Ruptured human Achilles tendon has elevated metabolic activity up to 1 year after repair

Eliasson, Pernilla; Couppé, Christian; Lonsdale, Markus Nowak; Svensson, René B.; Neergaard, Christian; Kjær, Michael; Friberg, Lars; Magnusson, S. Peter

doi:10.1007/s00259-016-3379-4

Cited by 46 publications

(57 citation statements)

References 26 publications

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“…If the latter scenario is true, such a failure to regain normal pre-injury values would be supported by a previous study, which demonstrated that ruptured human Achilles tendons may have elevated metabolic activity up to one year post-injury. 39 Tendons with IM1/ACT5 were significantly more likely to exhibit GAG staining than IM6/ACT0 tendons, which may suggest a potential compositional downside to returning to sport early. When compared to data 3-weeks post-injury, GAG deposits were more prevalent in tissues 6-weeks post-injury, suggesting that there is a temporal response to GAG accumulation in Achilles tendons following rupture.…”

Section: Discussionmentioning

confidence: 95%

Temporal Healing of Achilles Tendons After Injury in Rodents Depends on Surgical Treatment and Activity

Freedman

Salka²,

Morris³

et al. 2017

J Am Acad Orthop Surg

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Introduction Achilles tendon ruptures affect 15 (women) to 55 (men) per 100,000 people each year, and controversy continues to exist regarding optimal treatment and rehabilitation protocols. The objective of this study was to investigate the temporal effects of surgical repair and immobilization/activity (IM/ACT) on Achilles healing and limb function following complete transection in rodents. Methods Injured tendons (n=128) were repaired or left non-repaired, and animals groups immobilized in plantarflexion for 1, 3, or 6 weeks that later resumed cage and treadmill activity for 5, 3, or 0 weeks (IM1/ACT5, IM3/ACT3, IM6/ACT0). Animals were euthanized after 1- or 6-weeks post-injury. Results At 6-weeks post injury, IM1/ACT5 groups had increased range of motion and decreased ankle joint toe stiffness compared to IM3/ACT3 groups. IM6/ACT0 had decreased tendon cross sectional area, but increased tendon echogenicity and collagen alignment. Surgical treatment dramatically decreased fatigue cycles to failure in repaired tendons from earlier IM1/ACT5 groups. Normalized comparisons between 6- and 1-week post-injury data demonstrated that changes in healing tendon properties (area, alignment, and echogenicity) were maximized by IM1/ACT5 compared to IM6/ACT0. Discussion/Conclusion This study demonstrates how the temporal post-injury healing response of rodent Achilles tendons depends on both surgical treatment and the timing of IM/ACT.

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Section: Discussionmentioning

confidence: 95%

Temporal Healing of Achilles Tendons After Injury in Rodents Depends on Surgical Treatment and Activity

Freedman

Salka²,

Morris³

et al. 2017

J Am Acad Orthop Surg

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“…Interestingly, Eliasson, et al . 12 reported an elevated metabolic activity, particularly glucose uptake, in ruptured Achilles tendons up to 1 year after surgical repair. Further, we previously described a tendon cell population in human and rat tendons, which upon glucose stimulation secretes insulin 13 .…”

Section: Introductionmentioning

confidence: 95%

A high-glucose diet affects Achilles tendon healing in rats

Korntner

Kunkel

Lehner

et al. 2017

Sci Rep

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Chronic and acute tendinopathies are difficult to treat and tendon healing is generally a very slow and incomplete process and our general understanding of tendon biology and regeneration lags behind that of muscle or bone. Although still largely unexplored, several studies suggest a positive effect of nutritional interventions on tendon health and repair. With this study, we aim to reveal effects of a high-glucose diet on tendon neoformation in a non-diabetic rat model of Achilles tenotomy. After surgery animals received either a high-glucose diet or a control diet for 2 and 4 weeks, respectively. Compared to the control group, tendon repair tissue thickness and stiffness were increased in the high-glucose group after 2 weeks and gait pattern was altered after 1 and 2 weeks. Cell proliferation was up to 3-fold higher and the expression of the chondrogenic marker genes Sox9, Col2a1, Acan and Comp was significantly increased 2 and 4 weeks post-surgery. Further, a moderate increase in cartilage-like areas within the repair tissue was evident after 4 weeks of a high-glucose diet regimen. In summary, we propose that a high-glucose diet significantly affects tendon healing after injury in non-diabetic rats, potentially driving chondrogenic degeneration.

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“…In addition to muscle atrophy, tendon length has received attention in recent years as an explanation of the suboptimal function. The Achilles tendon tissue can undergo extensively elongation in the initial 12 weeks, and all the way up to 26 weeks after surgery, while the metabolic activity and stiffness of the tendon may take up to a year to normalize . Importantly, the tendon elongation appears to be related to the clinical outcome and muscle function, such that less elongation yielded a better outcome .…”

Section: Introductionmentioning

confidence: 99%

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

et al. 2019

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We examined muscle function, muscle architecture, and tendon length bilaterally in persons who experience a functional deficit 2 years after an Achilles tendon rupture. Eleven persons were investigated on the injured compared with the uninjured side 47 ± 7 months (mean ± SD) after a tendon rupture. Heel‐rise data, plantar flexion strength, tendon resting angle 3D MRI‐determined tendon length and muscle cross‐sectional area, ultrasound‐determined fascicle length, and pennation angle were obtained. The heel‐rise test yielded reduced max height (32%), number of repetitions (54%), and work performed (61%), P < .001. Plantar flexion strength was impaired (P < .001) with the knee in extension (20%‐42%) and flexion (29%‐39%). Muscle cross‐sectional area was reduced for both the soleus (36%) and gastrocnemius muscles (46%; P < .001). Both the soleus tendon (55%) and the gastrocnemius tendon (14%) were longer (P < .001), and the fascicle length of the medial gastrocnemius was substantially reduced (18%; P < .001). The difference in heel‐rise height correlated to that of the gastrocnemius tendon elongation, r = .66, P < .05, but not soleus tendon elongation. These data show that a functional deficit after an Achilles tendon rupture is associated with an elongated soleus and gastrocnemius tendon along with a reduced soleus and gastrocnemius muscle cross‐sectional area and gastrocnemius fascicle length.

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Ruptured human Achilles tendon has elevated metabolic activity up to 1 year after repair

Cited by 46 publications

References 26 publications

Temporal Healing of Achilles Tendons After Injury in Rodents Depends on Surgical Treatment and Activity

Temporal Healing of Achilles Tendons After Injury in Rodents Depends on Surgical Treatment and Activity

A high-glucose diet affects Achilles tendon healing in rats

Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross‐sectional area

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