Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patter...Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patterns, and a new US+DP-guided treatment method targeting the regions with vessels and nerves outside the tendon has shown promising results in patients with Jumper’s knee. Material: This study includes 12 patellar tendons from 9 professional rugby players (mean age 26 years) with a long duration (range 12 - 72 months) of pain from the proximal patellar tendon. For 3 tendons there was previously intratendinous revision surgery with a poor result. Method: Treatment with Ultrasound (US) and Doppler (DP)-guided arthroscopic shaving + open scraping, followed by immediate weight bearing and gradually increased loading up to full loading after 6 - 8 weeks, was performed. Results: For 9 tendons there was a good clinical result, and all returned to full professional rugby within 4 - 6 months. The mean VISA score increased from 49 to 78 (p < 0.05). Follow-ups (range 10 - 30 months) show remaining good results. For 3 tendons, all have had previous intratendinous revision surgery, the clinical results were poor and they couldn’t return to rugby. Conclusions: The short-term results in this relatively small material indicate that US+DP-guided arthroscopic shaving + open scraping is a good treatment method for professional rugby players with chronic painful Jumper’s knee.展开更多
Entheses are highly specialised organs connecting ligaments and tendons to bones,facilitating force transmission,and providing mechanical strengths to absorb forces encountered.Two types of entheses,fibrocartilaginous...Entheses are highly specialised organs connecting ligaments and tendons to bones,facilitating force transmission,and providing mechanical strengths to absorb forces encountered.Two types of entheses,fibrocartilaginous and fibrous,exist in interfaces.The gradual fibrocartilaginous type is in rotator cuff tendons and is more frequently injured due to the poor healing capacity that leads to loss of the original structural and biomechanical properties and is attributed to the high prevalence of retears.Fluctuating methodologies and outcomes of biological approaches are challenges to overcome for them to be routinely used in clinics.Therefore,stratifying the existing literature according to different categories(chronicity,extent of tear,and studied population)would effectively guide repair approaches.This literature review supports tissue engineering approaches to promote rotator cuff enthesis healing employing cells,growth factors,and scaffolds period.Outcomes suggest its promising role in animal studies as well as some clinical trials and that combination therapies are more beneficial than individualized ones.It then highlights the importance of tailoring interventions according to the tear extent,chronicity,and the population being treated.Contributing factors such as loading,deficiencies,and lifestyle habits should also be taken into consideration.Optimum results can be achieved if biological,mechanical,and environmental factors are approached.It is challenging to determine whether variations are due to the interventions themselves,the animal models,loading regimen,materials,or tear mechanisms.Future research should focus on tailoring interventions for different categories to formulate protocols,which would best guide regenerative medicine decision making.展开更多
文摘Background: Jumper’s knee is relatively common among rugby players, and treatment of this condition is known to be difficult. Intratendinous revision surgery has shown poor results. New research on innervation patterns, and a new US+DP-guided treatment method targeting the regions with vessels and nerves outside the tendon has shown promising results in patients with Jumper’s knee. Material: This study includes 12 patellar tendons from 9 professional rugby players (mean age 26 years) with a long duration (range 12 - 72 months) of pain from the proximal patellar tendon. For 3 tendons there was previously intratendinous revision surgery with a poor result. Method: Treatment with Ultrasound (US) and Doppler (DP)-guided arthroscopic shaving + open scraping, followed by immediate weight bearing and gradually increased loading up to full loading after 6 - 8 weeks, was performed. Results: For 9 tendons there was a good clinical result, and all returned to full professional rugby within 4 - 6 months. The mean VISA score increased from 49 to 78 (p < 0.05). Follow-ups (range 10 - 30 months) show remaining good results. For 3 tendons, all have had previous intratendinous revision surgery, the clinical results were poor and they couldn’t return to rugby. Conclusions: The short-term results in this relatively small material indicate that US+DP-guided arthroscopic shaving + open scraping is a good treatment method for professional rugby players with chronic painful Jumper’s knee.
文摘Entheses are highly specialised organs connecting ligaments and tendons to bones,facilitating force transmission,and providing mechanical strengths to absorb forces encountered.Two types of entheses,fibrocartilaginous and fibrous,exist in interfaces.The gradual fibrocartilaginous type is in rotator cuff tendons and is more frequently injured due to the poor healing capacity that leads to loss of the original structural and biomechanical properties and is attributed to the high prevalence of retears.Fluctuating methodologies and outcomes of biological approaches are challenges to overcome for them to be routinely used in clinics.Therefore,stratifying the existing literature according to different categories(chronicity,extent of tear,and studied population)would effectively guide repair approaches.This literature review supports tissue engineering approaches to promote rotator cuff enthesis healing employing cells,growth factors,and scaffolds period.Outcomes suggest its promising role in animal studies as well as some clinical trials and that combination therapies are more beneficial than individualized ones.It then highlights the importance of tailoring interventions according to the tear extent,chronicity,and the population being treated.Contributing factors such as loading,deficiencies,and lifestyle habits should also be taken into consideration.Optimum results can be achieved if biological,mechanical,and environmental factors are approached.It is challenging to determine whether variations are due to the interventions themselves,the animal models,loading regimen,materials,or tear mechanisms.Future research should focus on tailoring interventions for different categories to formulate protocols,which would best guide regenerative medicine decision making.
