Published also as Thesis (Ph. D.)--Columbia University. / Bibliography: p. 89-91.

Diss. (sammanfattning) Göteborg : Univ. , 2006. / Härtill 5 uppsatser.

Dissertation (MHSc--Health Science) -- Auckland University of Technology, 2005. / Also held in print (82 leaves, 30 cm.) in North Shore Theses Collection (T 612.76 POT)

Thèse--Liège. / Includes bibliography.

Thesis (D.PT.)--Sage Colleges, 2010. / "May 2010." "A Capstone project for PTY 768 presented to the faculty of The Department of Physical Therapy Sage Graduate School in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy." Includes bibliographical references.

This study quantified mechanical and structural responses to loading conditions at subtendon hierarchical levels. Tensile tests were performed at three strain rates on three groups of rabbit patellar tendon specimens. For each rate, tangent modulus (E) was computed from the stress-strain curves and the following structural responses were evaluated: (i) Area percent of collagen fibrils (FAR) and (ii) Skewness angle formed between proteoglycans and collagen fibrils. For 0.1%/s, 10%/s, and 70%/s, E was 48.8±20.3MPa, 64.7±29.3MPa, and 78.6±31.7MPa, respectively. For control, 0.1%/s, 10%/s, and 70%/s, the mean FAR was 0.7552±0.1476, 0.6628±0.1190, 0.6335±0.1013, and 0.6047±0.0384, respectively; and proteoglycan skewness angles were 14.70º±11.01º, 12.76º±10.13º, 15.08.0º±11.66º, and 16.68º±12.07º, respectively. For increased E, interfibrillar components had less time for effective fluid flow, energy dissipation, and structural rearrangement. The inverse relationship of FAR to strain rate may be due to broken fibrils and the Poisson effect. Proteoglycan skewness angle increase is likely due to stretched fibrils.

Flexor tendon lacerations in horses are traumatic injuries that can be career ending and life threatening. In the horse, a tendon repair must withstand the strains placed on the tenorrhaphy by immediate weight bearing and locomotion post-operatively. Despite the use of external coaptation, such strains can lead to significant gap formation, construct failure, longer healing time and poor quality of the healed tendon. Similar to equine surgery, gap formation and construct failure are common concerns in human medicine, with early return to post-operative physiotherapy challenging the primary repair. Early return to exercise and decreased gap formation has been shown to reduce adhesion formation. Based on these concerns, the ideal tenorrhaphy suture pattern for equines would provide: 1) high ultimate failure load, 2) resistance to gap formation, 3) minimal alteration in blood supply, and 4) minimal adhesion formation. Historically, various suture patterns and materials have been evaluated for human and equine flexor tendon repair. Results of equine studies suggest the three-loop pulley pattern (3LP) compares favorably to other patterns and is recommended for primary tenorrhaphy. However, this pattern still experiences significant gap formation and can result in failure. As a result, a technique which decreases the problems inherent in the 3LP is warranted for tenorrhaphy of equine flexor tendons. A review of the human literature highlights certain characteristics of the tenorrhaphy that may improve results including core purchase length and suture loop characteristics. Optimization of these tenorrhaphy characteristics can increase tenorrhaphy performance and patient outcome. The six-strand Savage technique (SSS) is a pattern routinely used in human hand surgery for tendon repair, and possesses high ultimate failure load and resistance to gap formation that may be beneficial for application in equine tendon repair. This study compared a novel tenorrhaphy pattern for horses, the SSS, with the currently recommended pattern, the 3LP, in an in vitro model. We hypothesize the SSS will fail at a higher ultimate load, resist pull through, and resist gap formation better than the 3LP. All testing used cadaveric equine superficial digital flexor tendons from horses euthanized for reasons other than musculoskeletal injury. All testing was approved by the IACUC. The two techniques were applied to cadaveric equine superficial digital flexor tendons. The same investigator performed all repairs (EE). Biomechanical properties were determined in a blinded, randomized pair design. Ultimate failure load, mode of failure and load required to form a 3mm gap were recorded on an Instron Electropuls materials testing system. Gap formation was determined using synchronized high-speed video analysis. Results are reported as mean + standard deviation. Statistical comparisons were made using Student's T test, with significance set at p<0.05. The tenorrhaphies were tested for their ultimate failure load and failure mode. The mean failure load for the SSS construct (421.1 ± 47.6) was significantly greater than that for the 3LP repaired tendons (193.7 ± 43.0). Failure mode was suture breakage for the SSS constructs (13/13) and suture pull through for the 3LP constructs (13/13). The maximum load to create a 3mm gap in the SSS repair (102.0N ± 22.4) was not significantly different from the 3LP repair (109.9N ± 16.0). The results of the current study demonstrate that the SSS tenorrhaphy has a higher ultimate failure load and resistance to pull through than the 3LP. The biomechanical properties of the SSS technique show promise as a more desirable repair for equine flexor tendons. However, in vivo testing of the effects of the pattern on live tissue and in a cyclic loading environment is necessary before clinical application of the pattern is recommended. / Master of Science

by Wang Wen. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 113-124). / Abstracts in English and Chinese. / ABSTRACT --- p.i / FLOWCHART --- p.vi / ACKNOWLEDGEMENT --- p.x / ABBREVIATIONS --- p.xi / INDEX FOR FIGURES --- p.xii / INDEX FOR TABLES --- p.xv / TABLE OF CONTENTS --- p.xvi / Chapter 1. --- INTRODUCTION --- p.1 / Chapter 1.1 --- PATELLAR TENDINOSIS --- p.1 / Chapter 1.1.1 --- Introduction --- p.1 / Chapter 1.1.2 --- Epidemiology of Patellar Tendinosis --- p.3 / Chapter 1.1.3 --- Etiology of Patellar Tendinosis --- p.3 / Chapter 1.1.4 --- Manifestations of Patellar Tendinosis --- p.4 / Chapter 1.1.5 --- Imaging Examination on Patellar Tendinosis --- p.4 / Chapter 1.1.6 --- Clinical Diagnosis of Patellar Tendinosis --- p.6 / Chapter 1.1.7 --- Management of Patellar Tendinosis … --- p.6 / Chapter 1.2 --- ANATOMY AND HISTOLOGY OF PATELLAR TCNDON --- p.7 / Chapter 1.3 --- STRUCTURE AND METABOLISM OF TENDON --- p.9 / Chapter 1.3.1 --- Tenocytes --- p.9 / Chapter 1.3.2 --- Extra-cellular Matrix --- p.11 / Chapter 1.3.2.1 --- Collagen --- p.11 / Chapter 1.3.2.2 --- Proteoglycans --- p.12 / Chapter 1.4 --- ROLES OF GROWTH FACTORS TENDON HEALING AND REPAIR --- p.14 / Chapter 1.4.1 --- Platelet-Derived Growth Factor --- p.14 / Chapter 1.4.2 --- Transforming Growth Factor-beta --- p.15 / Chapter 1.5 --- HISTOPATHOLOGY OF PATELLAR TENDINOSIS --- p.16 / Chapter 1.6 --- STUDY PLAN --- p.17 / Chapter 1.6.1 --- Characterization on Hypercellularity --- p.18 / Chapter 1.6.2 --- Characterization on Disorganization and Loosening of Collagen --- p.18 / Chapter 1.6.3 --- Characterization on Inflammatory Trace --- p.20 / Chapter 1.6.4 --- Characterization on Growth Factors in Tendinosis --- p.21 / Chapter 1.7 --- OBJECTIVES --- p.22 / Chapter 2. --- MATERIALS AND METHODS --- p.27 / Chapter 2.1 --- HUMAN TISSUES --- p.27 / Chapter 2.1.1 --- Patellar Tendinosis Tissues --- p.27 / Chapter 2.1.1.1 --- Diagnosis of patellar tendinosis --- p.27 / Chapter 2.1.1.2 --- Recruitment of patients --- p.27 / Chapter 2.1.4 --- Healthy Patellar Tendon tissues --- p.28 / Chapter 2.2 --- TISSUES COLLECTION AND PREPARATION --- p.28 / Chapter 2.3 --- HISTOLOGICAL STUDY ON HUMAN SPECIMENS --- p.28 / Chapter 2.3.1 --- Haematoxyline and Eosin Staining --- p.29 / Chapter 2.3.2 --- Safranin O Staining --- p.29 / Chapter 2.3.2.1 --- Reagents preparation --- p.29 / Chapter 2.3.2.2 --- Experimental procedure --- p.30 / Chapter 2.3.5 --- Polarization Microscopy --- p.30 / Chapter 2.4 --- IMMUNOHISTOCHEMICAL STAINING --- p.30 / Chapter 2.4.1 --- Reagents Preparation --- p.31 / Chapter 2.4.2 --- Experimental Procedure --- p.33 / Chapter 2.5 --- IMAGE ANALYSIS --- p.35 / Chapter 2.5.1 --- Equipment --- p.35 / Chapter 2.5.2 --- Procedures --- p.35 / Chapter 2.6 --- IN SITU ZYMOGRAPHY --- p.37 / Chapter 2.6.1 --- Reagents Preparation --- p.37 / Chapter 2.6.2 --- Experimental Procedure --- p.38 / Chapter 2.7 --- STATISTIC ANALYSIS.… --- p.39 / Chapter 3. --- RESULTS --- p.42 / Chapter 3.1 --- HUMAN SAMPLES --- p.42 / Chapter 3.1.1 --- Patellar tendinosis patients --- p.42 / Chapter 3.1.2 --- Healthy control group --- p.43 / Chapter 3.2 --- HISTOLOGICAL STUDY ON HUMAN SPECIMENS --- p.43 / Chapter 3.2.1 --- Gross Morphology --- p.43 / Chapter 3.2.2 --- Haematoxyline and Eosin Staining --- p.44 / Chapter 3.2.3 --- Safranin O Staining --- p.44 / Chapter 3.2.4 --- Polarization Microscopy --- p.44 / Chapter 3.3 --- IMAGE ANALYSIS --- p.45 / Chapter 3.3.1 --- Immunohistochemistry of PCNA --- p.45 / Chapter 3.3.2 --- Immunohistochemistry of hsp47 --- p.46 / Chapter 3.3.3 --- Immunohistochemistry of Procollogen Type I --- p.47 / Chapter 3.3.4 --- Immunohistochemistry of MMP1 --- p.47 / Chapter 3.3.5 --- Immunohistochemistry of TIMP1 --- p.48 / Chapter 3.3.6 --- Immunohistochemistry of COX-2 --- p.49 / Chapter 3.3.7 --- Immunohistochemistry of TGFP --- p.49 / Chapter 3.3.8 --- Immunohistochemistry of PDGFbb --- p.50 / Chapter 3.3.9 --- Immunohistochemistry of PDGFRβ --- p.51 / Chapter 3.3.10 --- Summary of Image Analysis of Immunohistochemical staining --- p.51 / Chapter 3.4 --- IN SITU ZYMOGRAPHY --- p.52 / Chapter 4. --- DISCUSSION --- p.93 / Chapter 4.1 --- DIAGNOSIS OF PATELLAR TENDINOSIS --- p.93 / Chapter 4.2 --- HYPERCELLULARITY IN PATELLAR TENDINOSIS --- p.95 / Chapter 4.3 --- COLLAGEN DISTURBANCE IN PATELLAR --- p.97 / Chapter 4.4 --- INFLAMMATORY RESPONSE IN PATELLAR TENDINOSIS --- p.100 / Chapter 4.5 --- THE EXPRESSION OF GROWTH FACTORS IN PATELLAR TENDINOSIS --- p.102 / Chapter 4.6 --- PROPOSED PATHOGENESIS FOR PATELLAR TENDINOSIS --- p.105 / Chapter 4.7 --- LIMITATION OF THIS STUDY --- p.108 / Chapter 4.8 --- FUTURE STUDY --- p.109 / Chapter 5. --- CONCLUSION --- p.111 / BIBLIOGRAPHY --- p.113

Chronic painful tendinopathies are common, not only in sports and recreationally active people, but also among people with a sedentary lifestyle. Both the lower and upper limbs are affected. There is lack of knowledge about the etiology and pathogenesis to tendinopathy, and many different treatments options have been presented. Unfortunately, most treatments have not been tested in scientific studies. Conservative (non-surgical) treatment has since long shown unsatisfactory results and surgical treatment is known to give unpredictable results. The aim of this thesis was to evaluate new models of painful eccentric training for the conservative treatment of different chronic tendinopathies. After promising results in a pilot study, using painful eccentric calf muscle training in patients with chronic mid-portion Achilles tendinopathy, we investigated if these results could be reproduced in a larger group of patients with both mid-portion and insertional Achilles tendinopathy (study I). After 12 weeks, 89% of the patients with pain from the mid-portion were satisfied and back in previous activities. In the group with insertional Achilles tendinopathy the results were poor. A new model for eccentric training was designed for patients with insertional Achilles tendinopathy. The eccentric calf muscle training was done from tip-toe to floor level (study II). With this new regimen 67% of the patients were satisfied and back in previous activities. The next step was to investigate the effects of painful eccentric quadriceps training on patients with jumper´s knee/patellar tendinopathy (study III). Two different training protocols were used. Eccentric training performed on a 250 decline board showed promising results with reduced pain and a return to previous activities, while eccentric training without the decline board had poor results. In a following prospective study, patients with jumper´s knee/patellar tendinopathy were randomised to either concentric or eccentric painful quadriceps training on a 250 decline board (study IV). After 12 weeks of training, there were significantly better results in the group that did eccentric training. In a pilot study (study V), we investigated painful eccentric deltoideus and supraspinatus muscle training on a small group of patients on the waiting list for surgical treatment of subacromial impingement syndrome. After 12 weeks of training, 5 out of 9 patients were satisfied with the results of treatment and withdrew from the waiting list for surgery. In conclusion, the present studies showed good clinical results with low risks of side effects and low costs. Thus, we suggest that painful eccentric training should be tried in patients with Achilles and patellar tendinopathy before intratendinous injections and surgery are considered. For patients with chronic painful impingement syndrome, the results of our small pilot study are interesting, and stimulates to randomised studies on larger materials.

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