Introdução: A discrepância no comprimento dos membros inferiores (DCMI) está associada a alterações biomecânicas na marcha e a uma grande variedade de desordens ortopédicas, que incluem uma possível sobrecarga do tendão tibial posterior. Neste sentido, hipotetizamos que há associação entre a presença de DCMI e disfunção do TTP. Objetivo: O presente estudo foi realizado para comparar a frequência e a magnitude de DCMI em um grupo com e outro sem disfunção do tendão tibial posterior (DTTP), bem como para relacionar características clínicas com a presença da doença. Modelo do estudo: Estudo caso-controle. Método: O estudo envolveu 118 pacientes com diagnóstico de DTTP atendidos entre janeiro de 2009 e setembro de 2012 e 118 voluntários controles pareados por gênero e raça. Através de escanometria radiográfica ou tomográfica, a frequência da DCMI, assim como a média da DCMI absoluta e a média da DCMI relativa foram comparadas entre os dois grupos. Resultados: A prevalência da DCMI e as médias da DCMI absoluta e da DCMI relativa foram significativamente maiores no grupo de casos (94,9%, 5,64 mm e 7,36% respectivamente) do que no grupo controle (79,7%, 3,28 mm e 4,18% respectivamente) (p<0.001). Conclusões: Os resultados deste estudo demonstram haver uma relação entre a DCMI e a presença de DTTP. Devido a importantes alterações biomecânicas geradas pela DCMI, esta é possivelmente um fator predisponente para o desenvolvimento da DTTP. / Background: Leg length discrepancy (LLD) is associated with a variety of orthopedic disorders and biomechanical gait changes that involve possible overload of the posterior tibial tendon (PTT). In view of the biomechanical disturbances induced by LLD, an association may exist between LLD and PTT dysfunction (PTTD). Purpose: To compare the frequency and magnitude of LLD between subjects with and without PTTD and ascertain whether associations exist between clinical features and presence of dysfunction. Study design: Casecontrol study. Methods: A total of 118 patients with a diagnosis of PTTD were seen between January 2009 and September 2012 and compared to 118 sex- and race-matched volunteers. The frequency of LLD, the mean absolute LLD and the mean relative LLD were measured by conventional (radiographic) or CT scanography and compared between cases and controls. Results: The prevalence of LLD and mean absolute and relative LLD values were significantly greater in the case group (94.9%, 5.64 mm and 7.36% respectively) than in the control group (79.7%, 3.28 mm and 4.18% respectively) (p<0.001). Conclusion: The findings of this study demonstrate a relationship between LLD and PTTD. In light of the major biomechanical changes it induces, LLD may be a predisposing factor for development of PTTD.

Introdução: A discrepância no comprimento dos membros inferiores (DCMI) está associada a alterações biomecânicas na marcha e a uma grande variedade de desordens ortopédicas, que incluem uma possível sobrecarga do tendão tibial posterior. Neste sentido, hipotetizamos que há associação entre a presença de DCMI e disfunção do TTP. Objetivo: O presente estudo foi realizado para comparar a frequência e a magnitude de DCMI em um grupo com e outro sem disfunção do tendão tibial posterior (DTTP), bem como para relacionar características clínicas com a presença da doença. Modelo do estudo: Estudo caso-controle. Método: O estudo envolveu 118 pacientes com diagnóstico de DTTP atendidos entre janeiro de 2009 e setembro de 2012 e 118 voluntários controles pareados por gênero e raça. Através de escanometria radiográfica ou tomográfica, a frequência da DCMI, assim como a média da DCMI absoluta e a média da DCMI relativa foram comparadas entre os dois grupos. Resultados: A prevalência da DCMI e as médias da DCMI absoluta e da DCMI relativa foram significativamente maiores no grupo de casos (94,9%, 5,64 mm e 7,36% respectivamente) do que no grupo controle (79,7%, 3,28 mm e 4,18% respectivamente) (p<0.001). Conclusões: Os resultados deste estudo demonstram haver uma relação entre a DCMI e a presença de DTTP. Devido a importantes alterações biomecânicas geradas pela DCMI, esta é possivelmente um fator predisponente para o desenvolvimento da DTTP. / Background: Leg length discrepancy (LLD) is associated with a variety of orthopedic disorders and biomechanical gait changes that involve possible overload of the posterior tibial tendon (PTT). In view of the biomechanical disturbances induced by LLD, an association may exist between LLD and PTT dysfunction (PTTD). Purpose: To compare the frequency and magnitude of LLD between subjects with and without PTTD and ascertain whether associations exist between clinical features and presence of dysfunction. Study design: Casecontrol study. Methods: A total of 118 patients with a diagnosis of PTTD were seen between January 2009 and September 2012 and compared to 118 sex- and race-matched volunteers. The frequency of LLD, the mean absolute LLD and the mean relative LLD were measured by conventional (radiographic) or CT scanography and compared between cases and controls. Results: The prevalence of LLD and mean absolute and relative LLD values were significantly greater in the case group (94.9%, 5.64 mm and 7.36% respectively) than in the control group (79.7%, 3.28 mm and 4.18% respectively) (p<0.001). Conclusion: The findings of this study demonstrate a relationship between LLD and PTTD. In light of the major biomechanical changes it induces, LLD may be a predisposing factor for development of PTTD.

Introdução: A discrepância no comprimento dos membros inferiores (DCMI) está associada a alterações biomecânicas na marcha e a uma grande variedade de desordens ortopédicas, que incluem uma possível sobrecarga do tendão tibial posterior. Neste sentido, hipotetizamos que há associação entre a presença de DCMI e disfunção do TTP. Objetivo: O presente estudo foi realizado para comparar a frequência e a magnitude de DCMI em um grupo com e outro sem disfunção do tendão tibial posterior (DTTP), bem como para relacionar características clínicas com a presença da doença. Modelo do estudo: Estudo caso-controle. Método: O estudo envolveu 118 pacientes com diagnóstico de DTTP atendidos entre janeiro de 2009 e setembro de 2012 e 118 voluntários controles pareados por gênero e raça. Através de escanometria radiográfica ou tomográfica, a frequência da DCMI, assim como a média da DCMI absoluta e a média da DCMI relativa foram comparadas entre os dois grupos. Resultados: A prevalência da DCMI e as médias da DCMI absoluta e da DCMI relativa foram significativamente maiores no grupo de casos (94,9%, 5,64 mm e 7,36% respectivamente) do que no grupo controle (79,7%, 3,28 mm e 4,18% respectivamente) (p<0.001). Conclusões: Os resultados deste estudo demonstram haver uma relação entre a DCMI e a presença de DTTP. Devido a importantes alterações biomecânicas geradas pela DCMI, esta é possivelmente um fator predisponente para o desenvolvimento da DTTP. / Background: Leg length discrepancy (LLD) is associated with a variety of orthopedic disorders and biomechanical gait changes that involve possible overload of the posterior tibial tendon (PTT). In view of the biomechanical disturbances induced by LLD, an association may exist between LLD and PTT dysfunction (PTTD). Purpose: To compare the frequency and magnitude of LLD between subjects with and without PTTD and ascertain whether associations exist between clinical features and presence of dysfunction. Study design: Casecontrol study. Methods: A total of 118 patients with a diagnosis of PTTD were seen between January 2009 and September 2012 and compared to 118 sex- and race-matched volunteers. The frequency of LLD, the mean absolute LLD and the mean relative LLD were measured by conventional (radiographic) or CT scanography and compared between cases and controls. Results: The prevalence of LLD and mean absolute and relative LLD values were significantly greater in the case group (94.9%, 5.64 mm and 7.36% respectively) than in the control group (79.7%, 3.28 mm and 4.18% respectively) (p<0.001). Conclusion: The findings of this study demonstrate a relationship between LLD and PTTD. In light of the major biomechanical changes it induces, LLD may be a predisposing factor for development of PTTD.

Abstract The Achilles tendon is the largest tendon in the human body and is affected by many diseases and is vulnerable to many forms of damage due to the heavy loads it must bear. Rupture of the Achilles tendon has become more common in recent times, with an almost four-fold increase in prevalence from 1979–1990 to 1991–2000 and a peak incidence of 19 ruptures per 100 000 of population in 1999 in our epidemiological assessment. The incidences of major complications, re-rupture and deep infection, increased along with primary ruptures, peaking in 1999. The results after successful primary repair are good in over 90% of cases, as we have shown in a randomized study and in a review of the literature, and the result after re-rupture is still good in about 70% of cases, but achieving good performance after deep infection is a highly random matter. Our retrospective survey did not identify any good results, but the deep infection cases in our randomized study showed good performance due to prompt action taken for their treatment. The best method for treating a ruptured Achilles tendon has been under debate for almost 100 years, with surgery and conservative methods advocated to equal extents. We have advocated surgical treatment as the primary choice and conservative treatment is given for selected high risk patients, for example patients with diabetes, skin problems, systemic use of corticosteroids or severe other illness. The type of surgery technique is not a straightforward choice, either, and various forms of open surgery and percutaneous techniques exist. We compared an end-to-end simple suture with the same suture augmented with one central gastrocnemius turn-over flap in a randomized series of 60 patients and found no differences with respect to subjective complaints, calf muscle strength or tendon elongation with time. The end-to-end technique is simpler and is therefore justified as the primary method of choice for the surgical repair of fresh complete Achilles tendon ruptures. The tissue composition has been shown to alter not only with time but also after repeated tearing of the tendon collagen fibres. A normal tendon is mainly composed of type I collagen, but the rupture areas express more type III collagen, which is thinner and withstands loads less effectively. Type III collagen accumulates slowly in the tendon, since its production does not increase very much, a situation that is indicative of microtrauma. Crosslinking of the fibres is important for collagen matrix properties, and we found that there is a change in the quality of crosslinking with age and that this may have role in the observed changes in tendon stiffness, as also noted in other studies. We also studied the appearance of tenascin-C at the rupture site in the Achilles tendon and at two other sites in the same tendon, but found no difference in its expression. It has been proposed that tenascin-C may take part in the tendon’s reaction to loading, but its exact function remains unknown.

O trabalho realizado estudou experimentalmente os efeitos do ultra-som terapêutico na prevenção de aderências tendinosas e no reparo tendíneo. Foi selecionado para o estudo o tendão flexor profundo do 3º dedo na transição das zonas 3 e 4 da pata dianteira direita de coelho. Foram utilizados 30 coelhos fêmeas adultas jovens, com peso corporal médio de 2,7 Kg, divididos em 3 grupos (A, B e C) de 10 animais, sob anestesia para a produção da lesão no tendão, feita por escarificação com o uso do bisturi e o esmagamento num segmento de 5 mm de diâmetro, utilizando um dispositivo de carga de 15 Kg, durante 10 minutos. As patas foram imobilizadas com órtese de material termoplástico durante todo o período experimental (21 dias). O ultra som terapêutico foi iniciado no 3º PO, e continuado por 7 dias consecutivos, com 5 minutos de duração. Foi empregado um ultra-som terapêutico, regulado na freqüência de 3 MHz, no modo contínuo, sendo que a intensidade de 0,2 W/'CM POT.2' foi aplicada nos animais do grupo A, 0,4 W/'CM POT.2' no grupo B e ultra-som desligado como placebo no grupo C. No 21º PO os animais foram sacrificados, e o tendão submetido à análise histológica. Os resultados foram submetidos à análise estatística e demonstraram que houve uma menor formação de aderência no grupo A. A aceleração do reparo tendinoso foi observada em todos os grupos / The work accomplished studied experimentally the effects of therapeutics ultrasound in prevention of tendon adherences and in tendon repair. The deep flexor tendon of the 3rd finger between zones 3 and 4 of a rabbit's right fore-foot was selected for the study. Thirty young adult female rabbits, with a body weight average of 2.7 Kg, divided into 3 groups (A, B, and C) of 10 animals each, were used. The tendon injury was made, under the effect of anesthesia, by reaming with the use of a scalpel, and the 5mm diameter crushing was made by the use of a device of 15 Kg load for 10 minutes. The feet were immobilized with orthesis made of thermoplastic material during all the experiment period (21 days). A therapeutics ultrasound, set at the frequency of 3 MHz, was applied. The intensity of 0.2 W/'CM POT.2' was applied to the animals of group A; 0.4 W/'CM POT.2' to the group B; and the equipment was off when applied to group C as a placebo. The therapeutics ultrasound was started in the 3rd PO and kept on for 7 consecutive days, with a duration of 5 minutes. On the 21st day the animals were sacrificed; the tendon was analysed histologically. The results were analysed statistically and showed that there was a minor adherence formation in group A. The acceleration of the tendon repair was observed in all groups

Studies of the microstructure of tendon-bone attachments in mammals have shed light on their role in mediating efficient force transfer between tendon and bone, two tissues that differ vastly in their structure, composition, and material properties. Studies have also elucidated the importance of mechanical stimulation in maintaining tendon-bone attachment structures so that they may function successfully in dissipating mechanical stresses at the tendon-bone interface, to minimize the risk of tissue failure. Gross anatomical studies in fish have focused on identifying pathways of myomere contractile force transmission to the backbone of the fish, via connective tissue septa, to achieve body undulation. Little focus has been placed on how these connective tissues connect to the bone at the microscopic level to achieve force transfer. Moreover, whether or not these attachments are capable of undergoing remodeling in response to novel force regimes—which may influence their function—remains to be elucidated. First, we characterized the microstructure and material properties of the epicentral tendon-vertebra attachment in rainbow trout by conducting histology and tensile-testing. Individual collagen fibers of the epicentral tendon projected directly into the cancellous bone of the vertebra. We observed rostral-to-caudal trends in material properties for attachments found at different positions within the region spanning the dorsal and adipose fin, suggesting that attachments differed in their structure and/or composition at different positions along the backbone. Furthermore, the angle of the epicentral tendon with respect to the bone influenced the material properties and structural integrity of the attachments during tensile-testing, suggesting that attachments may be optimized to transfer force along particular angles. Second, we studied the effect of unloading on the material properties of the epicentral tendon-vertebra attachment by severing a subset of epicentral tendons on one side of rainbow trout. Severing of epicentral tendons had no effect on attachment material properties, suggesting that attachments did not undergo any alterations in structure and/or composition. We propose that the contiguous network of connective tissues in which the epicentral tendons are embedded as well as the fish’s gross musculature may have supported the maintenance of function of the epicentral tendon-vertebra attachments.

No description available.

The purpose of this work was to analyze the biomechanics of degeneration, damage, and failure in biological soft tissues both experimentally and computationally to provide insight into tendon or ligament tearing, tendo-achilles lengthening and lumbar spine dysfunction. For soft tissue tearing, experimental studies for calculating fracture toughness were performed and determined that tendons and ligaments are able to completely resist tear propagation. For tendo-achilles lengthening, a damage model was developed to mimic the behavior of the lengthening that occurs as a result of the percutaneous triple hemisection technique. The model provided insight for predicting the amount of lengthening that occurs during the procedure. For lumbar spine dysfunction, a finite element model was validated against experimental testing and simulated using boundary conditions representing physiological loading. The model was able to predict how biomechanical changes can lead to pain and how the prevalence of Schmorl's nodes can be predicted. For each of the situations, the best verification and validation methods were selected and are presented throughout the research to demonstrate the predictive capabilities and limitations of the work. Results of these studies are presented along with how those results influence the clinical endeavors associated with the degeneration, damage and failure of soft tissues.

No description available.

No description available.