Influence of diabetes on tissue healing in orthopaedic injuries

Abstract

Diabetes is a group of metabolic diseases characterized by hyperglycaemia resulting from the defective action or secretion of insulin. Chronic hyperglycaemia can lead to the damage, dysfunction and failure of various organs. In the context of complications of healing and orthopaedic rehabilitation, vascular (microangiopathy) and nerve (neuropathy) disorders deserve particular attention. About 12% of the patients admitted to orthopaedic departments have diabetes. Studies indicate that there is an indisputable link between diabetes and: an increased risk of fractures, the difficult healing of injuries of bones, ligaments and musculotendinous. It appears that one of the main reasons for this is non-enzymatic glycosylation (glycation) of collagen molecules, a phenomenon observed in the elderly and diabetic populations, as it leads to the formation of advanced glycation end products (AGEs). Collagen is one of the major connective tissue components, and is therefore part of ligaments, tendons and bones. AGEs affect the weakening of its structure and biomechanical properties, and thus also affects the weakening of the structure and properties of the above-mentioned tissues. The aim of the study is to undertake an overview of the current knowledge of the impact of diabetes on the risk of some injuries and subsequent healing and rehabilitation of patients following orthopaedic injuries.

High glucose represses the proliferation of tendon fibroblasts by inhibiting autophagy activation in tendon injury

“…These results verify the important role of tendon fibroblasts autophagy in tendon injury and might provide a new opportunity to As connective tissue, tendons connect muscles and bones, transfer loads between muscles and bones through complex compositions and a hierarchy composed mainly of collagen type I, and play an important role in the sports system (20). Emerging studies have shown that diabetes has complex effects on tendons and bones in a number of ways, including clinical manifestations (pain, stiffness, decreased range of motion), imaging abnormalities, and decreased biomechanical properties (structural and functional changes) (21). The process of diabetic tendon injury is complex and can involve abnormal immune response, angiogenesis, accumulation of advanced glycation end products (AGEs), and other extracellular matrix changes (22)(23)(24)(25).…”

Multiscale modeling of knee ligament biomechanics

“…[65][66][67][68] These ovarian hormones alter collagen metabolism by generating enzymes that cleave and denature tropocollagen molecules. In addition, the effect of advanced glycation end products (AGEs), a phenomenon observed in the elderly and diabetic populations as responsible for the increased risk of ligament injuries, 69,70 could be a potential target using the proposed model. The viability of the model in detecting damage initiation may also help identify the differential and combined effects of the surgical and musculoskeletal factors that may contribute to the aberrant post-surgical ligament load.…”

Regenerative Rehabilitation for Bone Tissue Damage

“…Активация специфичного для остеобластов транскрипционного фактора RUNX2 (runt-related transcription factor 2) стимулирует дифференцировку остеобластов через регуляторный каскад AMPK/USF-1/SHP. Повышенная экспрессия RANKL (receptor activator for nuclear factor kappa-Β ligand) стимулирует остеокластогенез и подавляет остеобластогенез [16].…”

“…Существует бесспорная связь между диабетом и повышенным риском переломов, плохим заживлением повреждений костей, связок и мышечно-сухожильных пластин. Пови димому, одной из основных причин этого являет-ся неферментативное гликозилирование (гликирование) молекул коллагена, наблюдаемое в пожилых и диабетических популяциях, поскольку оно приводит к образованию конечных продуктов прогрессирующего гликирования [16].…”