The plantaris tendon is increasingly recognised as an important factor in midportion Achilles tendinopathy. Its innervation pattern is completely unknown. Plantaris tendons (n=56) and associated peritendinous tissue from 46 patients with... more
The plantaris tendon is increasingly recognised as an important factor in midportion Achilles tendinopathy. Its innervation pattern is completely unknown. Plantaris tendons (n=56) and associated peritendinous tissue from 46 patients with midportion Achilles tendinopathy and where the plantaris tendon was closely related to the Achilles tendon were evaluated. Morphological evaluations and stainings for nerve markers [general (PGP9.5), sensory (CGRP), sympathetic (TH)], glutamate NMDA receptor and Schwann cells (S-100β) were made. A marked innervation, as evidenced by evaluation for PGP9.5 reactions, occurred in the peritendinous tissue located between the plantaris and Achilles tendons. It contained sensory and to some extent sympathetic and NMDAR1-positive axons. There was also an innervation in the zones of connective tissue within the plantaris tendons. Interestingly, some of the nerve fascicles showed a partial lack of axonal reactions. New information on the innervation patterns...
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Background:“Tennis elbow” is a difficult condition to treat. Ultrasonography (US) and colour Doppler (CD) guided injections with polidocanol targeting the area with increased blood flow in the extensor origin have shown promising clinical... more
Background:“Tennis elbow” is a difficult condition to treat. Ultrasonography (US) and colour Doppler (CD) guided injections with polidocanol targeting the area with increased blood flow in the extensor origin have shown promising clinical results.Objective:To evaluate and compare effects of US and CD guided intratendinous injections with sclerosing polidocanol and a local anaesthetic (lidocaine + epinephrine), in patients with tennis elbow.Design:Prospective, randomised, controlled, double-blind, crossover study.Setting:Sports Medicine Unit, Umeå University.Patients:32 patients (36 elbows), age range 27 to 66 years, with a long duration of elbow pain diagnosed as tennis elbow, were included in the study. All patients were followed up 3 and 12 months after treatment. Two patients were excluded due to other interventions during the study.Interventions:One US and CD guided injection with the sclerosing agent polidocanol (group 1) or the local anaesthetic lidocaine plus epinephrine (gro...
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Research Interests: Mechanical Engineering, Biomedical Engineering, Ergonomics, Adolescent, Medicine, and 15 moreHumans, Doppler Ultrasound, Female, Male, Cohort Study, Structural Change, Adult, Analysis of Variance, Study design, Randomized Clinical Trial, Patellar Ligament, Clinical Diagnosis, Polyethylene Glycols, Cohort Studies, and Randomized Controlled Trials as Topic
Research Interests: Engineering, Education, British, Treatment Outcome, Adolescent, and 15 moreMedicine, Humans, Chronic Disease, Female, Male, Arthroscopy, Tendinopathy, Patient Satisfaction, Track and Field, Adult, Patellar Ligament, Polyethylene Glycols, Surgical Treatment, Recovery of Function, and Medical and Health Sciences
Full-thickness patellar cartilage defects are often, but not always, associated with disabling anterior knee-pain and inability to take part in regular daily activities. There is no treatment of choice for this condition. It is well known... more
Full-thickness patellar cartilage defects are often, but not always, associated with disabling anterior knee-pain and inability to take part in regular daily activities. There is no treatment of choice for this condition. It is well known that the cells in the cambium layer of the periosteum are pluripotent and can differentiate into hyaline (or hyaline-like) cartilage, especially if in a joint environment and under the influence of continous passive motion. In a few clinical studies autologous periosteum transplants alone have been used in the treatment of full thickness patellar cartilage defects. The results are varying. At our clinic, autologous periosteum transplantation alone, followed by continous passive motion (CPM) in the immediate postoperative period and non-weight bearing loading for 3 months, has shown promising clinical results. The best clinical results have been achieved on traumatic (fracture, contusion, dislocation) cartilage defects, where 83% of patients have be...
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Metabolic factors such as cholesterol appear to play an important role in the development of Achilles tendinopathy. There is, however, no morphologic proof explaining the link between high cholesterol and tendinopathy. As apolipoprotein... more
Metabolic factors such as cholesterol appear to play an important role in the development of Achilles tendinopathy. There is, however, no morphologic proof explaining the link between high cholesterol and tendinopathy. As apolipoprotein A1 (Apo‐A1) is essential for reverse cholesterol transport, it may be related to cholesterol overload in tendon. Nothing is known about Apo‐A1 expression in tendon tissue. We examined the distribution of Apo‐A1 protein in biopsies from normal and tendinopathy‐affected human Achilles tendons, and APOA1 mRNA production from cultured human hamstring tenocytes. Specific immunoreactions for Apo‐A1 were detected. The tenocytes showed specific Apo‐A1 immunoreactions. These reactions were usually distinct in the tendinopathy specimens. While the tendinopathy specimens often showed granular/small deposit reactions, the slender tenocytes of control specimens did not show this pattern. The magnitude of Apo‐A1 immunoreactivity was especially marked in the tendin...
Background: The peritendinous connective tissues can have importance in chronic tendon pain. Recently cytokine TNF-α has been suggested to be involved in tendinopathic processes. It is not known how TNF-α and its receptors TNFR1 and TNFR2... more
Background: The peritendinous connective tissues can have importance in chronic tendon pain. Recently cytokine TNF-α has been suggested to be involved in tendinopathic processes. It is not known how TNF-α and its receptors TNFR1 and TNFR2 are expressed in peritendinous tissues. Methods: The objective for this study was to immunohistochemically evaluate the expression patterns of these in the peritendinous tissue located between the plantaris and Achilles tendons and the one located superficially to the extensor origin at the elbow region for patients with tendinopathy/tennis elbow. Results: The nerve fascicles were of two types, one type being homogenously stained for the nerve markers βIII-tubulin and neurofilament and the other showing deficits for these suggesting features of axonal damage. Much more distinct TNFR1/TNFR2 immunoreactions were seen for the latter nerve fascicles. TNFR1 was seen in axons, TNFR2 mainly in Schwann cells. TNFR1 and particularly TNFR2 were seen in walls...
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In recent years, the plantaris tendon has been implicated in the development of chronic painful mid-portion Achilles tendinopathy. In some cases, a thickened plantaris tendon is closely associated with the Achilles tendon, and surgical... more
In recent years, the plantaris tendon has been implicated in the development of chronic painful mid-portion Achilles tendinopathy. In some cases, a thickened plantaris tendon is closely associated with the Achilles tendon, and surgical excision of the plantaris tendon has been reported to be curative in patients who have not derived benefit following conservative treatment and surgical interventions. The aim of this review is to outline the basic aspects of, and the recent research findings, related to the plantaris tendon, covering anatomical and clinical studies including those dealing with histology, imaging and treatment. Cite this article: Bone Joint J 2016;98-B:1312–19.
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Background: The mechanism that causes pain in chronic Achilles tendinosis is not known. However, high resolution colour Doppler ultrasound has shown that neovascularisation may be involved. Objective: To investigate if sclerosing the... more
Background: The mechanism that causes pain in chronic Achilles tendinosis is not known. However, high resolution colour Doppler ultrasound has shown that neovascularisation may be involved. Objective: To investigate if sclerosing the neovessels would affect the level of tendon pain. Methods: The effect of colour Doppler ultrasound guided injection of a sclerosing agent, polidocanol, against neovessels was studied in 10 patients (seven men and three women, mean age 55 years) with painful chronic mid-portion Achilles tendinosis. Results: Eight patients were satisfied with the results of treatment. There was significantly reduced pain during activity (reported on a visual analogue scale (VAS)) and no remaining neovascularisation after an average of two injections. Two patients were not satisfied, and neovascularisation remained. At the six month follow up, the same eight patients remained satisfied and could perform Achilles tendon loading activities as desired. Their VAS score had dec...
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The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carreér. Most common sites for tendinopathy are the... more
The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carreér. Most common sites for tendinopathy are the Achilles-, patellar-, extensor carpi radialis brevis (ERCB)-, and supraspinatus tendons. The origin of pain has for many years been unknown, but recently, by using ultrasound (US) + colour Doppler (CD), immunohistochemical analyses of tendon biopsies, and diagnostic injections of local anaestesia, we found a close relationship between areas with vasculo-neural ingrowth and tendon pain. Sensory nerves (Substance-P-SP and Calcitonin Gene Related Peptide-CGRP) were found inside and outside the vascular wall. In following clinical studies we have demonstrated good short-and mid-term clinical results using treatment with US+CD-guided sclerosing polidocanol injections, targeting the area with neovessels outside the tendon. Two-year follow ups have showed remainin...
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ABSTRACT Introduction: Tennis elbow/extensor carpi radialis brevis (ECRB) tendinopathy is well known to be difficult to treat. There is no concensus about treatment. Material and methods: Five patients (3 females and 2 males, mean age 43... more
ABSTRACT Introduction: Tennis elbow/extensor carpi radialis brevis (ECRB) tendinopathy is well known to be difficult to treat. There is no concensus about treatment. Material and methods: Five patients (3 females and 2 males, mean age 43 years) with a long duration (12–48 months) of pain symptoms related to Tennis elbow were in local anaesthesia treated with an ultrasound (US)+Doppler (CD)-guided open scraping procedure. Where the US+CD examination showed a localised high blood flow, there was macroscopically a richly vascularised fatty infiltration. This tissue, containing paratendinous fibrous tissue, blood vessels and fat, was carefully scraped loose and sent for immunohistochemical staining. The general nerve marker PGP 9.5 was studied. Results: In all specimens there were multiple nerve structures, often located in close relation to blood vessels and sometimes also inside blood vessel walls. Discussion: These findings might indicate that a major source of pain related to Tennis elbow is located in the tissues superficial to the extensor origin.Characterisation of the nerves is on-going. These new findings might have implications for new treatment strategies.
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The aim of this investigation was to study the consequences of anterior cruciate ligament injuries in female soccer players. Special interest was focused on young female soccer players (< 16 years) sustaining anterior cruciate... more
The aim of this investigation was to study the consequences of anterior cruciate ligament injuries in female soccer players. Special interest was focused on young female soccer players (< 16 years) sustaining anterior cruciate ligament injuries when playing at a senior level, which means playing together with players 19 years or older. In Sweden, all players belonging to an organized soccer club are insured by the same insurance company, the Folksam Insurance Company. Data of all soccer-related knee injuries in females reported to the Folksam Insurance Company between 1994 and 1998 were collected. A questionnaire was sent to 978 females who were registered to have sustained a knee injury before the age of 20 years. The response rate was 79%. Three hundred and ninety-eight female soccer players who had sustained an anterior cruciate ligament injury before the age of 19 years were analysed. Most of their anterior cruciate ligament injuries had been diagnosed using arthroscopy or magnetic resonance imaging (84%). Thirty-eight percent of the players had been injured before the age of 16 years. Of these, 39% were injured when playing in senior teams. When playing in senior teams 59% of the players below the age of 16 years and 44% of the players 16 years or older sustained their ACL injuries during contact situations. At the time of this investigation (2-7 years after the anterior cruciate ligament injury), altogether 78% (n = 311) reported that they had stopped playing soccer. The most common reason (80%) was symptoms from their anterior cruciate ligament-injured knee. It appears that many young female soccer players injure their anterior cruciate ligament when playing at a senior level. Therefore, we suggest that female soccer players under the age of 16 years should be allowed to participate only in practice sessions but not games at a senior level.
Research Interests: Soccer, Adolescent, Sweden, Anterior Cruciate Ligament, Humans, and 3 moreFemale, Rupture, and Knee injuries
In this prospective study, injuries in 153 adolescent female soccer players were recorded during one outdoor season (April-October). The overall injury incidence rate was 6.8 per 1000 h soccer (games and practice) and the incidence rate... more
In this prospective study, injuries in 153 adolescent female soccer players were recorded during one outdoor season (April-October). The overall injury incidence rate was 6.8 per 1000 h soccer (games and practice) and the incidence rate of traumatic injury 9.1 and 1.5 per 1000 player-hours in games and practice, respectively. Sixty-three players (41%) sustained 79 injuries. Sixty-six percent of the injuries were traumatic and 34% were overuse injuries. Most of the traumatic injuries occurred during games. Eighty-nine percent of the injuries were located in the lower extremities and 42% occurred in the knee or ankle. The most frequent type of injury was ankle sprain (22.8%). Forty-one percent of the traumatic injuries and 56% of the ankle sprains were re-injuries. Most of the injuries were of moderate severity (52%), while 34% were minor and 14% were major. Most of the major injuries were traumatic such as knee ligament injuries and ankle sprains.
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Research Interests: Soccer, Logistic Regression, Anterior Cruciate Ligament, Seasonality, Prospective studies, and 15 moreHumans, Female, Regression Analysis, Risk factors, Posture, Clinical Sciences, Adult, Sex Factors, Cumulative Trauma Disorders, Age Factors, Risk Factors, Ankle Joint, Knee Joint, Postural Sway, and Incidence Rate
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Research Interests: Pain, Humans, Strength Training, Chronic Disease, Female, and 14 moreMale, Follow-up studies, Clinical Sciences, Middle Aged, Adult, Knee injuries, Articular Cartilage Wear, Articular Cartilage, Postoperative care, Periosteum, Patella, Magnetic resonance image, Bone Transplantation, and Suture techniques
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Research Interests: Biomedical Engineering, Adolescent, Comparative Study, Female, Body Composition, and 15 moreBone Density, Body Size, Gymnastics, Body Mass Index, Calcified tissue, Clinical Sciences, Fat Mass, Bone Mineral Density, Cross sectional Study, Cross Sectional Studies, Bone and Bones, Control Group, Biochemistry and cell biology, Bone mineral content, and Bone mass
Research Interests: Biomedical Engineering, Adolescent, Muscle strength, Seasonality, Humans, and 15 moreFemale, Bone Density, Calcified tissue, Clinical Sciences, Fat Mass, Humerus, Muscle contraction, Body Fat, Endurance Training, Cross sectional Study, Cross Sectional Studies, Bone and Bones, Biochemistry and cell biology, Lean Body Mass, and Bone mass
In an ongoing prospective study of 14 recreational athletes (12 males and 2 females, mean age 44.2 +/- 7.1 years) with unilateral chronic Achilles tendinosis, we investigated the effect of treatment with heavy-loaded eccentric calf-muscle... more
In an ongoing prospective study of 14 recreational athletes (12 males and 2 females, mean age 44.2 +/- 7.1 years) with unilateral chronic Achilles tendinosis, we investigated the effect of treatment with heavy-loaded eccentric calf-muscle training. Pain during activity (recorded on a VAS scale) and isokinetic concentric and eccentric calf-muscle strength (peak torque at 90 degrees /second and 225 degrees /second) on the injured and noninjured side were evaluated. In this group of patients, we examined areal bone mineral density (BMD) of the calcaneus after 9 months (range 6-14 months) of training. BMD of the injured side (subjected to heavy-loaded eccentric training) was compared with BMD of the noninjured side. Before onset of heavy-loaded eccentric training, all patients had Achilles tendon pain which prohibited running activity, and significantly lower concentric and eccentric plantar flexion peak torque on the injured compared with the noninjured side. The training program consisted of 12 weeks of daily, heavy-loaded, eccentric calf-muscle training; thereafter the training was continued for 2-3 days/week. The clinical results were excellent-all 14 patients were back at their preinjury level with full running activity at the 3 month follow-up. The concentric and eccentric plantar flexion peak torque had increased significantly and did not significantly differ from the noninjured side at the 3 and 9 month follow-up. There were no significant side-to-side differences in BMD of the calcaneus. There was no significant relationship between BMD of the calcaneus and calf-muscle strength. As a comparison group, we used 10 recreational athletes (5 males and 5 females) mean age 40.9 years (range 26-55 years), who were selected for surgical treatment of chronic Achilles tendinosis localized at the 2-6 cm level. Their duration of symptoms and severity of disease were the same as in the experimental group. There were no significant side-to-side differences in BMD of the calcaneus preoperatively, but 12 months postoperatively BMD of the calcaneus was 16.4% lower at the injured side compared with the noninjured side. Heavy-loaded eccentric calf-muscle training resulted in a fast recovery in all patients, equaled the side-to-side differences in muscle strength, and was not associated with side-to-side differences in BMD of the calcaneus. In this group of middle-aged recreational athletes, BMD of the calcaneus was not related to calf-muscle strength.
Research Interests: Biomedical Engineering, Exercise therapy, Medicine, Humans, Chronic Disease, and 15 moreFemale, Male, Bone Density, Calcified tissue, Clinical Sciences, Middle Aged, Adult, Calcaneus, Achilles tendon, Leg, Cumulative Trauma Disorders, Biochemistry and cell biology, Bone mass, Experimental Group, and Athletic injuries
Research Interests: Engineering, Education, Pain, Microcirculation, Treatment Outcome, and 15 moreExercise therapy, Prospective studies, Humans, Chronic Disease, Female, Male, Tendinopathy, Body Mass Index, Middle Aged, Achilles tendon, Blood Flow, Oxygen Consumption, Oxygen saturation, Adverse effect, and Medical and Health Sciences
ABSTRACT Background Tendon degeneration is generally believed to be irreversible. Objective To use ultrasound to study the Achilles midportion tendon structure and thickness before and after treatment of chronic painful tendinosis. Design... more
ABSTRACT Background Tendon degeneration is generally believed to be irreversible. Objective To use ultrasound to study the Achilles midportion tendon structure and thickness before and after treatment of chronic painful tendinosis. Design Prospective study. Patients and interventions Middle aged patients on varying activity levels, having midportion chronic Achilles tendinosis, were followed with ultrasound examinations before and after treatment with eccentric training, sclerosing polidocanol injections and surgical scraping. Outcome measurements Tendon thickness and structure. Results 89 patients successfully treated (pain-free during tendon loading) with eccentric training (n=22), sclerosing polidocanol injections (n=38) and surgical scraping (n=29), had a significantly thinner Achilles midportion and a more normal tendon structure, after compared to before, treatment. Conclusion For the Achilles midportion, tendon degeneration might not be irreversible. The findings indicate a possible regeneration potential.
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In this study, structure, blood flow and thickness in the Achilles tendon related to tendon-loading activity were investigated. Examination by ultrasound (US) and colour Doppler (CD) immediately before and after 1 h of floor-ball... more
In this study, structure, blood flow and thickness in the Achilles tendon related to tendon-loading activity were investigated. Examination by ultrasound (US) and colour Doppler (CD) immediately before and after 1 h of floor-ball matchplay. Sports Medicine Unit, Umeå University, Sweden. 36 Achilles tendons in 18 middle-aged (mean 39 years) recreational male floor-ball players. Structure and high blood flow (HBF)/neovessels (NV) in the tendons were registered. Tendon thickness was measured 3 and 4.5 cm above the upper calcaneus and at the thickest part of the tendon. The US examination showed that 11/36 tendons (30.5%) in nine individuals had structural changes before and after the floor-ball match. In 7/36 tendons (five with structural changes), there were HBF/NV before, and after, the match. In six of these seven tendons, the blood flow was higher after than before the match. In three more tendons (two with structural changes), there were HBF/NV after, but not before, the match. After the match, mean tendon thickness had decreased significantly in both normal tendons and tendons with structural changes at the 3-cm level (6.0 (1.0) mm to 5.8 (0.9) mm; p<0.019), at the 4.5-cm level (5.7 (1.1) mm to 5.5 (1.0) mm; p<0.044), and at the thickest part (6.6 (1.1) mm to 6.3 (1.2) mm; p<0.000). In about 1/3 of the tendons, there were structural changes, about half of those tendons also had HBF/NV, which was higher after, than before, the match. Mean tendon thickness in both normal tendons and tendons with structural changes had decreased significantly after a 1-h floor-ball match.
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Research Interests: Engineering, Education, Anthropometry, Sports, Humans, and 15 moreFemale, Male, Body Mass Index, Risk factors, Victoria, Adult, Analysis of Variance, Body Weight, Risk Factors, Sensitivity and Specificity, Patellar Ligament, Cohort Studies, Waist Hip Ratio, Athletic injuries, and Medical and Health Sciences
Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular... more
Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery relieves pain in the majority of cases. Directing a patient through the algorithm presented here will maximise positive treatment outcomes.
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Chronic painful insertional Achilles tendinopathy is seen in both physically active and non-active individuals. Painful eccentric training, where the patients load the Achilles tendon into full dorsiflexion, has shown good results in... more
Chronic painful insertional Achilles tendinopathy is seen in both physically active and non-active individuals. Painful eccentric training, where the patients load the Achilles tendon into full dorsiflexion, has shown good results in patients with mid-portion Achilles tendinosis. However, only 32% of patients with insertional Achilles tendinopathy had good clinical results with that type of eccentric training regimen. To investigate whether a new model of painful eccentric training had an effect on chronic painful insertional Achilles tendinopathy. 27 patients (12 men, 15 women, mean age 53 years) with a total of 34 painful Achilles tendons with a long duration of pain (mean 26 months), diagnosed as insertional Achilles tendinopathy, were included. The patients performed a new model of painful eccentric training regimen without loading into dorsiflexion. This was done as 3x15 reps, twice a day, 7 days/week, for 12 weeks. Pain during Achilles-tendon-loading activity (VAS) and patient's satisfaction (back to previous activity) were evaluated. At follow-up (mean 4 months) 18 patients (67%, 23/34 tendons) were satisfied and back to their previous tendon-loading activity. Their mean VAS had decreased from 69.9 (SD 18.9) to 21 (SD 20.6) (p<0.001). Nine patients (11 tendons) were not satisfied with the treatment, although their VAS was significantly reduced from 77.5 (8.6) to 58.1 (14.8) (p<0.01). In this short-term pilot study this new model of painful eccentric calf-muscle training showed promising clinical results in 67% of the patients.
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We evaluated 10 men and 3 women (mean age, 44 +/- 8.5 years) with chronic Achilles tendinitis who underwent surgical treatment. Surgery was followed by immobilization in a weightbearing below-the-knee plaster cast for 6 weeks and a... more
We evaluated 10 men and 3 women (mean age, 44 +/- 8.5 years) with chronic Achilles tendinitis who underwent surgical treatment. Surgery was followed by immobilization in a weightbearing below-the-knee plaster cast for 6 weeks and a stepwise increasing strength training program. We prospectively studied calf muscle strength on the injured and noninjured sides preoperatively and at 16, 26, and 52 weeks postoperatively. Preoperatively, concentric peak torque in dorsiflexion at 90 deg/sec and plantar flexion at 225 deg/sec was significantly lower on the injured side. Postoperatively, concentric plantar flexion peak torque on the injured side increased significantly between Weeks 16 and 26 at 90 deg/sec but was significantly lower than the noninjured side from Weeks 16 to 52 at 90 and 225 deg/sec. Dorsiflexion peak torque at 90 and 225 deg/sec increased between Weeks 0 and 26 and was significantly higher on the injured side at Week 26. Eccentric plantar flexion peak torque was significantly lower on the injured side at Week 26 but not at 1 year. This prospective study demonstrates that 6 months of postoperative rehabilitation for chronic Achilles tendinitis is not enough to recover concentric and eccentric plantar flexion muscle strength compared with the noninjured side.
Research Interests: Mechanical Engineering, Biomedical Engineering, Muscle strength, Prospective studies, Humans, and 15 moreStrength Training, Chronic Disease, Female, Male, Exploration, Tendinopathy, Middle Aged, Skeletal Muscle, Adult, Achilles tendon, Leg, Force, Prospective Study, The American, and Surgical Treatment
... Department of Radiology, University of Umeå, Umeå, Sweden. Address correspondence and reprint requests to Ronny Lorentzon, MD, PhD ... Isokinetic calf muscle strength was measured innewton-meters with a Biodex isokinetic dynamometer... more
... Department of Radiology, University of Umeå, Umeå, Sweden. Address correspondence and reprint requests to Ronny Lorentzon, MD, PhD ... Isokinetic calf muscle strength was measured innewton-meters with a Biodex isokinetic dynamometer (Biodex Co., Shirley, New York). ...
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ABSTRACT
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Full-thickness patellar cartilage defects are often, but not always, associated with disabling anterior knee-pain and inability to take part in regular daily activities. There is no treatment of choice for this condition. It is well known... more
Full-thickness patellar cartilage defects are often, but not always, associated with disabling anterior knee-pain and inability to take part in regular daily activities. There is no treatment of choice for this condition. It is well known that the cells in the cambium layer of the periosteum are pluripotent and can differentiate into hyaline (or hyaline-like) cartilage, especially if in a joint environment and under the influence of continous passive motion. In a few clinical studies autologous periosteum transplants alone have been used in the treatment of full thickness patellar cartilage defects. The results are varying. At our clinic, autologous periosteum transplantation alone, followed by continous passive motion (CPM) in the immediate postoperative period and non-weight bearing loading for 3 months, has shown promising clinical results. The best clinical results have been achieved on traumatic (fracture, contusion, dislocation) cartilage defects, where 83% of patients have be...
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We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes)... more
We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of t...
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... Conservative treatment is recommended in the acute phase, but with persisting (chronic) pain, surgery is often required (Kvist 1991, 1994; Järvinen et al. 1997). ... Therefore, in clinical practice, it is often difficult to judge... more
... Conservative treatment is recommended in the acute phase, but with persisting (chronic) pain, surgery is often required (Kvist 1991, 1994; Järvinen et al. 1997). ... Therefore, in clinical practice, it is often difficult to judge where to address the treatment. ...
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This cross-sectional study investigated bone mass in female athletes participating in an impact-loading sport (soccer), and evaluated whether any changes in bone mass could be related to the type of weight-bearing loading and muscle... more
This cross-sectional study investigated bone mass in female athletes participating in an impact-loading sport (soccer), and evaluated whether any changes in bone mass could be related to the type of weight-bearing loading and muscle strength. The group of soccer players consisted of 16 second-division female players (age 20.9±2.2 years) training for about 6 hours/week. The reference group consisted of 13
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Physical activity affects the pain symptoms for Achilles tendinosis patients. Brain-derived neurotrophic factor (BDNF), tumor necrosis factor-alpha (TNF-α) and their receptors have been detected in human Achilles tendon. This pilot study... more
Physical activity affects the pain symptoms for Achilles tendinosis patients. Brain-derived neurotrophic factor (BDNF), tumor necrosis factor-alpha (TNF-α) and their receptors have been detected in human Achilles tendon. This pilot study aimed to compare serum BDNF and soluble tumor necrosis factor receptor I (sTNFRI) levels in Achilles tendinosis patients and healthy controls and to examine the influence of physical activity, and BMI and gender, on these levels. Physical activity was measured with a validated questionnaire, total physical activity being the parameter analyzed. Physical activity was strongly correlated with BDNF among tendinosis women [Spearman's rho (ρ)=0.90, P<0.01] but not among control women (ρ=-0.08, P=0.83), or among tendinosis and control men. Physical activity was significantly correlated with sTNFRI in the entire tendinosis group and among tendinosis men (ρ=0.65, P=0.01), but not in the entire control group or among control men (ρ=0.04, P=0.91). Thus, the physical activity pattern is related to the TNF and BDNF systems for tendinosis patients but not controls, the relationship being gender dependent. This is new information concerning the relationship between physical activity and Achilles tendinosis, which may be related to pain for the patients. This aspect should be further evaluated using larger patient materials.
Research Interests: Humans, Neurotrophins, Female, Male, Tendinopathy, and 14 moreYoung Adult, Exercise, Body Mass Index, Middle Aged, Questionnaires, Adult, Sex Factors, Achilles tendon, Tumor necrosis factor-alpha, Cumulative Trauma Disorders, Pilot Projects, Enzyme Linked Immunosorbent Assay, Case Control Studies, and Motor activity
PURPOSE: Androgenic-anabolic steroids (AAS) are beneficial for athletic performance (Giorgi et al., 1999). However, there is a paucity of literature that has examined the role of AAS, in particular, testosterone enanthate (TE), on immune... more
PURPOSE: Androgenic-anabolic steroids (AAS) are beneficial for athletic performance (Giorgi et al., 1999). However, there is a paucity of literature that has examined the role of AAS, in particular, testosterone enanthate (TE), on immune function. METHODS: Fifteen healthy young males (mean age 24.8 ± 5.2) were randomly assigned in a double blind method to either a 3.5mg/kg TE (mean age