OBJETIVO: Avaliar características clínicas, componente vertical da força de reação do solo e função muscular de flexores plantares e dorsais do tornozelo em corredores com e sem tendinopatia de calcâneo, e em indivíduos não corredores. MÉTODOS: Setenta e dois indivíduos (42H: 30M, idade 37,3 ±9,9 anos) foram divididos em três grupos: grupo tendinopatia de calcâneo (GTC, n= 24), grupo de corredores controle (GCC, n=24), e grupo de não corredores (GNC, n=24), sendo que em cada grupo ambos os tornozelos foram avaliados. A AOFAS ankle-hindfoot score, parâmetros da força de reação do solo e dados isocinéticos foram avaliados usando plataformas de força e dinamômetro isocinético. RESULTADOS: A AOFAS ankle-hindfoot score foi significativamente menor no GTC. A FRS foi igual entre os grupos, porém o impulso vertical inicial foi maior no GTC que GCC e GNC. Não houve diferenças para o impulso total. O GTC demonstrou menor trabalho total na velocidade 120º/s que GCC. Não houve diferenças para as outras variáveis isocinéticas entre GTC e GCC, apenas em relação ao GNC. CONCLUSÃO: Os corredores com tendinopatia de calcâneo têm maior impacto no momento de aterrissagem, menor resistência muscular dos flexores plantares e maior comprometimento clínico e funcional. A associação do maior impulso e menor resistência pode ser um fator predisponente e mantenedor para lesão no tendão calcâneo / OBJECTIVE: To evaluate the clinical characteristics, vertical component of the ground reaction force and muscle function of plantar flexors and dorsiflexors of the ankle in runners with and without Achilles tendinopathy and in non-runners. METHODS: Seventy-two subjects (42 M: 30W, 37.3±9.9 years old) were divided into three groups: Achilles Tendinopathy Group (GTC, n=24), Runners Control Group (GCC, n=24) and Non-Runners Group (GNC, n=24), in which both ankles were evaluated in each group. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, parameters of ground reaction force, and isokinetic data were evaluated by means of force platforms and isokinetic dynamometer. RESULTS: The AOFAS ankle-hindfoot score was significantly lower in the GTC. The GRF was similar between the groups; however, the initial vertical impulse was higher in the GTC than in the GCC and GNC. There were no differences regarding the total impulse. The GTC presented lower total work in the 120º/s speed than the GCC. There were no differences regarding the other isokinetic variables between the GTC and GCC, only regarding the GNC. CONCLUSION: Runners with Achilles tendinopathy show higher impact at the moment of landing, lower muscle endurance of plantar flexors and higher clinical and functional damage. The association between higher impulse and lower endurance could be a predisposing and maintaining factor for Achilles tendon

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-06-18T21:18:10Z No. of bitstreams: 1 Anna Cristina de Farias Marques.pdf: 2073138 bytes, checksum: 63fce77ba3e8c96e01965f2b4cecc62c (MD5) / Made available in DSpace on 2018-06-18T21:18:10Z (GMT). No. of bitstreams: 1 Anna Cristina de Farias Marques.pdf: 2073138 bytes, checksum: 63fce77ba3e8c96e01965f2b4cecc62c (MD5) Previous issue date: 2015-12-18 / This study investigates the effect of low-level laser therapy (LLLT) on collagen type I and III, matrix metalloproteinase (MMP), and vascular endothelial growth factor (VEGF) in experimentally induced tendinopathy in female aged rats. Tendinopathy was induced by collagenase peritendinous of the Achilles tendon. Forty-two Wistar rats (Norvegicus albinus) were used; groups consisted of 36 aged animals (18 months old; mean body weight, 517.7 ± 27.54 g) and 6 adult animals (12 weeks old; mean body weight, 266 ± 19.30 g). The animals were randomlydivided in three groups: control, aged tendinopathy, and aged tendinopathy LLLT; the aged groups were subdivided according to experimental periods: 7, 14, and 21 days. LLLT involved a gallium-arsenide-aluminum laser (Theralaser, DMC®) with active medium operating at wavelength 830 ± 10 nm, 50 mW power, 0.028 cm2 laser beam, 107 J/cm2 energy density, 1.7 w/cm2 power density, and 6 J of energy, with a frequency of 3 times per week, until euthanasia. VEGF, MMP-3, and MMP-9 were analyzed by immunohistochemistry, and collagen type I and III by Sirius red. LLLT increased the deposition of collagen type I and III in a gradual manner, with significant differences relative to the group aged tendonitis (p<0.001), and in relation to VEGF (p<0.001); decreased expression of MMP-3 and 9 was observed in group aged tendinopathy (p<0.001). LLLT, therefore, increased the production of collagen type I and III, downregulated the expression of MMP-3 and MMP-9, and upregulated that of VEGF, with age and age-induced hormonal deficiency. / O objetivo deste estudo foi investigar O Efeito da terapia Laser de baixa intensidade no Colágeno tipo I e III, Metaloproteinase e VEGF em Modelo Experimental de Tendinopatia, em ratas fêmeas idosas. A colagenase foi induzida na região peritendínea no tendão Calcâneo dos animais. Quarenta e duas ratas Wistar (Norvegicus albinus) foram utilizadas no estudo, com grupos consistindo de 36 animais idosos (18 meses de idade; com média da massa, 517.7 ± 27.54 g) e 6 animais adultos (12 semanas de idade; média da massa, 266, 19:30 0 ± g). Os animais foram randomizados e divididos em três grupos, Controle, tendinopatia idoso e tendinopatia Laser idoso, e subdividido em três grupos experimentai, 7, 14 e 21 dias. O tratamento com Laser de baixa intensidade foi aplicado utilizando um Laser Arseneto de Galium e Alumínio (AsGaAl) (Theralaser, DMC®) operando no comprimento de onda de 830nm (±10nm), 50 mW de potência, saída do feixe de 0,028 cm2, densidade de energia de 107J /cm2, densidade de potência 1,7 w/cm2 e energia de 3 J, com uma frequência de 3 vezes por semana, até a data da eutanásia (7, 14 e 21 dias). Foram analisados VEGF e MMP 3 e 9 por meio de Imunohistoquímica e Colágeno tipo I e III por Sirius red. Os resultados sugerem que a Terapia a Lesar de Baixa Intensidade foi capaz de aumentar os níveis de Colágeno tipo I e III de maneira gradual e com significante diferença no grupo Tendinpatia Idoso (p<0,001), isso pode ser observado em relação ao VEGF (p<0.001), foi também observado diminuição da expressão de MMP 3 e MMP 9 em relação ao grupo tendinopatia Idoso, com diferença estatística (p<0,001). Nós concluímos que a terapia Laser de Baixa Intensidade foi capaz de diminuir a produção de Colágeno tipo I e III, reduzir a expressão de MMP 3 e 9, e aumentar a expressão de VEGF, mesmo nas ratas fêmeas idosas com deficiência hormonal causada pela idade.

Die equine Regenerationsmedizin versucht nach einer Sehnenverletzung (oberflächliche, tiefe Beugesehne: OBS, TBS) oder Bandverletzung (Fesselträger FT) die konsekutive Narbenbildung mit intraläsional applizierten potenziell regenerativen Therapeutika (prT) zu vermeiden. PrT sind mesenchymale stromale multipotente Progenitorzellen (MSC) aus unterschiedlichen Gewebequellen, sowie blutzellbasierende - meist Platelet Rich Plasma (PRP) - oder azelluläre Blutprodukte. Ein Langzeiterfolg ist noch nicht evident nachgewiesen; die Arbeit möchte dazu beitragen, die bestehende Lücke zu schließen. Die Arbeitsfrage lautet: Wie kann mit einer einzigen quantitativen Effektvariable bei Sportpferden, die nach einer natürlich entstandenen Erkrankung der OBS,TBS oder FT konservativ, mit kontrollierter Bewegung allein (KtrB) oder regenerativ (PrTB) behandelt werden, die ‚langfristige Gebrauchsfähigkeit’ (GF) valide gemessen und bisherige Studienergebnisse verglichen werden? Material: Inkludiert sind 51 in vivo Studien (1983-2016) entsprechend der Arbeitsfrage. Exkludiert sind in vivo Studien mit künstlich induzierten Erkrankungen, mit konventioneller oder chirurgischer Behandlung sowie in vitro Studien Methoden: Da die Studienergebnisse nicht direkt vergleichbar sind, wird ein evidenzbasiertes einfaches Evaluationsmodell mit der neuen quantitativen Effektgröße 'Gebrauchsfähigkeitsrate' GFR entworfen. Die metaanalytische gepoolte Reanalyse kann damit unabhängig von den Ergebnissen der Primärstudien die GF der Sportpferde neu bewerten. Als maßgebliche Einflussfaktoren auf GF werden u.a. definiert: Gewebestruktur, prT, sportliche Disziplin, Läsionsgrad, Altersklasse der Pferde, Prüfzeitdauer nach Rehabilitation zur Kontrolle des ‚Erfolgsmerkmals’ (EM) auf ein Rezidiv. Die Daten werden aus den Studien extrahiert und zu sog. Behandlungsgruppen (BehG) zusammengefasst. Nach Gewebestruktur (OBS-TBS, FT-Ursprung/-Körper/-Schenkel) und Behandlungsform (KtrB, PrTB) geordnete BehG werden soweit vergleichbar zu größeren BehG mit präziserem GFR gepoolt. Der Effektunterschied zwischen prT wird gegebenenfalls statistisch gesichert. Als EM ist definiert: 'Nach Rehabilitation kehren die Sportpferde zur Arbeit auf (mindestens) dem ursprünglichen Leistungsniveau zurück'. Die Erfolgsrate bzgl. EM ist E. In der Prüfzeitdauer nach Rehabilitation wird die Rezidivrate (R) ermittelt. E und R ergeben die Effektgröße GFR = E(1-R). Diese wird mittels 3 ganzzahliger Variablen A, B, C normiert: GFR = (N-A-B-C)/(N-A). A, B, C sind disjunkte Fallgruppen der N Patienten einer BehG. Die standardisierte Studiendauer ergibt sich aus der projektierten Rehabilitationsdauer (proj. Reha) und der ‚standardisierten Prüfzeit’ (P). Im Konsens mit den untersuchten Studien ist sie bei OBS-TBS 3 Jahre (1 Jahr proj. Reha + 2 Jahre P), beim FT 2,25 Jahre (0,75 Jahre proj. Reha + 1,5 Jahre P). Ergebnisse und Schlussfolgerung: Bei der OBS erscheint die Chance (OR, odds ratio) auf die zweijährige GF mit Amnion-MSC (2GFR = 94,1 %, n* = 34) 7-fach größer (OR = 7,2 [1,7-31,4]) sowohl vs. Knochenmark-MSC (2GFR = 68,8 %, n* = 145) als auch 9-fach größer (OR = 9,7 [2,1-45]) vs. PRP (2GFR = 60,4 %, n* = 51) sowie 11-fach größer (OR = 11,4 [2,5-52,1]) vs. KtrB (2GFR = 57,5 %, n* = 60). Erstmals kann bei diesen prT die Effektdifferenz dGFR > 25 % mittels Poweranalyse per Signifikanznachweis (Power >90 %; p < 0,025) durch die erforderliche Fallzahl statistisch gesichert werden. Allerdings stützt sich das Ergebnis für Amnion-MSC noch auf nur eine Studie. Bei TBS und FT fehlen Vergleichsgruppen noch. Da replizierbare wissenschaftliche Ergebnisse mit hoher interner und externer Evidenz nur mit standardisierten Parametern erzielt werden können, erscheint das GFR-Modell für zukünftige Studien von wesentlichem Interesse. / The equine regenerative medicine is seeking to avoid the subsequent scarring after a tendon (superficial and deep digital flexor tendon: SDFT, DDFT) or ligament (suspensory ligament: SL) injury by intralesionally applicated potential regenerative therapeutics (prT). PrT are mesenchymal stromal multipotential progenitor cells (MSC) from different sources of tissue, as well as products of blood, based on blood cells (PRP in most cases, platelet rich plasma) or acellular. Evidence of long-term treatment-success has not yet provided. This study wants to go towards closing the gap on this front. The leading question is: How can the 'long-term fit for use' (FfU) of sport horses, which are treated either conservatively with controlled exercise allone (CtrT) or regeneratively (PrTT) after suffering from naturally occuring tendinopathies of SDFT, DDFT or FT, be quantified in a valid way with a single effect variable? And how can the results of previous research studies be compared? Material: Includet are 51 in vivo studies (1983-2016) relating to the leading question. Excluded are in vivo studies with artificially induced lesions, with conventional or surgical treatment as well as in vitro studies. Methods: Findings of the studies are not directly comparable. As a consequence an evidence-based simple evaluation-model with the new quantitative effect size called ‘rate of fit for use’ (FFU) is developed. Based on this model the meta-analytical pooled re-analysis can re-assess FfU of the sport horses independently from findings of primary studies. The following influencing factors affecting FfU are defined: Structure of tissue, prT, sportive kind-of-use, degree of lesion, age class of horses, duration of monitoring after rehabilitation to controll the outcome (OC) for recurrence. The data are extracted from the studies and configured to so-called treatment groups (TGs). According to structure of tissue (SDFT, DDFT, SL-body, SL-origin, SL-branches) and kind of treatment (CtrT, PrTT) comparable TGs are pooled to bigger TGs with more precise FFU. If possible difference of effect between prTs is statistically assured. OC is defined as: 'After rehabilitation the sport horses return to work at (not less than) the initial level of performance'. Rate of OC is E. During duration of monitoring after rehabilitation the rate of recurrence (R) is checked. E and R are combined to FFU = E(1-R). In addition FFU is standardized in accord with the formula FFU = (N-A-B-C)/(N-A). A, B, C are integer variables representing disjunctive case groups of N, which is the total number of treated patients of a TG. The standardized duration of study results from the 'planned duration of rehabilitation' (planReha) and ‘standardized duration of monitoring’ (DoM). In consence with research studies it adds up to 3 years at SDFT-DDFT (1 year planReha +2 years DoM) and 2.25 years at SL (0.75 year planReha +1.5 years DoM). Results and conclusion: The chance (OR, odds ratio) with AM-MSC for biennial FfU (2FFU = 94.1 %, N-A = 34) appears to be more than at least 7-fold (OR = 7.2 [1.7-31.4]) as high as with BM-MSC (2FFU = 68.8 %, N-A = 145) as well as 9-fold (OR = 9.7 [2.1-45]) high as with PRP (2FFU = 60.4 %, N-A = 51) as well as 11-fold (OR = 11.4 [2.5-52.1]) high as with CtrT (2FFU = 57.5 %, N-A = 60). For the first time, power-analysis can statistically assure the difference of effect 25 % < dFFU (power > 90 %; p < 0.025) between these TGs through significant evidence based on the needed number of cases. However 2FFU with AM-MSC still relies on only 1 study. At DDFT and at LS comparison groups still are lacking. Because replicable scientific results with high internal and external evidence only can be approached based on standardized parameters, FFU-model seems to be essential for future studies.

Introduktion: Många idrottare drabbas av patella tendinopati, framförallt idrotter som inkluderar många hopp och snabba riktningsförändringar. Smärtan som kommer med tillståndet kan påverka en professionell idrottares prestation och karriär.  Syfte: Syftet med denna systematiska litteraturöversikt är att studera effekten av olika behandlingsmetoder avseende på smärta och funktion hos volleybollspelare och basketspelare diagnostiserade med patellar tendinopati.  Metod: Metoden utformades och följde riktlinjerna enligt Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Sökningen gjordes i PubMed och SPORTdiscus med en söksträng framtagen med hjälp av personal från Medicinska biblioteket i Umeå, Sverige. Sammanlagt inkluderades 5 studier i litteraturöversikten. PEDro skalan användes för att kvalitetsgranska samtliga artiklar i litteraturöversikten.  Resultat: Totalt 5 artiklar inkluderades i denna studie. Ingen av studierna uppfyllde kriterierna för låg kvalitet. Fyra av fem studier uppfyllde kriterierna för moderat till god kvalitet och en studie uppnådde hög kvalitet vid kvalitetsgranskningen. Fyra av fem studier utvärderade träning som en behandlingsmetod för patellar tendinopati, en av fem studier utvärderade stötvågsbehandling för patellar tendinopati. Konklusion: Majoriteten av studierna i denna systematiska litteraturöversikt visar på positiva effekter på smärta och funktion av isometrisk, isotonisk och excentrisk träning. Samtliga inkluderande studier uppfyllde moderat till hög kvalitet enligt PEDro skalan. Evidensen i just denna litteraturstudie räcker ej till för att rekommendera en viss behandlingsform till volleyboll-och basketspelare diagnostiserade med patellar tendinopati. Mer forskning kring behandlingsmetoder av patellar tendinopati behövs, specifikt på aktiva volleyboll-och basketspelare.

Das Dokument enthält eine fehlerhafte Darstellung der Abbildung 3.3 (Seite 38). DieOriginalabbildung ist dem entsprechenden Fachartikel im Scandinavian Journal of Medicineand Science in Sports zu entnehmen:Mersmann, F., Bohm, S., Schroll, A., Boeth, H., Duda, G., Arampatzis, A. (2015): Muscleshape consistency and muscle volume prediction of thigh muscles. Scandinavian Journal ofMedicine & Science in Sports, 25: e208–e213 doi: 10.1111/sms.12285.The document contains a corrupted rendering of figure 3.3 (page 38). The original figurecan be obtained in the respective journal article:Mersmann, F., Bohm, S., Schroll, A., Boeth, H., Duda, G., Arampatzis, A. (2015): Muscleshape consistency and muscle volume prediction of thigh muscles. Scandinavian Journal ofMedicine & Science in Sports, 25: e208–e213 doi: 10.1111/sms.12285. / Bei jugendlichen Athleten wirken sowohl die körperliche Reifung als auch die erhöhte mechanische Belastung auf die Entwicklung des Muskel- und Sehnengewebes. Die Interaktion dieser beiden adaptationswirksamen Stimuli könnte, insbesondere bei Sportlern aus Sprungdisziplinen, Dysbalancen des Kraftpotenzials der Muskulatur und der Widerstandsfähigkeit der Sehne auslösen und somit potentiell das Verletzungsrisiko der Sehne erhöhen. Vor diesem Hintergrund untersucht die vorliegende Arbeit mittels Magnetresonanztomographie, Ultraschall und Dynamometrie die Entwicklung der morphologischen und mechanischen Eigenschaften der Knieextensoren und der Patellarsehne bei jugendlichen Kader-Volleyballathleten. Durch eine Querschnitts- und zwei Längsschnittstudien konnte Evidenz dafür erbracht werden, dass sich unter dem Einfluss der sportartspezifischen Belastung Kraft und Morphologie des Muskels in Relation zu den mechano-morphologischen Eigenschaften der Patellarsehne bei den jugendlichen Athleten nicht ausgewogen entwickeln, was zu einer erhöhten chronischen Belastung und Beanspruchung des Sehnengewebes führt. Darüber hinaus können muskulotendinöse Dysbalancen im Trainingsprozess durch erhöhte Fluktuationen der Muskelkraft und einer nicht-adäquaten Modulation der Widerstandsfähigkeit der Sehne zu episodischen Spitzen der mechanischen Beanspruchung der Sehne führen. Eine derart unausgewogene Entwicklung von Muskel und Sehne könnte für die Ausprägung von Überlastungsbeschwerden in der hier untersuchten Risikogruppe für Tendinopathien prädisponieren. Im Rahmen der Forschungsbemühungen wurde darüber hinaus ein Verfahren zur Vorhersage des Volumens von Oberschenkelmuskeln auf der Basis einfach zu erhebender Parameter entwickelt. Durch das Verfahren ließe sich zukünftig der Zeit- und Kostenaufwand muskelmorphologischer Diagnostik deutlich reduzieren. / In adolescent athletes, the development of muscle and tendon tissue is influenced both by maturation and mechanical loading. The interaction of these two driving stimuli could initiate imbalances in the development of the muscle strength capacity and tendon stiffness, especially in athletes from sports that feature a high frequency of jumps. A consequence could be an increased mechanical demand placed upon the tendon by the working muscle, which might increase the risk of tendon injury. Considering the lack of information on the effects of maturation and superimposed mechanical loading on the muscle-tendon unit during adolescence, the present work examines the development of the morphological and mechanical properties of the knee extensors and patellar tendon in adolescent elite volleyball athletes by means of magnetic resonance imaging, ultrasound and dynamometry. A cross-sectional comparison and two longitudinal studies provided evidence that the two-fold stimulus of sport-specific loading and maturation results in and imbalanced development of muscle strength and morphology in relation to the mechano-morphological properties of the patellar tendon in mid-adolescent volleyball athletes and results in increased tendon stress and strain. Moreover, during a training process, fluctuations of muscle strength and an inadequate modulation of tendon stiffness initiate episodes of high-level tendon strain during maximum muscle contractions. Such an imbalanced development of muscle and tendon could predispose for the development of tendon overuse injury in adolescent volleyball athletes, which are known to be at high risk of developing tendinopathy. Moreover, in the context of the described research endeavour, a method for the volume prediction of thigh muscles on the basis of easily measurable parameters has been developed, which could greatly reduce the time and costs involved in the diagnostics of muscle morphology in the future.

In den letzten Jahrzehnten ist die Zahl der Erwachsenen und Jugendlichen, die an nicht organisierten oder wettbewerbsorientierten Sportarten teilnehmen, gestiegen. In der Pubertät beeinflussen sowohl hormonelle Veränderungen als auch mechanische Belastungen die Entwicklung von Muskeln und Sehnen. Derzeit gibt es keine Informationen über die Interaktion dieser beiden Stimuli, aber es besteht die Vermutung, dass im Zuge der Pubertät bei Athleten und Nicht-Athleten im Vergleich zu Muskelkraft und Sehnensteifigkeit ungleiche Verhältnisse auftreten können. Die Folge dieses Ungleichgewichts könnte eine höhere mechanische Belastung für die Sehnen sein, was weiter zu Verletzungen führen kann. Angesichts der unzureichenden Beweise für die Entwicklung des muskulotendinösen Gewebes während der Pubertät und des Mangels an Kenntnissen darüber, wie die Reifung die Muskel-Sehnen-Einheit, insbesondere die Interaktion mit überlagerten mechanischen Belastungen, beeinflusst, untersucht diese Arbeit die morphologische und mechanische Entwicklung von Knieextensoren und Patellasehne, indem Nicht-Athleten und Athleten aus drei Altersgruppen verglichen werden (frühe Pubertät: 12–14 Jahre, engl.:EA; späte Pubertät: 16–18 Jahre, engl.: LA; Erwachsene: 20–35 Jahre, engl.: YA). Athleten erreichten häufiger Dehnungsgrößen von mehr als 9% Dehnung im Vergleich zu Nicht-Athleten, was auf einen erhöhten mechanischen Bedarf an der Sehne hinweist. Obwohl das Training die Eigenschaften der M. quadriceps femoris-Sehnen-Einheit verbessert, bleibt ihre Entwicklung von früher Pubertät bis zum Erwachsenenalter bei Athleten und Nicht-Athleten ähnlich, mit dem Hauptunterschied zwischen früher Pubertät und später Pubertät. Alter und sportliches Training waren jedoch mit einer höheren Prävalenz von Ungleichgewichten innerhalb der Muskel-Sehnen-Einheit und einer damit einhergehenden erhöhten mechanischen Belastung oder Beanspruchung für die Patellasehne verbunden. / In recent decades, the number of adults and especially adolescents who participate in some kind of non-organized or competitive sports has been increasing. During adolescence, the development of muscle and tendons is affected both by maturation, due to hormonal changes, and by mechanical loading. However, there is no information currently on the interaction of this double fold stimulus although there is reason to believe that during adolescence in athletes and non-athletes there may be imbalances developing between muscle strength capacity and tendon stiffness. The result of this imbalance could be the tendon exposure to high mechanical demand by the associated working muscles, which might further lead to tendon injury. Considering the not satisfactory evidence of the musculotendinous tissue development during adolescence, and the lack of knowledge about how maturation affects the muscle-tendon unity, especially in interaction with superimposed mechanical loading, this thesis investigates the morphological and mechanical development of the knee extensors and patellar tendon, by comparing non-athletes and athletes in three different age groups (i.e., early adolescents: EA 12–14 years; late adolescents: LA 16–18 years, and young adults: YA 20–35 years). Athletes were more likely to reach strain magnitudes higher than 9% strain compared to non-athlete controls indicating an increased mechanical demand for the tendon. Although athletic training enhances the properties of the quadriceps femoris muscle-tendon unit, their development from early-adolescence to adulthood remains similar in athletes and non-athletes with the major alterations between early and LA. However, both age and athletic training were associated with a higher prevalence of imbalances within the muscle-tendon unit and a resultant increased mechanical demand for the patellar tendon.

Problématique : La quantification de l’intégrité du tendon d’Achille (TA) représente un défi en réadaptation. L’adoption de mesures quantitatives du TA, extraites à partir d’une image ultrasonographique (QUS), pourrait remédier à cette lacune. Objectifs : 1) Évaluer la fiabilité test-retest et la précision de mesures QUS du TA; 2) Déterminer le meilleur protocole de collecte de mesures QUS à employer en pratique clinique. Méthodologie : Un total de 23 TAs présentant des symptômes d’une tendinopathie achilléenne et 63 TAs asymptomatiques ont été évalués. Pour chaque TA, 8 images ont été enregistrées (2 visites * 2 évaluatrices * 2 images). Différents types de mesures QUS ont été prises : géométriques (épaisseur, largeur, aire), dérivées d’un histogramme des niveaux de gris et dérivées d’une matrice de co-occurrence. Une étude de généralisabilité a quantifié la fiabilité et la précision de chaque mesure QUS et une étude de décision a fait ressortir les meilleurs protocoles de prise de mesures. Résultats : Les mesures géométriques ont démontré une excellente fiabilité et précision. Les mesures dérivées de l’histogramme des niveaux de gris ont démontré une fiabilité et précision médiocres. Les mesures dérivées d’une matrice de co-occurrence ont démontré une fiabilité modérée à excellente et une précision variable. En pratique clinique, il est recommandé de moyenner les résultats de trois images collectées par un évaluateur lors d’une visite. Conclusion : L’utilisation des mesures QUS géométriques permet de quantifier l’intégrité du TA (clinique et recherche). Davantage d’études sur les mesures QUS dérivées d’une matrice de co-occurrence s’avèrent nécessaires. / Background: Quantifying the integrity of the Achilles tendon (AT) represents a challenge in rehabilitation. The adoption of quantitative measurements of the AT, extracted from an ultrasound image (QUS) could remedy this shortcoming. Objectives: 1) To assess the test-retest reliability and accuracy of QUS measurements of the AT; 2) To determine the best protocol of QUS measurements to use in clinical practice. Methods: A total of 23 ATs with symptoms of mid-portion Achilles tendinopathy and 63 asymptomatic ATs were evaluated. For each AT, 8 images were recorded (2visits* 2 evaluators* 2 images). Different types of QUS measurements were taken: geometric (thickness, width, area), derived from a gray-level histogram and derived from a co-occurrence marix. A generalizability study quantified the reliability and accuracy of each QUS measurement whereas a decision study highlighted the best protocols for measuring use. Results: The geometric measurements showed excellent reliability and accuracy. The measures derived from the gray-level histogram showed poor reliability and accuracy. The measurements derived from a co-occurrence matrix have shown moderate to excellent reliability and a variable precision. In clinical practice, it is recommended averaging the results of three images collected by an assessor during a single visit. Conclusions: The use of geometric QUS measures allows to quantify the integrity of the AT in clinical practice and in research. Further studies on QUS measurements derived from a matrix of co-occurrence are needed.

Utilisée depuis plus d'un siècle en chirurgie esthétique, la greffe autologue de tissu adipeux, ou lipofilling, est une technique sûre permettant le comblement des tissus mous. Cependant, bien que la technique ait connue de nettes améliorations au cours du temps, les chirurgiens font toujours face à une résorption du greffon qui oblige dans la majorité des cas à planifier plusieurs autres interventions afin que le résultat esthétique soit en adéquation avec les attentes du patient. Le procédé MICROFILL® a été développé dans le but d'augmenter le taux de prise de greffe en favorisant la survie cellulaire au sein du greffon. Cette dernière est optimisée par : un prélèvement et une réinjection de lobules adipeux de petite taille permettant de diminuer l'ischémie et la mauvaise nutrition des cellules - une élimination des éléments délétères (anesthésiques, cytokines inflammatoires) par un protocole de lavages et centrifugations non traumatique. D'autre part, au cours de ces dernières années, le tissu adipeux s'est révélé posséder un pouvoir thérapeutique plus important par l'hébergement de cellules souches mésenchymateuses au fort potentiel. Ces cellules sont présentes en grande quantité et facilement accessibles à partir d'une simple lipoaspiration. Cependant, la lipoaspiration implique bien souvent l'usage d'un anesthésique local et d'un vasoconstricteur qui peuvent nuire aux cellules. Nos études ont en effet montré que la lidocaïne, un anesthésique couramment utilisé, est cytotoxique pour les cellules souches du tissu adipeux, ayant pour effets l'inhibition de la prolifération cellulaire (arrêt du cycle cellulaire en phase G0-G1) et la nécrose des cellules. En revanche, une manipulation appropriée du tissu adipeux, se rapprochant du protocole MICROFILL®, permet de diminuer la mortalité cellulaire. L'effet délétère de la lidocaïne semble lié à l'apparition d'une vacuolisation cytoplasmique dont la nature est à ce jour non élucidée. De plus, la lidocaïne induit également un processus d'autophagie, dont les mécanismes moléculaires d'induction sont eux aussi inconnus et dont la finalité physiologique serait le maintien en vie de la cellule malgré le stress provoqué. Les conclusions de ces études mènent à certaines recommandations à suivre quant à l'usage de la lidocaïne en vue de la réinjection extemporanée de cellules souches adipeuses chez un patient. Aussi, dans le but de traiter les tendinopathies équines, ces études ont permis d'optimiser le protocole de prélèvement du tissu adipeux chez le cheval ainsi que le protocole d'extraction des cellules souches du tissu adipeux. Cette thèse a finalement permis de développer un kit à usage vétérinaire permettant de traiter les tendinopathies équines. Ce nouveau procédé de thérapie cellulaire a été testé chez des chevaux et s'est avéré très prometteur, permettant la régénération de la structure tendineuse et un retour au travail rapide des chevaux. / Despite the dark side of obesity in the pathogenesis of metabolic diseases, adipose tissue has been shown to be a good therapeutic tool. First, autologous fat grafting, also named lipofilling, has been used for over a century and represents a safe technique for soft tissue filling. However, although the technique has seen marked improvements over time, surgeons are still facing graft resorption that often requires overcorrection of the treated area or other interventions so that the aesthetic result is in line with expectations of the patient. Thus, MICROFILL® process has been developed in order to increase the rate of engraftment by promoting cell survival within the graft. The latter is enhanced by: - sampling and reinjection of small fat lobules in order to reduce ischemia and poor nutrition of the cells- elimination of deleterious elements (anesthetics, inflammatory cytokines) by a non-traumatic protocol involving soft centrifugations and washings. Furthermore, in recent years, adipose tissue has been found to have a greater therapeutic power by hosting mesenchymal stem cells with great potential. These adipose stem cells (ASCs) are present in large quantities and can be easily obtained from a simple liposuction. However, liposuction procedure often involves the use of a local anesthetic and a vasoconstrictor that can harm cells. Our studies have shown that lidocaine, an anesthetic commonly used, exerts cytotoxic effects on adipose stem cells, inhibiting cell proliferation (cell cycle arrest in G0-G1 phase) and inducing necrosis. Nonetheless, appropriate handling of adipose tissue, quite similarly to MICROFILL® protocol, reduces cell death. The deleterious effects of lidocaine appear to be related to the occurrence of cytoplasmic vacuolization whose nature is so far unclear. In addition, lidocaine also induces a process of autophagy, including molecular mechanisms of induction also unknown and whose physiological purpose could be cell survival despite the stress. The findings of these studies lead to some recommendations to follow regarding the use of lidocaine for the extemporaneous reinjection of ASCs in a patient. Also, in order to treat equine tendinopathy, these studies have been used to optimize adipose tissue harvest by liposuction on horses and the protocol of extraction of ASCs.Finally, this thesis has allowed developing a kit for veterinary use to treat equine tendinopathy. This new method of cell therapy has been tested in horses and has shown very promising results for tendon regeneration, knowing that treated horses could rapidly return to work.

Title Comparison between the effectiveness of extracorporeal shockwave therapy (ESWT) and the surgical approach in the treatment of the rotator cuff tendinopathy. Objective The main goal of this research work is comparing the effectiveness of extracorporeal shock wave therapy and the surgical intervention (arthroscopic approach) in the treatment of calcific rotator cuff tendinopathy depending on the outcome measures of the Constant-Murley Score (CMS), and the Visual Analogue Scale (VAS) from the recent scientific publications. Methodology This thesis is systemic (literature) review. The studies which recruited in this research were randomized controlled trials, prospective studies, and retrospective case series studies which written in English language form, and published between the year 2000 to the year 2018. The studies were retrieved from following databases: EMBASE, PubMed, CINAHL, Medline, SpringerLink, ProQuest using different integrations of the key words. The participants in the studies were from both genders and all ages. The type of the pathology which included in this research was chronic calcific rotator cuff tendinopathy. Regarding the intervention types both Radial, and Focused ESWT with low, medium, and high intensities and the arthroscopic interventions were the main types of...

Indiana University-Purdue University Indianapolis (IUPUI) / Tendinopathy is a common degenerative pathology that is characterized by activity related pain, focal tendon tenderness, intratendinous imaging changes, and typically results in changes in the histological, mechanical, and molecular properties of the tendon. Tendinopathy is difficult to study in humans, which has contributed to limited knowledge of the pathology, and thus a lack of appropriate treatment options. However, most believe that the pathology is degenerative as a result of a combination of both extrinsic and intrinsic factors. In order to gain understanding of this pathology, animal models are required. Because each tendon is naturally exposed to different conditions, a universal model is not feasible; therefore, an appropriate animal model must be established for each tendon susceptible to degenerative changes. While acceptable models have been developed for several tendons, a reliable model for the Achilles tendon remains elusive. The purpose of this dissertation was to develop an animal model of Achilles tendinopathy by investigating the individual and combined effects of an intrinsic and extrinsic factor on the rodent Achilles tendon. Rats selectively bred for high capacity running and Sprague Dawley rats underwent uphill treadmill running (an extrinsic factor) to mechanically overload the Achilles tendon or served as cage controls. Collagenase (intrinsic factor) was injected into one Achilles tendon in each animal to intrinsically break down the tendon. There were no interactions between uphill running and collagenase injection, indicating that the influence of the two factors was independent. Uphill treadmill running alone failed to produce any pathological changes in the histological or mechanical characteristics of the Achilles tendon, but did modify molecular activity. Intratendinous collagenase injection had negative effects on the histological, mechanical, and molecular properties of the tendon. The results of this dissertation demonstrated that the combined introduction of uphill treadmill running and collagenase injection did not lead to degenerative changes consistent with human Achilles tendinopathy. Intratendiouns collagenase injection negatively influenced the tendon; however, these changes were generally transient and not influenced by mechanical overload. Future studies should consider combinations of other intrinsic and extrinsic factors in an effort to develop an animal model that replicates human Achilles tendinopathy.