Current concepts for the use of platelet-rich plasma in the foot and ankle

Platelet-rich plasma (PRP) injections have been used and studied since the 1970s. Its use has become more popularized over the last several years in the treatment of foot and ankle injuries. Platelets are a normal product found in the clotting cascade and inflammatory process of healing. They produce granules that release growth factors that promote healing. PRP works by increasing the concentration of platelets, thereby increasing the concentration of growth factors and increasing healing potential. PRP has an advantage over many tissue engineering products in that it is autologous. It has been studied and used for the treatment of tendon injuries, chronic wounds, ligamentous injuries, cartilage injuries, muscle injuries, and bone augmentation. The results from in vitro and in vivo studies in foot and ankle injuries are promising. The applications for treatment in the foot and ankle may be broader than once thought.     

Novel use of a manual therapy technique and management of a patient with peroneal tendinopathy: a case report

Peroneal tendinopathy is an uncommon but underappreciated source of lateral hindfoot pain and dysfunction. There is a paucity of literature describing optimal intervention for those suffering with pain secondary to peroneal tendinopathy. The purpose of this case report is to describe the evaluation and treatment incorporating manual therapy and therapeutic exercise for a patient diagnosed with peroneal tendinopathy. The patient was a 50 year-old female with a history of chronic lateral ankle pain and whose presentation was consistent with peroneal tendinopathy. Despite attempts to improve pain and function with over-the-counter orthotics, manual therapy to a hypomobile talocrural joint, and strengthening of the peroneal tendons, successful response was not reported until a lateral calcaneal glide was added. Improvement in impairments (pain, talocrural dorsiflexion, unilateral heel raises, and Star Excursion Balance Test) and function (Lower Extremity Functional Scale and Global Rating of Change), were observed over a course of eight visits. The patient was able to return to work and her recreational work out routine without limitations. In conclusion a successful physical therapy intervention for a patient with peroneal tendinopathy included a unique manual therapy technique, the lateral calcaneal glide, in conjunction with other manual therapy techniques and a structured home exercise program.     

电击跳跃法建立大鼠跟腱病动物模型

目的:采用电击跳跃法建立大鼠跟腱病动物模型.方法:采用电击刺激大鼠足部的方法,在电击笼内大鼠会向上跳跃,反复电击使大鼠肌腱产生过度损伤.结果:对大鼠跟腱进行HE染色、甲苯胺蓝染色、Tunel法细胞凋亡学检测.训练8周后跟腱胶原纤维排列明显紊乱,细胞核较圆,同时可见腱周组织中细胞数量和毛细血管数量增加,腱周组织中细胞数量、嗜碱性颗粒及毛细血管明显增加,提示电击刺激造模后的大鼠跟腱存在凋亡表现.结论:本研究从过度损伤后大鼠肌腱的逐渐变化进一步揭示肌腱病过度损伤的病理生理的过程,较其他造模法更好的反映了肌腱过度使用逐渐引起的肌腱变化.本实验能为进一步研究跟腱病的发病因素、病理机制和治疗提供合适的动物模型.     

Assessment of peritrochanteric high T2 signal depending on the age and gender of the patients

Introduction

The aim of this study is to evaluate the incidence of peritrochanteric high T2 signal (peritrochanteric edema, peritendinitis) on routine MR imaging studies and to determine whether reporting peritrochanteric edema is always clinically relevant depending on the age and gender of the patients.

Materials and methods

We evaluated 79 consecutive bilateral hip MR images performed in our department between January 2006 and December 2006 (57 female, 22 male patients, mean age 49 years). Each study was evaluated for areas of T2 hyperintensity representing edema around the greater trochanter. Patients with a known fracture, tumor, history of radiation therapy, history of hip surgery and prothesis were excluded from the study. Patients with signal intensity alterations within the thickened gluteus medius/minimus tendons (tendinitis) or peritrochanteric bursal fluid accumulation (bursitis) were also excluded. All patients were scanned with our routine MR imaging protocol for hip imaging.

Results

In 55 of the 79 patients (70%) peritrochanteric edema was detected on MR images and 52 of these 55 patients (95%) had these changes on both hips. The median age was 56 years for the patients with peritrochanteric edema and 35.5 years for the patients without peritrochanteric edema. There was statistical significance between the median ages of the patients and a significant increased risk of peritrochanteric edema was found over 40 years of age. There was no significant difference between male and female patients.

Conclusion

Bilateral peritrochanteric high T2 signal may be a part of the degeneration process and we suggest that it may not be necessarily reported if the clinical findings do not support greater trochanteric pain syndrome.     

同种异体肌腱及自体腓骨短肌重建踝关节外侧副韧带的比较

背景：目前临床多采用自体腓骨短肌或同种异体肌腱移植重建踝关节外侧副韧带,但两种材料的组织学和生物力学特性不同。 目的：对比自体腓骨短肌与同种异体肌腱重建踝关节外侧副韧带的临床疗效。 方法：纳入66例陈旧性踝关节外侧副韧带损伤引起的慢性外踝不稳患者,年龄15-63岁,其中34例采用自体腓骨短肌腱重建踝关节外侧韧带,32例采用深冻同种异体肌腱重建踝关节外侧韧带,重建后随访观察两组腓骨肌反应时间、距骨倾斜角和距骨前移距离,以及目测类比评分和美国足踝外科协会踝-后足功能评分。 结果与结论：两组末次随访的目测类比评分、距骨倾斜角和距骨前移距离均低于治疗前(P < 0.05),美国足踝外科协会踝-后足功能评分均高于治疗前(P < 0.05);自体腓骨短肌腱组末次随访腓骨肌反应时间高于治疗前(P < 0.05),同种异体肌腱末次随访腓骨肌反应时间低于治疗前(P < 0.05);末次随访时,两组间目测类比评分、美国足踝外科协会踝-后足功能评分、距骨倾斜角、距骨前移距离及腓骨肌反应时间比较差异均无显著性意义。表明同种异体肌腱重建踝关节外侧副韧带后的踝关节功能、稳定性及运动水平与自体腓骨短肌腱重建效果相当,但具有创伤小、手术时间短、保留完整腓骨短肌的优点。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

富血小板血浆治疗肌腱病的疗效分析

富血小板血浆(PRP)已被广泛应用于骨科和运动医学等领域来治疗肌腱病。然而临床运用PRP治疗肌腱病疗效究竟如何仍具有争议。本文回顾了近年来所报道的基于良好控制条件下所进行的关于PRP的基础科学研究,并联系临床试验结果,进行对比和讨论。事实上,无论是体内研究还是体外研究,都描述了PRP对肌腱具有促进合成代谢和抗炎作用。虽然一些临床试验支持这些发现,但也有一部分试验否认这些观点。本篇综述将基于基础研究呈现的证据来讨论PRP治疗肌腱损伤的有效性,同时探讨部分临床试验结果出现争议的潜在原因。最后,文章总结了用于改善PRP对肌腱病疗效的方法。     

发散型体外冲击波治疗青少年游泳运动员冈上肌肌腱病的前瞻对照研究

目的评价发散型体外冲击波应用于青少年游泳运动员冈上肌肌腱病的疗效及安全性。 方法采用前瞻性随机对照研究方法,将16名经临床及核磁共振确诊为肩袖冈上肌肌腱病并排除冈上肌撕裂的青少年游泳运动员随机分配到对照组及发散型体外冲击波治疗组(rESWT组),对照组7例采用冰敷、按摩、中频治疗仪治疗,rESWT组9例采用冰敷、发散型体外冲击波治疗。在治疗前及随访期内评估运动员可视化疼痛评分(VAS),简明肩关节测试评分(SST),Constant评分,治疗后复查肩关节MRI评价冈上肌肌腱的肌腱病分级。采用独立样本t检验进行组间对照,P< 0.05为差异具有统计学意义。 结果rESWT组治疗后6周及12周时VAS评分显著低于对照组(6周：t＝3.757, P<0.01;12周：t ＝3.982, P<0.01)。与治疗前相比,治疗后MRI复查未见冈上肌肌腱信号改变。未发生冲击波治疗相关并发症。 结论发散型体外冲击波可以在短期内有效改善青少年游泳运动员冈上肌肌腱病的肩痛症状,远期效果尚不明确。