Development and evaluation of multiple tendon injury models in the mouse

The mouse has proven to be an advantageous animal model system in basic science research focused on aiding in development and evaluation of potential treatments; however, the small size of mouse tendons makes consistent and reproducible injury models and subsequent biomechanical evaluation challenging for studying tendon healing. In this study, we investigated the feasibility and reproducibility of multiple mouse tendon injury models. Our hypothesis was that incisional (using a blade) and excisional (using a biopsy punch) injuries would result in consistent differences in tendon material properties. At 16 weeks of age, 17 C57BL/6 mice underwent surgery to create defects in the flexor digitorum longus, Achilles, or patellar tendon. Each animal received 1-2 full-thickness, central-width incisional or excisional injuries per limb; at least one tendon per limb remained uninjured. The injuries were distributed such that each tendon type had comparable numbers of uninjured, incisionally injured, and excisionally injured specimens. Three weeks after injury, all animals were euthanized and tendons were harvested for mechanical testing. As hypothesized, differences were detected for all three different tendon types at three weeks post-injury. While all models created injuries that produced predictable outcomes, the patellar tendon model was the most consistent in terms of number and size of significant differences in injured tendons compared to native properties, as well as in the overall variance in the data. This finding provides support for its use in fundamental tendon healing studies; however, future work may use any of these models, based on their appropriateness for the specific question under study.     

Mechanically overloading collagen fibrils uncoils collagen molecules,placing them in a stable,denatured state

Due to the high occurrence rate of overextension injuries to tendons and ligaments, it is important to understand the fundamental mechanisms of damage to these tissues' primary load-bearing elements: collagen fibrils and their constituent molecules. Based on our recent observations of a new subrupture, overload-induced mode of fibril disruption that we call discrete plasticity, we have sought in the current study to re-explore whether the tensile overload of collagen fibrils can alter the helical conformation of collagen molecules. In order to accomplish this, we have analyzed the conformation of collagen molecules within repeatedly overloaded tendons in relation to their undamaged matched-pair controls using both differential scanning calorimetry and variable temperature trypsin digestion susceptibility. We find that tensile overload reduces the specific enthalpy of denaturation of tendons, and increases their susceptibility to trypsin digestion, even when the digestion is carried out at temperatures as low as 4 °C. Our results indicate that the tensile overload of collagen fibrils can uncoil the helix of collagen molecules, placing them in a stable, denatured state.     

A cardio-facio-cutaneous syndrome case with tight Achilles tendons

Cardio-facio-cutaneous syndrome (CFCS) is a multiple congenital anomaly disorder characterized by craniofacial features, cardiac defects, ectodermal anomalies and neurocognitive delay. Clinical findings of patients with CFCS show similarities to those of patients with Costello Syndrome (CS). CFCS and CS are caused by mutations in genes encoding proteins of the RAS-MAPK signaling pathway. Musculoskeletal findings including tight Achilles tendons and contractures of elbows, shoulders or hips have been reported in CS patients. However, limited extension of joints were observed in some patients with CFCS. According to the literature, no tight Achilles tendons have been reported in CFCS patients so far. In this case report, we present a male CFCS patient with tight Achilles tendons with a de-novo heterozygote N581D mutation in the BRAF gene detected by DNA sequence analysis.     

Advanced glycation end productions and tendon stem/progenitor cells in pathogenesis of diabetic tendinopathy

Tendinopathy is a challenging complication observed in patients with diabetes mellitus. Tendinopathy usually leads to chronic pain, limited joint motion, and even ruptured tendons. Imaging and histological analyses have revealed pathological changes in various tendons of patients with diabetes, including disorganized arrangement of collagen fibers, microtears, calcium nodules, and advanced glycation end product (AGE) deposition. Tendon-derived stem/ progenitor cells (TSPCs) were found to maintain hemostasis and to participate in the reversal of tendinopathy. We also discovered the aberrant osteochondrogenesis of TSPCs in vitro. However, the relationship between AGEs and TSPCs in diabetic tendinopathy and the underlying mechanism remain unclear. In this review, we summarize the current findings in this field and hypothesize that AGEs could alter the properties of tendons in patients with diabetes by regulating the proliferation and differentiation of TSPCs in vivo.     

Lacerations from glass in childhood.

A study of 62 glass injuries to children serious enough to warrant admission to hospital showed that 30 were due to architectural glass in doors or windows and 26 of these occurred in houses. Glass bottles caused 12 injuries. Architectural glass produced more serious injuries affecting major arteries, nerves and tendons, and internal viscera. In view of the frequency and severity of architectural glass injuries in houses, safety glass in recommended for all glass doors, French windows, patio doors, and the lower parts of windows.     

The BGN and ACAN genes and carpal tunnel syndrome

The causes of idiopathic carpal tunnel syndrome (CTS) remain unknown and the involvement of the tendons within the carpal tunnel structure in the aetiology of CTS cannot be excluded. Variants within the COL5A1 gene, an important regulator of fibril assembly in tendons, have previously been associated with modulating the risk of CTS. Furthermore, proteoglycans are also important structural components of tendons and variants within the aggrecan gene are associated with musculoskeletal soft tissue injuries. The aim of this study was to determine whether ACAN and BGN variants are associated with CTS.     

Biomechanical and structural response of healing Achilles tendon to fatigue loading following acute injury

Achilles tendon injuries affect both athletes and the general population, and their incidence is rising. In particular, the Achilles tendon is subject to dynamic loading at or near failure loads during activity, and fatigue induced damage is likely a contributing factor to ultimate tendon failure. Unfortunately, little is known about how injured Achilles tendons respond mechanically and structurally to fatigue loading during healing. Knowledge of these properties remains critical to best evaluate tendon damage induction and the ability of the tendon to maintain mechanical properties with repeated loading. Thus, this study investigated the mechanical and structural changes in healing mouse Achilles tendons during fatigue loading. Twenty four mice received bilateral full thickness, partial width excisional injuries to their Achilles tendons (IACUC approved) and twelve tendons from six uninjured mice were used as controls. Tendons were fatigue loaded to assess mechanical and structural properties simultaneously after 0, 1, 3, and 6 weeks of healing using an integrated polarized light system. Results showed that the number of cycles to failure decreased dramatically (37-fold, p<0.005) due to injury, but increased throughout healing, ultimately recovering after 6 weeks. The tangent stiffness, hysteresis, and dynamic modulus did not improve with healing (p<0.005). Linear regression analysis was used to determine relationships between mechanical and structural properties. Of tendon structural properties, the apparent birefringence was able to best predict dynamic modulus (R²=0.88–0.92) throughout healing and fatigue life. This study reinforces the concept that fatigue loading is a sensitive metric to assess tendon healing and demonstrates potential structural metrics to predict mechanical properties.     

The locomotory system of pearlfish Carapus acus: What morphological features are characteristic for highly flexible fishes?

The body curvature displayed by fishes differs remarkably between species. Some nonmuscular features (e.g., number of vertebrae) are known to influence axial flexibility, but we have poor knowledge of the influence of the musculotendinous system (myosepta and muscles). Whereas this system has been described in stiff‐bodied fishes, we have little data on flexible fishes. In this study, we present new data on the musculotendinous system of a highly flexible fish and compare them to existing data on rigid fishes. We use microdissections with polarized light microscopy to study the three‐dimensional anatomy of myoseptal tendons, histology and immunohistology to study the insertion of muscle fiber types into tendons, and μ‐CT scans to study skeletal anatomy. Results are compared with published data from stiff‐bodied fishes. We identify four important morphological differences between stiff‐bodied fishes and Carapus acus: (1) Carapus bears short tendons in the horizontal septum, whereas rigid fishes have elongated tendons. (2) Carapus bears short lateral tendons in its myosepta, whereas stiff‐bodied fishes bear elongated tendons. Because of its short myoseptal tendons, Carapus retains high axial flexibility. In contrast, elongated tendons restrict axial flexibility in rigid fishes but are able to transmit anteriorly generated muscle forces through long tendons down to the tail. (3) Carapus bears distinct epineural and epipleural tendons in its myosepta, whereas these tendons are weak or absent in rigid fishes. As these tendons firmly connect vertebral axis and skin in Carapus, we consider them to constrain lateral displacement of the vertebral axis during extreme body flexures. (4) Ossifications of myoseptal tendons are only present in C. acus and other more flexible fishes but are absent in rigid fishes. The functional reasons for this remain unexplained. J. Morphol., 2012. © 2011 Wiley Periodicals, Inc.     

Onset of neonatal locomotor behavior and the mechanical development of Achilles and tail tendons

Tendon tissue engineering approaches are challenged by a limited understanding of the role mechanical loading plays in normal tendon development. We propose that the increased loading that developing postnatal tendons experience with the onset of locomotor behavior impacts tendon formation. The objective of this study was to assess the onset of spontaneous weight-bearing locomotion in postnatal day (P) 1, 5, and 10 rats, and characterize the relationship between locomotion and the mechanical development of weight-bearing and non-weight-bearing tendons. Movement was video recorded and scored to determine non-weight-bearing, partial weight-bearing, and full weight-bearing locomotor behavior at P1, P5, and P10. Achilles tendons, as weight-bearing tendons, and tail tendons, as non-weight-bearing tendons, were mechanically evaluated. We observed a significant increase in locomotor behavior in P10 rats, compared to P1 and P5. We also found corresponding significant differences in the maximum force, stiffness, displacement at maximum force, and cross-sectional area in Achilles tendons, as a function of postnatal age. However, the maximum stress, strain at maximum stress, and elastic modulus remained constant. Tail tendons of P10 rats had significantly higher maximum force, maximum stress, elastic modulus, and stiffness compared to P5. Our results suggest that the onset of locomotor behavior may be providing the mechanical cues regulating postnatal tendon growth, and their mechanical development may proceed differently in weight-bearing and non-weight-bearing tendons. Further analysis of how this loading affects developing tendons in vivo may inform future engineering approaches aiming to apply such mechanical cues to regulate engineered tendon formation in vitro.     

The presence of Candida spp and rods of Enterobacteriaceae family in the vaginal swab specimens

The aim of the present work was to determine the presence and quantity of yeasts (Candida) and rods of Enterobacteriaceae family in the ontocenosis of vagina in women. Also, we aimed at finding which species of Enterobacteriaceae accompany the yeasts. Furthermore we aimed at determining the etiological factor (Candida yeasts or Enterobacteriaceae rods) causing identical clinical symptoms such as burn, itch, leucorrhea. Vagina secretion collected from 649 patients constituted the material for examination Candida. In 137 patients (which constituted 21.1%) Candida yeasts were found (group I). These patients were additionally divided into 2 subgroups (I a and I b). Group I a consisted of 92 patients (14.2%) who exhibited the presence of Candida without the accompanying rods of Enterobacteriaceae and group I b consisting of 45 patients (6.9%), in whom Candida was found together with the rods. 171 patients (26.3%) were classified to group II, who had only Enterobacteriaceae rods in the vagina. Among Candida yeasts, the most common species were C. albicans, C. krusei, C. tropicalis. The most common rods of Enterobacteriaceae family were E. coli and P. mirabilis. The bacterium which most frequently accompanied the yeasts was E. coli. Considering the fact that patients in group I and patients in group II reported similar problems, the role of the etiological factor in the vaginal inflammatory processes should be analyzed.     

Gene therapy and tissue engineering for sports medicine

Sports injuries usually involve tissues that display a limited capacity for healing. The treatment of sports injuries has improved over the past 10 to 20 years through sophisticated rehabilitation programs, novel operative techniques, and advances in the field of biomechanical research. Despite this considerable progress, no optimal solution has been found for treatment of various sports-related injuries, including muscle injuries, ligament and tendon ruptures, central meniscal tears, cartilage lesions, and delayed bone fracture healing. New biological approaches focus on the treatment of these injuries with growth factors to stimulate and hasten the healing process. Gene therapy using the transfer of defined genes encoding therapeutic proteins represents a promising way to efficiently deliver suitable growth factors into the injured tissue. Tissue engineering, which may eventually be combined with gene therapy, may potentially result in the creation of tissues or scaffolds for regeneration of tissue defects following trauma. In this article we will discuss why gene therapy and tissue engineering are becoming increasingly important in modern orthopaedic sports medicine practice. We then will review recent research achievements in the area of gene therapy and tissue engineering for sports-related injuries, and highlight the potential clinical applications of this technology in the treatment of patients with musculoskeletal problems following sports-related injuries.     

Isolated fibrillar damage in tendons stimulates local collagenase mRNA expression and protein synthesis

The etiology of repetitive stress injuries in tendons has not been clearly identified. While minor trauma has been implicated as an inciting factor, the precise magnitude and structural level of tissue injury that initiates this degenerative cascade has not been determined. The purpose of this study was to determine if isolated tendon fibril damage could initiate an upregulation of interstitial collagenase (MMP13) mRNA and protein in tendon cells associated with the injured fibril(s). Rat tail tendon fascicles were subjected to in vitro tensile loading until isolated fibrillar damage was documented. Once fibrillar damage occurred, the tendons were immediately unloaded to 100g and maintained at that displacement for 24h under tissue culture conditions. In addition, non-injured tendon fascicles were maintained under unloaded (stress-deprived) conditions in culture for 24h to act as positive controls. In situ hybridization or immunohistochemistry was then performed to localize collagenase mRNA expression or protein synthesis, respectively. Fibrillar damage occurred at a similar stress (41.13+/-5.94MPa) and strain (13.24+/-1.94%) in the experimental tendons. In situ hybridization and immunohistochemistry demonstrated an upregulation of interstitial collagenase mRNA and protein, respectively, in only those cells associated with the damaged fibril(s). In the control (stress-deprived) specimens, collagenase mRNA expression and protein synthesis were observed throughout the fascicle. The results suggest that isolated fibrillar damage and the resultant upregulation of collagenase mRNA and protein in this damaged area occurs through a mechanobiological understimulation of tendon cells. This collagenase production may weaken the tendon and put more of the extracellular matrix at risk for further damage during subsequent loading.     

Roping injuries in the hand: mechanism of injury and functional results

Twenty-two patients with roping injuries to 38 digits, including 19 patients injured while team roping, are discussed. Ten digits in nine patients were successfully revascularized or replanted. Seven digits in three patients failed after initial success. One patient is included in both categories. The failure rate is 41 percent for all 17 digits. Average follow-up is 18 months. The dominant hand was injured in 83 percent of team roping injuries; the thumb is the most commonly injured digit. Average interphalangeal motion for thumb replants is zero; for revascularizations, it is 47 degrees. There was 43 percent return of pinch strength for thumb replants compared to 83 percent return for a single thumb revascularization. The most common mechanism of injury was catching the roping thumb in the "thumb up" position during dallying. There are good motion and pinch strength with thumb revascularizations provided tendons and the interphalangeal joint are intact. Reconstruction of the flexor pollicis longus in the replanted thumb gave poor results. Primary tenodesis or arthrodesis is recommended.     

A new clinical approach: use of blood-derived stem cells (BDSCs) for superficial digital flexor tendon injuries in horses

AimsIn this study, we present an innovative therapy using stem cells that were obtained from the peripheral blood of racehorses affected by uninduced superficial digital flexor tendon (SDFT) injuries.Main methodsBlood-derived stem cells (BDSCs) were generated from the blood samples of three horses in the presence of macrophage colony-stimulating factor (M-CSF). The racehorses received a single autologous BDSC treatment, which resulted in the successful repair of the tendons injuries.Key findingsThe results demonstrated that the BDSCs injection into the damaged tendon stimulated the regeneration of normal tissue. Furthermore, a relationship may exist between the speed and the quality of new tissue formation and the welfare and management of the treated animals.SignificanceThis study demonstrates that stem cell technology offers new tools for tissue repair that in many cases is considered incurable, and provides additional evidence that BDScs injections increase the speed and quality of the regeneration process in different animal tissues.     

New molecular rods--characterization of their interaction with membranes

Molecular rods are synthetical molecules consisting of a hydrophobic backbone which are functionalized with varying terminal groups. Here, we report on the interaction of a recently described new class of molecular rods with lipid and biological membranes. In order to characterize this interaction, different fluorescently labeled rods were synthesized allowing for the application of fluorescence spectroscopy and microscopy based approaches. Our data show that the rods are incorporated into membranes with a perpendicular orientation to the membrane surface and enrich preferentially in liquid-disordered lipid domains. These characteristics underline that rods can be applied as stable membrane-associated anchors for functionalizing membrane surfaces.     

Contribution of biomechanics to management of ligament and tendon injuries

The contribution of biomechanics to the advancement of management of ligament and tendon injuries has been significant. Thanks to Professor Y.C. Fung's writing and guidance, our field of research has done fundamental work on anatomy and biology of ligaments and tendons, developed methods to accurately determine mechanical properties, identified various experimental factors which could change the outcome measurements as well as examined biological factors that change tissue properties in-vivo. Professor Fung also gave us his quasi-linear viscoelastic theory for soft tissues so that the time and history dependent properties of ligaments and tendons could be properly described. We have further adopted Professor Fung's eight steps on methods of approach for biomechanical investigation to understand as well as enhance the treatment of ligament and tendon injuries during work or sports related activities. Examples on how to better treat the tears of the medial collateral ligament of the knee, as well as how to improve reconstruction procedures for the anterior cruciate ligament are presented in detail. Currently the use of functional tissue engineering for ligament and tendon healing is a topic of great interest. Here the use of biological scaffolds, such as porcine small intestinal submucosa, has shown promise. For the last 35 to 40 years, the field of biomechanics has made great strides in the treatment of ligament and tendon injuries, and many patients have benefited. The future is even brighter because of what has been done properly in the past. Exciting advances can be made in the field of tissue engineering through novel in-vitro culture and bioscaffold fabrication techniques. Recent technology can also allow the collection of in-vivo data so that ligament and tendon injuries can be better understood. Yet, solving new and more complex problems must still follow the stepwise methods of approach as taught by Professor Fung.     

Decorin expression is important for age-related changes in tendon structure and mechanical properties

The aging population is at an increased risk of tendon injury and tendinopathy. Elucidating the molecular basis of tendon aging is crucial to understanding the age-related changes in structure and function in this vulnerable tissue. In this study, the structural and functional features of tendon aging are investigated. In addition, the roles of decorin and biglycan in the aging process were analyzed using transgenic mice at both mature and aged time points. Our hypothesis is that the increase in tendon injuries in the aging population is the result of altered structural properties that reduce the biomechanical function of the tendon and consequently increase susceptibility to injury. Decorin and biglycan are important regulators of tendon structure and therefore, we further hypothesized that decreased function in aged tendons is partly the result of altered decorin and biglycan expression. Biomechanical analyses of mature (day 150) and aged (day 570) patellar tendons revealed deteriorating viscoelastic properties with age. Histology and polarized light microscopy demonstrated decreased cellularity, alterations in tenocyte shape, and reduced collagen fiber alignment in the aged tendons. Ultrastructural analysis of fibril diameter distributions indicated an altered distribution in aged tendons with an increase of large diameter fibrils. Aged wild type tendons maintained expression of decorin which was associated with the structural and functional changes seen in aged tendons. Aged patellar tendons exhibited altered and generally inferior properties across multiple assays. However, decorin-null tendons exhibited significantly decreased effects of aging compared to the other genotypes. The amelioration of the functional deficits seen in the absence of decorin in aged tendons was associated with altered tendon fibril structure. Fibril diameter distributions in the decorin-null aged tendons were comparable to those observed in the mature wild type tendon with the absence of the subpopulation containing large diameter fibrils. Collectively, our findings provide evidence for age-dependent alterations in tendon architecture and functional activity, and further show that lack of stromal decorin attenuates these changes.     

Effects of stretching on morphological and biochemical aspects of the extracellular matrix of the rat calcaneal tendon

Several studies have demonstrated the relationship between exercise and the extracellular matrix of muscle tendons, and have described alterations in their structural and biochemical properties when subjected to strenuous exercise. However, little is known about what happens to tendons when they are subjected to stretching. We evaluated the changes in the composition and structure of rat calcaneal tendons subjected to a stretching program. The animals had their muscles stretched for 30 s with 30 s of rest, with 10 repetitions, three and five times a week for 21 days. For morphological analysis, the sections were stained with hematoxylin-eosin and toluidine blue. For biochemical analysis, the tendons were treated with 4 M guanidine hydrochloride and analyzed in SDS-PAGE. The contents of total proteins and glycosaminoglycans were also measured. In the sections stained with toluidine blue, we could observe an increase of rounded cells, especially in the enthesis region. In the region next to the enthesis was a metachromatic region, which was more intensely stained in the stretched groups. In the tension regions, the cells appeared more aligned. Cellularity increased in both regions. The SDS-PAGE analysis showed a larger amount of collagen in the stretched groups and a polydispersed component of 65 kDa in all the groups. The amounts of proteins and glycosaminoglycans were also larger in the stretched tendons. The agarose-gel electrophoresis confirmed the presence of dermatan sulfate in the tension and compression regions, and of chondroitin sulfate only in the latter. Our results showed that the stretching stimulus changed the cellularity and the amount of the extracellular matrix compounds, confirming that tendons are dynamic structures with a capacity to detect alterations in their load.