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Background Skeletal muscle is a highly adaptive tissue, capable of responding to different physiological and functional demands, even in situations that may cause instability. Objectives: To evaluate how partial calcaneal tendon (CT) injuries affect the remodeling and plasticity of the gastrocnemius muscle over time. Methods and results The study was carried out with Wistar rats randomly divided into five groups. The control group comprised animals not subjected to partial CT damage. The remaining four groups were subjected to partial CT damage and were further categorized based on the time of euthanasia: 3, 14, 28, and 55 days after injury. The gastrocnemius muscle was collected and used for gene expression analysis, zymography, flow cytometry, and morphology. The calcaneal tendon was analyzed only to verify the presence of the partial injury. Results: The impact of partial CT injury on the gastrocnemius homeostasis, particularly on gene expression, was more pronounced in the 3-day group compared to the other groups, especially the control group. Cytokine profile and morphologic alterations occurred in the 55 days group when compared to the other groups. Conclusions The data reported here suggest that partial injury can negatively affect intracellular signaling and degradation pathways, disturbing the muscular extracellular matrix regulatory mechanisms and communication with the tendon. However, skeletal muscle seems to mitigate these harmful effects in comparison with lesions that affect muscle and tendon.

Background: Both nonoperative and operative treatments have been proposed to manage distal biceps brachii tendon avulsions. However, the advantages and disadvantages of these approaches have not been properly quantified. Purpose: To summarize the current literature on both nonoperative and operative approaches for distal biceps brachii tendon ruptures and to quantify results and limitations. The advantages and disadvantages of the different surgical strategies were investigated as well. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search was performed in March 2020 using PubMed Central, Web of Science, Cochrane Library, MEDLINE, Iscrctn.com, clinicaltrials.gov, greylit.org, opengrey.eu, and Scopus literature databases. All human studies evaluating the clinical outcome of nonoperative treatment as well as different surgical techniques were included. The influence of the treatment approach was assessed in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index; extension, flexion, supination, and pronation range of motion (ROM); and flexion and supination strength ratio between the injured and uninjured arms. Risk of bias and quality of evidence were assessed using the Cochrane guidelines. Results: Of 1275 studies, 53 studies (N = 1380 patients) matched the inclusion criteria. The results of the meta-analysis comparing operative versus nonoperative approaches for distal biceps tendon avulsion showed significant differences in favor of surgery in terms of DASH score (P = .02), Mayo Elbow Performance Index (P < .001), flexion strength (94.7% vs 83.0%, respectively; P < .001), and supination strength (89.2% vs 62.6%, respectively; P < .001). The surgical approach presented 10% heterotopic ossifications, 10% transient sensory nerve injuries, 1.6% transient motor nerve injuries, and a 0.1% rate of persistent motorial disorders. Comparison of the different surgical techniques showed similar results for the fixation methods, whereas the single-incision technique led to a better pronation ROM versus the double-incision approach (81.5° vs 76.1°, respectively; P = .01). Conclusion: The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. The single-incision surgical approach demonstrated a slightly better pronation ROM compared with the double-incision approach, whereas all fixation methods led to similar outcomes.

The treatment of tendinopathies with multipotent mesenchymal stromal cells (MSCs) is a promising option in equine and human medicine. However, conclusive clinical evidence is lacking. The purpose of this study was to gain insight into clinical treatment efficacy and to identify suitable outcome measures for larger clinical studies. Fifteen horses with early naturally occurring tendon disease were assigned to intralesional treatment with allogeneic adipose-derived MSCs suspended in serum or with serum alone through block randomization (dosage adapted to lesion size). Clinicians and horse owners remained blinded to the treatment during 12 months (seven horses per group) and 18 months (seven MSC-group and five control-group horses) of follow-up including clinical examinations and diagnostic imaging. Clinical inflammation, lameness, and ultrasonography scores improved more over time in the MSC group. The lameness score difference significantly improved in the MSC group compared with the control group after 6 months. In the MSC group, five out of the seven horses were free of re-injuries and back to training until 12 and 18 months. In the control group, three out of the seven horses were free of re-injuries until 12 months. These results suggest that MSCs are effective for the treatment of early-phase tendon disease and provide a basis for a larger controlled study.

Background: Forearm fractures are one of the most common fractures in children. Over the last years, a tendency towards surgical treatment was seen, especially closed reduction and internal fixation with elastic stable internal nailing (ESIN). Despite an overall low complication rate being described, a risk of intraoperative complications remains. Material and Methods: A total of 237 patients (mean age 8.3 ± 3.4 (1–16) years) with forearm or radius fractures treated with ESIN between 2010 and 2020 were included in the study. The retrospective review of 245 focused on fracture pattern, pre- and postoperative fracture angulation, intra- and postoperative complications, and surgical approach for nail implant. The fracture pattern and pre- and postoperative angulation were measured radiographically. Complications such as ruptures of the extensor pollicis longus (EPL) tendon and sensibility disorders of the superficial radial nerve were further analyzed. Results: In 201 cases (82%), we performed a dorsal approach; 44 fractures (17.9%) were treated with a radial approach. In total, we found 25 (10%) surgery-related complications, of which 21 (8.6%) needed further surgical treatment. In total, we had 14 EPL ruptures (5.7%), 4 sensibility disorders of the superficial radial nerve (1.6%), 2 refractures after implant removal (0.8%), 2 superficial wound infections (0.8%), and 1 child with limited range of motion after surgery (0.4%). No statistical significance between pre- and postoperative angulation correlated to fracture patterns or diameter of the elastic nail was seen. As expected, there was a significant improvement of postoperative angulation. Using radial approach in distal radial fractures showed a lower rate of surgical related complications, 2.3% of which need further surgical treatment as well as better postoperative angulations compared to the dorsal approach (8.5%). Conclusion: Especially due to the low risk of damaging the EPL tendon, the radial approach showed a lower complication rate which needed further surgical treatment. The risk of lesions of the superficial radial nerve remains.

Purpose To detect concomitant intra-articular glenohumeral injuries, in acute displaced fractures of the lateral clavicle, initially missed due to unfeasible clinical evaluation of the acutely injured shoulder. Methods All patients suffering from an acute displaced lateral clavicle fracture with indication to surgical treatment underwent diagnostic shoulder arthroscopy prior to open reduction and internal fixation. In case of therapy-relevant intra-articular glenohumeral injuries, subsequent surgical treatment was performed. Results Intra-articular injuries were found in 13 of 28 patients (46.4 %) with initially suspected isolated lateral clavicle fracture. Additional surgical treatment was performed in 8 of 28 cases (28.6 %). Superior labral anterior-posterior (SLAP) lesions were observed in 4 of 28 patients (14.3 %; SLAP II a: 1; II b: 1; III: 1; and IV: 1). Lesions of the pulley system were found in 3 of 28 patients (10.7 %; Habermeyer III°). One partial articular supraspinatus tendon avulsion lesion (3.6 %) and one lesion of the subscapularis tendon (3.6 %; Fox and Romeo II°) were observed. Conclusions Traumatic concomitant glenohumeral injuries in lateral clavicle fractures seem to be more frequent than expected in general. Subsequent surgical treatment of these formerly missed but therapy-relevant injuries may increase functional outcome and reduce complication rate. Level of evidence IV.

An 8-year-old intact male German shorthaired pointer was presented for a left pelvic limb lameness. Examination revealed a plantigrade stance with flexed digits in the left pelvic limb, and swelling of the left common calcanean tendon distally. Magnetic resonance imaging revealed a partial rupture of the left common calcanean tendon, involving rupture to the tendons of the biceps femoris, gracilis, and semitendinosus muscles. Surgical repair was performed using a modified 3-loop pulley suture. Postoperatively, the tarsus was immobilized with external coaptation. Destabilization of the external coaptation occurred over 9 weeks followed by physical rehabilitation and complete return to function at 10 months post-operative. This case report illustrates the utility of MRI as a diagnostic tool for evaluation of tendon pathology. MRI provided exceptional detail of the tendons that comprise the common calcaneal tendon and the anatomical relationships to surrounding structures which facilitated appropriate surgical correction.

Purpose To evaluate clinical results of arthroscopic treatment for posterior tibial tendon (PTT) lesions using a posterior approach. Methods Sixteen patients with PTT lesions underwent arthroscopic treatment using a posterior approach. After routine posterior arthroscopy to expose the posterior tibiotalar compartment, the posterior subtalar compartment, and the flexor hallucis longus tendon, the shaver was then moved through the flexor hallucis longus tendon to detect and treat the PTT lesion, including synovectomy, debridement, and repair of the PTT. American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) scale and visual analog scale (VAS) for subjective satisfaction were used to evaluate pre- and post-operative clinical results. Results Fifteen patients (94 %) (15 ankles) were followed for a mean of 26 ± 10 months. No patients experienced vascular or nerve complications during or after the operation. Mean AOFAS score improved from 49 ± 12 points preoperatively to 84 ± 8.5 points post-operatively ( p  = 0.000). Mean VAS improved from 6.2 ± 1.7 preoperatively to 2.4 ± 1.3 post-operatively ( p  = 0.000). There were three patients (20 %) with excellent outcomes, eight patients (53 %) with good outcomes, three patients (20 %) with fair outcomes, and one patient (7 %) with a poor outcome at follow-up. Conclusions A posterior arthroscopic approach can provide a safe, reliable technique for detecting and treating PTT lesions and a satisfactory surgical outcome. The technique is an alternative to PTT tendoscopy. Level of evidence IV.

Purpose To assess the capability of a commercial sonoelastography system to detect small tendon lesions by quantitative analysis of elastogram profiles. Materials and methods Strips of equine digital flexor tendons were used to model small human tendons. Two tendons were examined. From each tendon, six unmodified tendon strips (controls) and six tendon strips with a central defect of the same tendons were compared. The tendon strips were placed under a physiological tensile strain of 5%. Sonoelastographic visualization of the strain profile was performed. Regions of interest (ROI) were defined left and right of the tendon defects. Average tissue strains in these ROI were compared with tissue strain in controls. Results In the first series of experiments, there was a significant ( p  = 0.011) difference in the strain profile in regions proximal and distal to the tendon lesions compared with the respective tendon areas in the control tendon strips. In a second series of experiments, similar trends were observed, but the differences were not significant ( p  = 0.824). Conclusion Even under carefully controlled experimental conditions using computational post-processing of sonoelastograms, tendon lesions could only be partially detected within elastograms from a clinical sonoelastography system. The ability to detect differences in some strain profiles indicates that tensile sonoelastography has the potential to identify small tendon lesions (such as those in the hand), but that substantial improvements with respect to quantitative analysis are required to make such measures diagnostically relevant.

Bone remodelling is regulated at a cellular level by local factors. They affect the differentiation of precursor cells, the activity and numbers of osteoblasts and osteoclasts. They modulate the activity of other systemic regulators. They are produced by osteocytes, endothelial cells, blood cells, fibroblasts and chondrocytes. They are represented by growth tactors, cytokines and prostaglandins.

Besides generalised osteoporosis, there are conditions associated with local bone mineral density loss. Normally referred to as regional or localised osteoporosis, it can be found after a fixation and immobilisation of a limb, after poliomyelitis, at insertions of tendon lesions, and in the area surrounding inflamed joints in active RA. The cause of localised osteoporosis in an immobilised site is mainly due to a decrease of afferent signalling from various receptors, the so-called decrease of a trophic influence of the nervous system. The aetiopathogenesis of periarticular osteoporosis in rheumatoid arthritis is multifactorial and local factors play the key role. They directly regulate bone remodelling at the cellular level. They affect the differentiation of precursor cells, the activity of osteoblasts and osteoclasts and their numbers.