Tendinopathy: A Major Medical Problem in Sport

Renström, Per; Woo, Savio L‐Y.

doi:10.1002/9780470757987.ch1

Cited by 22 publications

(26 citation statements)

References 58 publications

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“…Tendon adhesions are a common problem in healing tendons [6]. Thus, restoration of normal structure and function to injured tendons is one of the most challenging areas in orthopedic/sports medicine [7]. …”

Section: Introductionmentioning

confidence: 99%

Tendon Biomechanics and Mechanobiology—A Minireview of Basic Concepts and Recent Advancements

Wang

Guo²,

2012

Journal of Hand Therapy

248

197

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Due to their unique hierarchical structure and composition, tendons possess characteristic biomechanical properties, including high mechanical strength and viscoelasticity, which enable them to carry and transmit mechanical loads (muscular forces) effectively. Tendons are also mechano-responsive by adaptively changing their structure and function in response to altered mechanical loading conditions. In general, mechanical loading at physiological levels is beneficial to tendons, but excessive loading or disuse of tendons is detrimental. This mechano-adaptability is due to the cells present in tendons. Tendon fibroblasts (tenocytes) are the dominant tendon cells responsible for tendon homeostasis and repair. Tendon stem cells (TSCs), which were recently discovered, also play a vital role in tendon maintenance and repair by virtue of their ability to self-renew and differentiate into tenocytes. TSCs may also be responsible for chronic tendon injury, or tendinopathy, by undergoing aberrant differentiation into non-tenocytes in response to excessive mechanical loading. Thus, it is necessary to devise optimal rehabilitation protocols in order to enhance tendon healing while reducing scar tissue formation and tendon adhesions. Moreover, along with scaffolds that can mimic tendon matrix environments and platelet-rich plasma (PRP), which serves as a source of growth factors, TSCs may be the optimal cell type for enhancing repair of injured tendons.

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Section: Introductionmentioning

confidence: 99%

Tendon Biomechanics and Mechanobiology—A Minireview of Basic Concepts and Recent Advancements

Wang

Guo²,

2012

Journal of Hand Therapy

248

197

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“…Although the exact aetiology, pathophysiology and healing mechanisms are not fully understood, it seems that cumulative microtraumata occur because of repetitive overload. The healing capacity of the tendon can be insufficient, and leads to a tendinosis zone 10 11. Another hypothesis is that inflammation plays a role in the early stage as well as in the chronic stage of tendinopathy 12.…”

Section: Introductionmentioning

confidence: 99%

Injection treatments for patellar tendinopathy

2011

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ObjectiveInjection treatments are increasingly used as treatment for patellar tendinopathy. The aim of this systematic review is to describe the different injection treatments, their rationales and the effectiveness of treating patellar tendinopathy.MethodsA computerised search of the Medline, Embase, CINAHL and Web of Knowledge databases was conducted on 1 May 2010 to identify studies on injection treatments for patellar tendinopathy.Results11 articles on seven different injection treatments (dry needling, autologous blood, high-volume, platelet-rich plasma, sclerosis, steroids and aprotinin injections) were found: 4 randomised controlled trials (RCTs), 1 non-RCT, 4 prospective cohort studies and 2 retrospective cohort studies. All studies reported positive results. The Delphi scores of the four RCTs ranged from 5 to 8 out of 9. Different and sometimes contradictory rationales were used for the injection treatments.ConclusionAll seven different injection treatments seem promising for treating patellar tendinopathy. Unlike the other injection treatments, steroid treatment often shows a relapse of symptoms in the long term. Results should be interpreted with caution as the number of studies is low, few high-quality studies have been conducted and the studies are hard to compare due to different methodology. More high-quality studies using the same cross-cultural reliable and valid outcome measure are needed, as well as further research into the pathophysiology. Finally, some implications are provided for clinicians who want to use injection treatments as a part of their treatment for patellar tendinopathy, distinguishing between reactive and degenerative phase of patellar tendinopathy.

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“…Tendon is a highly organized, dynamic connective tissue which performs the essential mechanical role of transmitting tensile forces from muscle to bone. From a clinical standpoint, tendinopathy (defined as a syndrome of tendon pain, tenderness and swelling that affects function) is a very common medical condition and is associated with sporting and physical activity in active individuals over the age of 25 years (Renstrom & Woo, 2008), with tendon injuries estimated to account for 30-50% of all sporting injuries (Kannus, 1997). However, tendon problems are by no means restricted to younger individuals, and the incidence of tendinopathy has been shown to increase with age, which is thought to be as a result of degenerative changes in the tissue (Kannus et al, 2005;Rees et al, 2006).…”

mentioning

confidence: 99%

Metabolism of proteoglycans in tendon

Rees

Dent

Caterson

2009

Scandinavian Med Sci Sports

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Tendons are dense, fibrous connective tissues that are responsible for transmitting mechanical forces from skeletal muscle to bone. From a clinical perspective, tendinopathy (defined as a syndrome of tendon pain, tenderness and swelling that affects function) is very common, both within the sporting arena and in the workplace. Importantly, proteoglycans are essential components of the tendon extracellular matrix (ECM) and changes in their expression and metabolism/turnover have been associated with tendinopathy. Within tendons, the small leucine-rich proteoglycans (SLPRs), decorin, fibromodulin, lumican and keratocan predominate within tensional regions, while in tendon fibrocartilage, increased concentrations of proteoglycans common to the articular cartilage phenotype are present, including aggrecan, biglycan and proteoglycan 4. However, the rate of proteoglycan turnover within tendon is markedly higher than that of cartilage, mediated via the "aggrecanases," which are constitutively active in the tendon matrix. Data suggest that this increased proteoglycan turnover is likely to be required to maintain normal tendon homeostasis, with perturbations in proteoglycan metabolism contributing to tissue dysfunction. Thus, future studies aimed at furthering our fundamental knowledge of tendon proteoglycan metabolism in health and disease are important in the development of improved treatments for tendon disorders.

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Tendinopathy: A Major Medical Problem in Sport

Cited by 22 publications

References 58 publications

Tendon Biomechanics and Mechanobiology—A Minireview of Basic Concepts and Recent Advancements

Tendon Biomechanics and Mechanobiology—A Minireview of Basic Concepts and Recent Advancements

Injection treatments for patellar tendinopathy

Metabolism of proteoglycans in tendon

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