Laser Photobiomodulation in the acute inflammatory response of the calcaneal tendon injury in rats exposed to cigarette smoke / Fotobiomodulação Laser na resposta inflamatória aguda em lesão do tendão calcâneo em ratos expostos a fumaça de cigarro / Fotobiomodulación láser en la respuesta inflamatoria aguda en lesión del tendón calcáneo en ratones expuestos a humo de cigarrillo

ABSTRACT Nicotine delays the healing process and increases the levels of myeloperoxidase (MPO), an enzyme that plays a key role in the production of reactive oxygen species during the inflammatory process. Laser Photobiomodulation (PBM) is one of the most used electrophysical agents in the treatment of the calcaneal tendon, however, its effects on MPO activity need to be further elucidated. This study aimed to evaluate the effects of laser PBM on MPO activity after inflicting an injury to the calcaneal tendon of rats exposed to cigarette smoke. Thirty-four male Wistar rats with 90 days of age were used. After 14 days of exposure to cigarette smoke, the animals were divided into three experimental groups: control group (CG, n=12), not submitted to injury or treatment; sham group (ShG, n=10), submitted to partial calcaneal tendon injury and laser PBM simulation; and laser PBM group (PBMG, n=12), submitted to partial calcaneal tendon lesion and treated with laser PBM within the first minute after injury. PBM decreased MPO activity levels in PBMG compared to ShG (CG: 1.38±0.69pg/ml; ShG: 3.78±1.09pg/ml; PBMG: 2.58±0.93pg/ml; p<0.005). In conclusion, applying laser PBM immediately after inflicting damage to the calcaneal tendon attenuates acute inflammatory activity in rats exposed to cigarette smoke.

RESUMO A nicotina retarda o processo de cicatrização e eleva os níveis da enzima mieloperoxidase (MPO), a qual possui um papel fundamental na produção de espécies reativas de oxigênio durante o processo inflamatório. A fotobiomodulação laser (FBM) é um dos agentes eletrofísicos mais utilizados no tratamento do tendão calcâneo, no entanto, os seus efeitos sobre a atividade da MPO carecem de maior elucidação. Este estudo objetivou avaliar os efeitos da FBM sobre a atividade da MPO, após lesão do tendão calcâneo em ratos expostos à fumaça de cigarro. Foram utilizados 34 ratos Wistar, machos, com 90 dias de vida. Após 14 dias de exposição à fumaça de cigarro, os animais foram divididos em três grupos experimentais: grupo controle (GC, n=12), não submetido à lesão ou tratamento; grupo sham (GSh, n=10), submetido à lesão parcial do tendão calcâneo e a simulação da FBM laser; grupo FBM laser (GFBM, n=12), submetido à lesão parcial do tendão calcâneo e tratados com FBM laser, no primeiro minuto após a lesão. A FBM diminuiu os níveis de atividade da MPO no GFBM em comparação ao GSh (GC: 1,38±0,69 pg/ml; GSh: 3,78±1,09pg/ml; GFBM: 2,58±0,93pg/ml; p<0,005). Conclui-se que a FBM laser aplicada imediatamente após lesão do tendão calcâneo, atenua a atividade inflamatória aguda em ratos expostos à fumaça de cigarro.

RESUMEN La nicotina retarda el proceso de cicatrización y eleva los niveles de la enzima mieloperoxidasa (MPO), que tiene un papel fundamental en la producción de especies reactivas de oxígeno durante el proceso inflamatorio. La fotobiomodulación con láser (FBM) es uno de los agentes electrofísicos más utilizados en el tratamiento del tendón calcáneo, sin embargo sus efectos sobre la actividad de la MPO carecen de mayor elucidación. Este estudio objetivó evaluar los efectos de la FBM sobre la actividad de la MPO después de lesión del tendón calcáneo en ratones expuestos al humo de cigarrillo. Se utilizaron 34 ratones Wistar, machos, con 90 días de vida. Después de 14 días de exposición al humo de cigarrillo, los animales fueron divididos en tres grupos experimentales: grupo de control (GC, n=12), no sometido a la lesión o tratamiento; grupo sham (GSh, n=10), sometido a la lesión parcial del tendón calcáneo y a la simulación de la FBM láser; y el grupo FBM láser (GFBM, n=12), sometido a la lesión parcial del tendón calcáneo y tratado con FBM láser, en el primer minuto después de la lesión. La FBM disminuyó los niveles de actividad de MPO en el GFBM en comparación con el GSh (GC: 1,38±0,69 pg/ml; GSh: 3,78±1,09pg/ml; GFBM: 2,58±0,93pg/ml, p<0,005). Se concluye que la FBM láser aplicada inmediatamente después de la lesión del tendón calcáneo atenúa la actividad inflamatoria aguda en ratones expuestos al humo de cigarrillo.

Effects of eccentric exercise in pressure pain threshold in subjects with functional ankle equinus condition

SUMMARY Stretching exercises are widely used by the population before sporting activities. One of the most common technique is eccentric exercise. Here, we made a clinical examination of 98 subjects with equinus condition before activity and after 30 min of running (49 participants with previous eccentric exercise and 49 with no previously eccentric exercise). The clinical assessment of the Achilles tendon was based on the pressure pain threshold (PPT). We identified significant PPT changes between the previous eccentric stretching and the non-previous eccentric stretching group in the Achilles tendon evaluations. Based on our findings, we propose that subjects with equinus condition could use eccentric stretching in order to improve the Achilles tendon status.

RESUMO Exercícios de alongamento são amplamente utilizados pela população antes da atividade esportiva. Uma das técnicas mais comuns é o exercício excêntrico. Aqui, fizemos um exame clínico de 98 indivíduos com condição de pé equino antes da atividade e após 30 minutos de corrida (49 corredores com exercício excêntrico anterior e 49 sem exercício excêntrico anterior). A avaliação clínica do tendão de Aquiles foi baseada no limiar de dor à pressão (PPT). Identificamos modificações significativas no PPT entre alongamentos prévios excêntricos e nenhum exercício anterior excêntrico de alongamento para as avaliações do tendão de Aquiles. Com base em nossos achados, propomos que sujeitos com condição de pé equino poderiam fazer alongamentos com exercícios excêntricos para melhorar o status do tendão de Aquiles.

Correlation of some predisposing intrinsic conditions with the morphological integrity of the Achilles tendon

Background: Most studies have focused on ill-tendons with a little insight on how intrinsic factors correlate with the Achilles tendon (AT) morphology. Aim: This study aims at establishing how blood pressure (BP), blood glucose (BG), and body mass index (BMI) correlate with the morphology of the AT with emphasis on width changes. Materials and Methods: Participants were volunteers who were recruited during and after an organized health fair by the Medical Students' body of All Saints University, School of Medicine, Commonwealth of Dominica. A total of 336 people, consisting of 135 males and 201 females volunteered for the study. The most dominant age group was between 60 and 65 years. A self-administered questionnaire was used to acquire necessary information, and a preliminary clinical procedure was used to check for BP, BG, and BMI. Ultrasound examination was done in B-mode using a linear array high-frequency probe with a mediolateral approach at the AT. Results: Among the participants, 42.68%, 69.75%, and 30.38% had normal BP, BG, and BMI readings, respectively. BP, BG, and BMI statistically supported the hypothesis.Individuals with extreme BP, BG, and BMI had their AT width wider when compared with individuals with normal systemic readings. Sonographic examination revealed most participants with normal tendon morphology while some identifiable changes were observed among others. Conclusion: This study suggests that BP, BG, and BMI could affect the morphological integrity of the AT. It indicates that asymptomatic high blood sugar and BP could weaken the AT, leading to pain which may appear unrelated to the physician and patient

Tendón de aquiles y su estudio ultrasonográfico: más allá de sus alteraciones inflamatorias / Achilles tendon and ultrasound study: beyond their inflammatory disorders

The Achilles tendon is formed by the union of the soleus and gastrocnemius tendons, its function is to perform plantar flexion. The prevalence of its injury is unknown, but has a multifactorial etiology and occurs most frequently in male than female by a 3:1 ratio, mostly between the fourth and fifth decades of life. The mechanisms of injury include increased weight bearing with the knee in extension, sudden and violent dorsiflexion, and direct trauma. With ultrasound tendon ruptures, complete or partial, Achilles tendinopathy and postoperative changes unrelated to inflammatory process are detected. Ultrasound is a safe imaging technique, low-cost and can be performed in real time, with good rates of sensitivity and specificity compared to other techniques...

El tendón de Aquiles está formado por la unión de los tendones de los músculos sóleo y gastrocnemio, cuya función es realizar flexión plantar. La prevalencia de su lesión es desconocida, su etiología es multifactorial, y se presenta con mayor frecuencia en el género masculino que en el femenino en una proporción de 3:1, entre la cuarta y quinta décadas de la vida. Los mecanismos de lesión incluyen incremento en el soporte de peso con la rodilla en extensión, dorsiflexión súbita y violenta y trauma directo. Con la US se detectan rupturas del tendón de Aquiles completas o parciales, tendinopatía y cambios postoperatorios no relacionados a proceso inflamatorio; la US es un método inocuo, de bajo costo y se realiza en tiempo real; tiene buena sensibilidad y especificidad...

Spontaneous atraumatic achilles tendon rupture in healthy individuals: biomechanical aspect

Achilles tendon rupture bilaterally secondary to predisposing factors such as steroid, fluoroquinolones, SLE, RA etc. Other factors are well-described in the literature but this is an extremely rare phenomenon in the absence of risk factors. Available reports in healthy athletes, all had history of severe trauma. We report an unusual presentation of bilateral and unilateral spontaneous rupture of Achilles tendon in healthy lifeguards without any marked trauma. Knowledge of training environment will alert the trainers, athletes and surgeons to recognise training environment at risk and take preventive measures

Sweet's syndrome with tendinitis.

A 30 years man presented with fever and skin manifestations in the form of multiple tender, erythematous, asymmetric nodules and papules predominantly over the upper arms and back. The nodules were coalescing to form irregular sharply demarcated plaques over the forearms and thighs. There were pustules over the nodules. He also had tendoachilles tendinitis. The total leucocyte count, differential count and skin biopsy confirmed the diagnosis of Sweet's syndrome (acute febrile neutrophilic dermatosis). This patient, a case of Idiopathic Sweet's syndrome with tendoachilles tendinitis responded to oral corticosteroids.

Análise comparativa das propriedades mecânicas do ligamento da patela e do tendão calcâneo / Comparative analysis of the mechanical properties of the patellar ligament and calcaneus tendon

Com a finalidade de se comparar as propriedades mecânicas do ligamento da patela e do tendão calcâneo foram realizados ensaios de tração em material obtido de 25 cadáveres humanos. A idade dos doadores foi 58 ± 14 anos (33-85), sendo 19 (76 por cento) masculinos e 6 (24 por cento) femininos, 23 brancos (92 por cento) e dois negros (8 por cento). Os materiais foram testados em seus 10 mm centrais, com velocidade de aplicação de carga de 30 mm/min. Foi obtida a área de secção dos corpos de prova para que fossem estudadas as propriedades estruturais e materiais. Foram estudadas as seguintes variáveis: carga máxima (N), tensão(MPa), módulo de elasticidade (MPa), energia (Nm), alongamento absoluto (mm) e específico ( por cento), limite de proporcionalidade (N), além da tensão (MPa) e alongamentos neste ponto. A análise estatística revelou que ambos possuem carga máxima, limite de proporcionalidade e tensão semelhantes (p>0,05). Nas outras variáveis ocorreu diferença significativa (p<0,05) com o tendão calcâneo apresentando valores maiores para energia e alongamento. O módulo de elasticidade, significativamente maior no ligamento da patela (p<0,05), foi a variável que melhor caracterizou a diferença do comportamento mecânico dos dois materiais.

Ultrastructural characteristics of tensional regions in tendons from rats of different ages

The calcaneal tendon and the deep digital flexor tendon are collagen-rich structures which are adapted to resist tensile stress. Since during aging tendons undergo modifications in their mechanical properties and in collagen aggregation, an understanding of the structural changes involved is important. In this work, the structural organization of the tensile region of the calcaneal and deep difital flexor tendons was studied in male Wistar rats 30, 180 and 730 days old. Large quantities of rough endoplasmic reticulum and peripheral secretory microvesicles were observed in the calcaneal tendon of 30-day-old rats. In the case of the deep digital flexor tendon, this organelle remained well-developed up to 180 days. A marked decrease in rough endoplasmic reticulum was observed in both tendons in 730-day-old rats. Proteoglycans associated with collagen fibrils were visible in the two tendons of all age groups. The reduced amount of rough endoplasmic reticulum and secretory microvesicles may be correlated with the known lower turnover of extracellular matrix components during aging.

Tratamiento de la ruptura del tendón de Aquiles, en deportistas con prótesis de Leeds-Keio / Repair of the Achilles-tendon rupture by the Leeds-Keio prosthesis in athletes

El tratamiento de las rupturas totales del tendón de Aquiles es aún un tema de discusión, no queda duda que en pacientes que no realizan ninguna actividad física importante el tratamiento puede ser poco agresivo. Sin embargo en deportistas se debe garantizar la pronta rehabilitación y reintegración al deporte, eliminando el riesgo de una ruptura interativa. Desde 1975 se ha realizado la reparación de las rupturas totales de tendón de Aquiles en deportistas con sutura reforzada con el peroneo lateral corto con la técnica Pérez-Teufer y después con plastías artificiales. En este trabajo presentamos una serie de 29 pacientes, todos ellos deportistas de práctica habitual, que sufrieron durante la misma ruptura de su tendón de Aquiles. Se realizó la reconstrucción mediante una plastía con injerto sintético Leeds-Keio. Gracias a la solidez y a la resistencia que ofrece este montaje se pudo iniciar la rehabilitación en el postoperatorio inmediato. Todos los pacientes con excepción de uno volvieron a practicar su deporte al mismo nivel y en su mismo puesto entre el tercero y cuarto mes después de la cirugía. En esta serie no se presentaron complicaciones graves, ni rupturas

Resonancia magnética de tobillo / Magnetic resonance imaging of the ankle

La articulación del tobillo debido a la frecuencia con que sufren traumatismos nos obliga a conocer profundamente su anatomía y patología, sobre todo con Resonancia Magnética, la cual nos permite visualizar y evaluar cada una de sus estructuras. En este artículo, tratamos en forma suscinta la anatomía y patología de ligamentos y tendones de esta articulación

Conservative treatment for acute rupture of the achilles tendon

[22] Patients with acute ruptures of the Achilles tendon were treated by immobilisation in a plaster cast for 12 week. [20] were followed up for a mean time of [40] months. [2] re-ruptures occurred shortly after the initial treatment. Most patients had no or only slight complaints, three had moderate and one severe, problems. The activity level dropped slightly from 5.3 to 5.03, [Tegner score]. The results are satisfactory with a low complication rate. The method is an alternative to operative repair, especially in patients declining operation and in those in whom operation or anaesthesia is contraindicated