finger, and tibial ligament in a 62-, a 54-, and a 30-year-old male patient, respectively, are described. Two cases (1 and 2) represented painless, slowly enlarging masses that limited motion of the involved digits. The third case was discovered at surgery during the repair of a tibial ligament after a motorcycle accident. Following surgical excisions, no recurrences were present 18 months and 9 months after resection. The fibromas of tendon sheath origin are distinct entities and should be separated from other lesions of tendon sheaths. Trauma should be considered as the etiology. The fibromas are benign lesions but may recur.     

Giant cell tumour of the tendon sheath of the hand: A pictorial essay

Giant cell tumour of the tendon sheath is a soft tissue mass found occasionally in the hand. Its diagnosis can be readily made preoperatively if the characteristic MRI features are appreciated. This pictorial essay demonstrates and describes the imaging findings correlated with histopathological findings in a group of patients with proven giant cell tumour of the tendon sheath.     

Differential effects of heat stress on fibre capillarisation in tenotomised soleus and plantaris muscles

Purpose: Capillary regression is commonly observed in response to disuse muscle atrophy. Heat stress is known to alleviate muscle atrophy, while effect of heat exposure on capillary adaptation following disuse atrophy is not defined. Here, we examined the effect of heat treatment on capillarisation and the associated signalling in slow-oxidative soleus and fast-glycolytic plantaris muscles following Achilles tendon ablation (tenotomy).

Materials and methods: Male Wistar rats were assigned into control (CON), control with heat stress (CON?+?HEAT), tenotomy (TEN) and tenotomy with heat stress (TEN?+?HEAT) groups. Tenotomy was induced for 8?days in TEN and TEN?+?HEAT groups. Heat stress was maintained at 40.5–41.5?°C, 30?min for 7?days.

Results: Tenotomy resulted in reduction of capillary-to-fibre ratio, decreased VEGFR-2 and increased TSP-1 in soleus muscle, whereas VEGF protein expression remained unaffected. Tenotomy had no effect on capillary distribution and angiogenic signalling in plantaris muscle. These results were concomitant with larger reduction of cross-sectional area (CSA) in MHC type I and II myofibres of soleus compared to plantaris muscles. Interestingly, heat stress increased VEGFR-2 and attenuated TSP-1 protein expression in tenotomised soleus, but not plantaris muscles. Additionally, CSA of both type I and type II myofibres was greater in tenotomised soleus than plantaris muscles after heat treatment.

Conclusions: Heat stress mitigated effect of tenotomy-induced capillary regression in a fibre-type-specific response, in part, by shifting the balance between angiogenic and angiostatic regulators. These results suggest beneficial effect of heat treatment for maintaining microcirculation in disuse muscle atrophy.