Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical...Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical outcomes. Aim: a literature review of the clinical studies reporting on tendoscopic peroneal tendon stabilisation surgery along with its outcomes and complications. Methods: We carried out a comprehensive review of the literature up until September 2022 with an extensive search of the MEDLINE, Embase and Cochrane library databases. Results: Initial search resulted in 66 articles. Four duplicate articles were removed. Further 30 articles were excluded after title and abstract screening. Eight studies satisfied the inclusion criteria and were included in this review. Articles were analysed for outcomes and complications. Conclusion: The tendoscopic technique for peroneal tendon instability is an effective and safe surgical technique with very low failure rate. Levels of Evidence: Level IV.展开更多
BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or...BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.CASE SUMMARY A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound^TM mapping system. In addition to the left anterior papillary muscle,the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.CONCLUSION This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the Carto Sound TM system.展开更多
Fracture of an ossification of the Achilles tendon(OAT)is a rare entity,and its etiology,pathology,and treatment remain unclear.We reviewed and scrutinized 18 cases(16 articles)of the fracture of an OAT.The most commo...Fracture of an ossification of the Achilles tendon(OAT)is a rare entity,and its etiology,pathology,and treatment remain unclear.We reviewed and scrutinized 18 cases(16 articles)of the fracture of an OAT.The most common etiologies of the ossifications include previous surgery and trauma.The fractures often occur without any trigger or with minimal trigger.The long,>5 cm,ossification in the body of the Achilles tendon may have a higher risk of fracture.The OAT itself is often asymptomatic;however,its fracture causes severe local pain,swelling,and weakness of plantar flexion,which forces patients to undergo aggressive treatments.Regarding the treatments of the fractures,nonoperative treatment by immobilizing ankle joint could be an option for elderly patients.However,because it often cannot produce satisfactory results in younger patients,surgical treatment is typically recommended.Excision of the fractured mass and repairing the tendon is applicable if the remnant is enough.If there is a defect after the excision,reconstruction with autologous grafts or adjacent tendon transfer is performed.Gastrocnemius fascia turndown flap,hamstring tendon and tensor fascia lata are used as autologous grafts,whereas peroneus brevis and flexor hallucis longus tendons are used for the tendon transfer.If the fracture of an OAT is treated properly,the functional result will be satisfactory.展开更多
Tendon ruptures remain a significant musculoskeletal injury. Despite advances in surgical techniques and procedures, traditional repair techniques maintain a high incidence of rerupture or tendon elongation. Mechanica...Tendon ruptures remain a significant musculoskeletal injury. Despite advances in surgical techniques and procedures, traditional repair techniques maintain a high incidence of rerupture or tendon elongation. Mechanical loading and biochemical signaling both control tissue healing. This has led some researchers to consider using a technique based on tension regulation at the suture line for obtaining good healing. However, it is unknown how they interact and to what extent mechanics control biochemistry. This review will open the way for understanding the interplay between mechanical loading and the process of tendon healing.展开更多
BACKGROUND Injuries to the pectoralis major are infrequent,with only a few hundred cases currently recorded in the literature.CASE SUMMARY We report a case of a patient who sustained bilateral pectoralis major tendon ...BACKGROUND Injuries to the pectoralis major are infrequent,with only a few hundred cases currently recorded in the literature.CASE SUMMARY We report a case of a patient who sustained bilateral pectoralis major tendon ruptures.While other cases of bilateral pectoralis major tears have been reported in the literature,the operative management in this report differs.Due to delayed presentation of the patient right and left pectoralis major repairs were performed simultaneously.CONCLUSION Patients with delayed presentation of bilateral pectoralis major tendon ruptures can undergo simultaneous repair of both tendon with a good postoperative outcome and high patient satisfaction.展开更多
This study investigates the viscoelastic behavior of soft bio-fibres in association with their fractal structures. A spring-dashpot fractal network with the self-similar topology, named the -type fractal ladder hyper-...This study investigates the viscoelastic behavior of soft bio-fibres in association with their fractal structures. A spring-dashpot fractal network with the self-similar topology, named the -type fractal ladder hyper-cell (FLHC), is abstracted from the micro/nano-structure of ligaments and tendons (LTs). Its constitutive operator is derived by the Heaviside operational calculus, which is of intrinsic fractional order. In terms of this operator, the long-term viscoelastic relaxation of bio-fibres arising from the fractal ladder topology is expounded. In addition, the fractional-order viscoelastic constitutive equation is obtained based on the FLHC of LTs, and its results are consistent with those of available human knee and spinal LT relaxation experiments. Results on the constitutive equation of FLHCs are formulated into two propositions. The multidisciplinary invariance and implications from the fractal ladder pattern of bio-fibres are also discussed.展开更多
Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the t...Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.展开更多
After corrosion failure of post-tensioned tendons was identified in a Florida bridge in early 2011, laboratory tests were conducted in this study on extracted sections from the failed tendons to identify the grout pro...After corrosion failure of post-tensioned tendons was identified in a Florida bridge in early 2011, laboratory tests were conducted in this study on extracted sections from the failed tendons to identify the grout properties and makeup leading to the failure and also to elucidate the mechanism of corrosion. The initial steps in identification of PT tendons with a high propensity for corrosion initiation or damaged included a detailed visual inspection and identification of voids in the grout. Voids in tendon can be a result of bleed water formation or construction problems. General characteristics of the deficient grout and corrosion behavior of steel in the affected bridge gave a first approach to assessing grout deficiency and corrosion susceptibility. However, refinements in the understanding of the mechanisms causing grout segregation and the elucidation of the role of sulfates, oxygen content, and pore water pH in corrosion development are required.展开更多
Tendon and ligament(TL)injuries affect millions of people annually.Biopolymers play a significant role in TL tissue repair,whether the treatment relies on tissue engineering strategies or using artificial tendon graft...Tendon and ligament(TL)injuries affect millions of people annually.Biopolymers play a significant role in TL tissue repair,whether the treatment relies on tissue engineering strategies or using artificial tendon grafts.The biopolymer governs the mechanical properties,biocompatibility,degradation,and fabrication method of the TL scaffold.Many natural,synthetic and hybrid biopolymers have been studied in TL regeneration,often combined with therapeutic agents and minerals to engineer novel scaffold systems.However,most of the advanced biopolymers have not advanced to clinical use yet.Here,we aim to review recent biopolymers and discuss their features for TL tissue engineering.After introducing the properties of the native tissue,we discuss different types of natural,synthetic and hybrid biopolymers used in TL tissue engineering.Then,we review biopolymers used in commercial absorbable and non-absorbable TL grafts.Finally,we explain the challenges and future directions for the development of novel biopolymers in TL regenerative treatment.展开更多
Offshore triceratops is one of the successful manifestations of the form-dominant design approaches deployable in ultra-deepwater oil and gas exploration.The deck’s geometric shape and partial isolation from the legs...Offshore triceratops is one of the successful manifestations of the form-dominant design approaches deployable in ultra-deepwater oil and gas exploration.The deck’s geometric shape and partial isolation from the legs counteract lateral loads.Legs are position-restrained to the sea bed by taut-moored tendons,while ball joints partially isolate the deck from the buoyant legs.However,compliance in the horizontal plane imposes large displacements,intuiting the necessity to examine tendon failure.Numerical analysis of triceratops under wave and wind combined action is carried out under the postulated conditions of a tendon failure.10-yr,100-yr,and 1000-yr post-Katrina hurricane conditions are assumed as loading to the platform.Results confirm a marginal increase in the natural periods of stiff degrees of freedom even under postulated failure conditions,ensuring good adaptability to ultra-deep water.Under postulated failure,the tension of adjacent tendons varies significantly,causing a shift to the mean position of the platform.Fatigue life is significantly reduced under the postulated failure of tendons,making the platform free-floating without affecting its stability.Results also show that the pitch response of the deck is a clear manifestation of the postulated failure,which is otherwise absent due to the presence of ball joints.The attempted study deliberates on the fatigue life of tendons,assessing the platform’s suitability to ultra-deep waters and identifying the vulnerable legs for the chosen load combinations.展开更多
Since the assumption of plane sections cannot be applied to the strain of unbonded tendons in prestressed concrete beams subjected to loadings,a moment-curvature nonlinear analysis method is used to develop analytical...Since the assumption of plane sections cannot be applied to the strain of unbonded tendons in prestressed concrete beams subjected to loadings,a moment-curvature nonlinear analysis method is used to develop analytical programs from stress increases in unbonded tendons at the ultimate limit state.Based on the results of model testing and simulation analysis,equations are proposed to predict the stress increase in tendons at the ultimate state in simple or continuous beams of partially prestressed concrete,considering the loading type,non-prestressed reinforcement index βp,prestressing reinforcement index βs,and span-depth ratio L/h as the basic parameters.Results of 380 beams studied here and test results for 35 simple beams obtained by the China Academy of Building Research were compared with those from prediction equations given in codes and other previous studies.The comparison reveals that the values predicted by the proposed equations agree well with experimental results.展开更多
Prestressed concrete segmental box girder bridges are composed of short concrete segments that are either precast or cast in situ and then joined together by longitudinally post-tensioning internal,external,or mixed t...Prestressed concrete segmental box girder bridges are composed of short concrete segments that are either precast or cast in situ and then joined together by longitudinally post-tensioning internal,external,or mixed tendons.The objectives of this study are to monitor the construction process of the external prestressing tendons to strengthen the bridge structure and perform a field load test to measure the strain and the deflection of the anchorage devices of the external prestressing tendons to determine the state of these devices after tension forces are applied.The monitoring process of the external prestressing tendons construction includes inspecting the cracks in the diaphragm anchorage and the deviation block devices before the tension forces are applied to the external tendons;measuring the deformation of the steel deviation cross beam during the tension process;measuring the deformation of the box girder after different levels of tension forces are applied;measuring the elongation of the external tendons in each level of the tension;and measuring the natural frequency of the external tendons after the tension process is complete.The results of the monitoring process show that the measured values of the deformation,the elongation,and the natural frequency meet the requirements.Therefore,there is no damage during the construction and the tensioning of the external prestressing tendons.A field load test is performed to the anchorage beam,the steel deviation block devices,and the steel deviation cross beam.The field load test results of the anchorage devices show that the values of the strains,the stresses,and the deflection are less than the respective allowable limit values in the requirements.Therefore,the anchorage devices have sufficient strength,and the working state is good after the tension forces are applied to the external prestressing tendons.展开更多
Background:Achilles tendinopathy(AT)is a common problem among runners.There is only limited evidence for risk factors for AT,and most studies have not defined the AT subcategories.No study has compared the incidence a...Background:Achilles tendinopathy(AT)is a common problem among runners.There is only limited evidence for risk factors for AT,and most studies have not defined the AT subcategories.No study has compared the incidence and risk factors between insertional AT and midportion AT,though they are considered distinct.This study aimed to assess incidence and risk factors of AT based on data from a large prospective cohort.The secondary aim was to explore differences in risk factors between insertional and midportion AT.Methods:Participants were recruited from among registered runners at registration for running events.Questionnaires were completed at baseline,1 month before the event,1 week before the event,and 1 month after the event.Information concerning demographics,training load,registered events,and running-related injuries were collected at baseline.The follow-up questionnaires collected information about new injuries.A pain map was used to diagnose midportion and insertional AT.The primary outcome was the incidence of AT.Multivariable logistic regression analysis was applied to identify risk factors for the onset.Results:We included 3379 participants with a mean follow-up of 20.4 weeks.The incidence of AT was 4.2%.The proportion of insertional AT was 27.7%and of midportion AT was 63.8%;the remaining proportion was a combined type of insertional and midportion AT.Men had a significantly higher incidence(5%,95%confidence interval(95%CI):4.1%-6.0%)than women(2.8%,95%CI:2.0%-3.8%).AT in the past12 months was the most predominant risk factor for new-onset AT(odds ratio(OR)=6.47,95%CI:4.27-9.81).This was similar for both subcategories of AT(insertional:OR=5.45,95%CI:2.51-11.81;midportion:OR=6.96,95%CI:4.24-11.40).Participants registering for an event with a distance of 10/10.55 km were less likely to develop a new-onset AT(OR=0.59,95%CI:0.36-0.97)or midportion AT(OR=0.47,95%CI:0.23-0.93).Higher age had a significant negative association with insertional AT(OR=0.97,95%CI:0.94-1.00).Conclusion:The incidence of new-onset AT among recreational runners was 4.2%.The proportion of insertional and midportion AT was 27.7%and 63.8%,respectively.AT in the past 12 months was the predominant risk factor for the onset of AT.Risk factors varied between insertional and midportion AT,but we could not identify clinically relevant differences between the 2 subtypes.展开更多
BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective man...BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.展开更多
The effectiveness of platelet-rich plasma(PRP)for the treatment of Achilles tendon disorders still needs to be evaluated through a series of prospective studies,but genomic analysis can reveal the existence of complem...The effectiveness of platelet-rich plasma(PRP)for the treatment of Achilles tendon disorders still needs to be evaluated through a series of prospective studies,but genomic analysis can reveal the existence of complementary PRP treatment options.Based on the 96 platelet activation-related genes in the Kyoto Encyclopedia of Genes and Genomes(KEGG)database,we performed Gene Ontology functional enrichment analysis and KEGG enrichment analysis,pathway correlation analysis,and enrichment mapping to determine the enrichment results of the gene set enrichment analysis and found that the cAMP signalling pathway may be the key to enhancing the effectiveness of PRP treatment.The cAMP signalling pathway interacts with the Rap1 signalling pathway and cGMPPKG signalling pathway to mediate the entire pathophy-siological process of Achilles tendon disease.Moreover,ADCY1-9 may be the key to the activation of the cAMP signalling network.Further based on the data in the Gene Expression Omnibus database,it was found that ADCY4 and ADCY7 may be the players that play a major role,associated with the STAT4-ADCY4-LAMA5 axis and the GRbeta-ADCY7-SEMA3C axis,which is expected to be a complementary target for enhancing the efficacy of PRP in the treatment of Achilles tendon disease.展开更多
Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation o...Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.展开更多
Abnormal tendons are rarely ever repaired to the natural structure and morphology of normal tendons.To better guide the repair and regeneration of injured tendons through a tissue engineering method,it is necessary to...Abnormal tendons are rarely ever repaired to the natural structure and morphology of normal tendons.To better guide the repair and regeneration of injured tendons through a tissue engineering method,it is necessary to have insights into the internal morphology,organization,and composition of natural tendons.This review summarized recent researches on the structure and function of the extracellular matrix(ECM)components of tendons and highlight the application of multiple detection methodologies concerning the structure of ECMs.In addition,we look forward to the future of multi-dimensional biomaterial design methods and the potential of structural repair for tendon ECM components.In addition,focus is placed on the macro to micro detection methods for tendons,and current techniques for evaluating the extracellular matrix of tendons at the micro level are introduced in detail.Finally,emphasis is given to future extracellular matrix detection methods,as well as to how future efforts could concentrate on fabricating the biomimetic tendons.展开更多
Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture fo...Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture for stumps connection. The aim of our research is to quantify the stress that the suture and barbs should withstand in order to ensure perfect stumps connections. Methods: Seven different cross-section sutures were selected for the research study. One circular and 6 different elliptical shapes were defined according to the ratio of their minor and major axes (ρ = b/a). Barbs were designed with 3 different depths and 3 different cut angles. Thus, 9 different situations were considered for each suture geometry. Finally, 2 loading conditions were applied on each barb and tested in ANSYS Workbench using a finite element analysis technique. Results: Studies showed that a barbed suture with 0.18-mm depth, 150° cut angle and ρ = 3 produced the lowest stresses within the barb itself, while a barbed suture with 0.18-mm depth, 160° cut angle and ρ = 4 demonstrated lowest stress within the entire suture. Conclusion: The stress values in these two configurations are observed to be very close and both can fit a single barbed suture for tendon insertion and repair.展开更多
BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniq...BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniques that has been described in recent years.All-inside anterior cruciate ligament(ACL)reconstruction is based on a tibial socket instead of a full tunnel.This method has many potential advantages.AIM To compare clinical outcomes of knee ACL autograft reconstruction using allinside quadrupled semitendinosus(AIST)and traditional hamstring tendon(TBT)techniques.METHODS From January 2017 to October 2019,the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed,including 67 males and 13 females.The patients had an average age of 24.3±3.1 years(age range:18-33 years).The AIST technique was used in 42 patients and the TBT technique was used in 38 patients.The time between operation and injury,operative duration,postoperative visual analogue scale(VAS)score and knee functional recovery were recorded and compared between the two groups.The International Knee Documentation Committee(IKDC)and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.RESULTS Eighty patients were followed for 24-36 mo,with an average follow-up duration of 27.5±1.8 mo.There were no significant differences in the time between surgery and injury,operative duration,IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups.There were significant differences in VAS scores 1 d,3 d,7 d,2 wk and 1 mo after surgery(P<0.05).There was no significant difference in VAS score at 3 mo,6 mo and 1 year after operation.CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique,but the postoperative pain was less with the AIST technique.Thus,the AIST technique is an ideal treatment choice for ACL reconstruction.展开更多
文摘Introduction: There has been a surge in the use of tendoscopic surgery for treating peroneal tendons instability. The novelty of this approach demanded a literature review of its indications, limitations, and clinical outcomes. Aim: a literature review of the clinical studies reporting on tendoscopic peroneal tendon stabilisation surgery along with its outcomes and complications. Methods: We carried out a comprehensive review of the literature up until September 2022 with an extensive search of the MEDLINE, Embase and Cochrane library databases. Results: Initial search resulted in 66 articles. Four duplicate articles were removed. Further 30 articles were excluded after title and abstract screening. Eight studies satisfied the inclusion criteria and were included in this review. Articles were analysed for outcomes and complications. Conclusion: The tendoscopic technique for peroneal tendon instability is an effective and safe surgical technique with very low failure rate. Levels of Evidence: Level IV.
文摘BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.CASE SUMMARY A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound^TM mapping system. In addition to the left anterior papillary muscle,the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.CONCLUSION This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the Carto Sound TM system.
文摘Fracture of an ossification of the Achilles tendon(OAT)is a rare entity,and its etiology,pathology,and treatment remain unclear.We reviewed and scrutinized 18 cases(16 articles)of the fracture of an OAT.The most common etiologies of the ossifications include previous surgery and trauma.The fractures often occur without any trigger or with minimal trigger.The long,>5 cm,ossification in the body of the Achilles tendon may have a higher risk of fracture.The OAT itself is often asymptomatic;however,its fracture causes severe local pain,swelling,and weakness of plantar flexion,which forces patients to undergo aggressive treatments.Regarding the treatments of the fractures,nonoperative treatment by immobilizing ankle joint could be an option for elderly patients.However,because it often cannot produce satisfactory results in younger patients,surgical treatment is typically recommended.Excision of the fractured mass and repairing the tendon is applicable if the remnant is enough.If there is a defect after the excision,reconstruction with autologous grafts or adjacent tendon transfer is performed.Gastrocnemius fascia turndown flap,hamstring tendon and tensor fascia lata are used as autologous grafts,whereas peroneus brevis and flexor hallucis longus tendons are used for the tendon transfer.If the fracture of an OAT is treated properly,the functional result will be satisfactory.
文摘Tendon ruptures remain a significant musculoskeletal injury. Despite advances in surgical techniques and procedures, traditional repair techniques maintain a high incidence of rerupture or tendon elongation. Mechanical loading and biochemical signaling both control tissue healing. This has led some researchers to consider using a technique based on tension regulation at the suture line for obtaining good healing. However, it is unknown how they interact and to what extent mechanics control biochemistry. This review will open the way for understanding the interplay between mechanical loading and the process of tendon healing.
文摘BACKGROUND Injuries to the pectoralis major are infrequent,with only a few hundred cases currently recorded in the literature.CASE SUMMARY We report a case of a patient who sustained bilateral pectoralis major tendon ruptures.While other cases of bilateral pectoralis major tears have been reported in the literature,the operative management in this report differs.Due to delayed presentation of the patient right and left pectoralis major repairs were performed simultaneously.CONCLUSION Patients with delayed presentation of bilateral pectoralis major tendon ruptures can undergo simultaneous repair of both tendon with a good postoperative outcome and high patient satisfaction.
基金Project supported by the National Natural Science Foundation of China(No.11672150)the Beijing Nova Program Interdisciplinary Cooperation Project(No.xxjc201705)+1 种基金the Capital Clinical Special Promotion Project(No.Z161100000516233)the Key Issue of the 12th Five-Year Plan of People’s Liberation Army of China(No.BKJ13J004)
文摘This study investigates the viscoelastic behavior of soft bio-fibres in association with their fractal structures. A spring-dashpot fractal network with the self-similar topology, named the -type fractal ladder hyper-cell (FLHC), is abstracted from the micro/nano-structure of ligaments and tendons (LTs). Its constitutive operator is derived by the Heaviside operational calculus, which is of intrinsic fractional order. In terms of this operator, the long-term viscoelastic relaxation of bio-fibres arising from the fractal ladder topology is expounded. In addition, the fractional-order viscoelastic constitutive equation is obtained based on the FLHC of LTs, and its results are consistent with those of available human knee and spinal LT relaxation experiments. Results on the constitutive equation of FLHCs are formulated into two propositions. The multidisciplinary invariance and implications from the fractal ladder pattern of bio-fibres are also discussed.
文摘Normal tendon substance is strong and is unlikely to break before the muscle origin, muscle, musculotendinous junction or the insertion yield. In almost all the cases, closed ruptures of the flexor tendon within the tendinous portion have been described in association with distinct underlying pathologies. We report a case of flexor tendon rupture of the index finger which seems to be associated with previous trauma occurred more than 40 years ago and abnormal healing.
文摘After corrosion failure of post-tensioned tendons was identified in a Florida bridge in early 2011, laboratory tests were conducted in this study on extracted sections from the failed tendons to identify the grout properties and makeup leading to the failure and also to elucidate the mechanism of corrosion. The initial steps in identification of PT tendons with a high propensity for corrosion initiation or damaged included a detailed visual inspection and identification of voids in the grout. Voids in tendon can be a result of bleed water formation or construction problems. General characteristics of the deficient grout and corrosion behavior of steel in the affected bridge gave a first approach to assessing grout deficiency and corrosion susceptibility. However, refinements in the understanding of the mechanisms causing grout segregation and the elucidation of the role of sulfates, oxygen content, and pore water pH in corrosion development are required.
基金supported by the Department of Jobs,Tourism,Science and Innovation(JTSI),Government of Western Australia,through the Science Industry PhD Fellowship Program.
文摘Tendon and ligament(TL)injuries affect millions of people annually.Biopolymers play a significant role in TL tissue repair,whether the treatment relies on tissue engineering strategies or using artificial tendon grafts.The biopolymer governs the mechanical properties,biocompatibility,degradation,and fabrication method of the TL scaffold.Many natural,synthetic and hybrid biopolymers have been studied in TL regeneration,often combined with therapeutic agents and minerals to engineer novel scaffold systems.However,most of the advanced biopolymers have not advanced to clinical use yet.Here,we aim to review recent biopolymers and discuss their features for TL tissue engineering.After introducing the properties of the native tissue,we discuss different types of natural,synthetic and hybrid biopolymers used in TL tissue engineering.Then,we review biopolymers used in commercial absorbable and non-absorbable TL grafts.Finally,we explain the challenges and future directions for the development of novel biopolymers in TL regenerative treatment.
文摘Offshore triceratops is one of the successful manifestations of the form-dominant design approaches deployable in ultra-deepwater oil and gas exploration.The deck’s geometric shape and partial isolation from the legs counteract lateral loads.Legs are position-restrained to the sea bed by taut-moored tendons,while ball joints partially isolate the deck from the buoyant legs.However,compliance in the horizontal plane imposes large displacements,intuiting the necessity to examine tendon failure.Numerical analysis of triceratops under wave and wind combined action is carried out under the postulated conditions of a tendon failure.10-yr,100-yr,and 1000-yr post-Katrina hurricane conditions are assumed as loading to the platform.Results confirm a marginal increase in the natural periods of stiff degrees of freedom even under postulated failure conditions,ensuring good adaptability to ultra-deep water.Under postulated failure,the tension of adjacent tendons varies significantly,causing a shift to the mean position of the platform.Fatigue life is significantly reduced under the postulated failure of tendons,making the platform free-floating without affecting its stability.Results also show that the pitch response of the deck is a clear manifestation of the postulated failure,which is otherwise absent due to the presence of ball joints.The attempted study deliberates on the fatigue life of tendons,assessing the platform’s suitability to ultra-deep waters and identifying the vulnerable legs for the chosen load combinations.
基金Project supported by the National Natural Science Foundation of China (No.50178026)the New Century Excellent Talents in UniversityChangjiang Scholars Program of China (No.2009-37)
文摘Since the assumption of plane sections cannot be applied to the strain of unbonded tendons in prestressed concrete beams subjected to loadings,a moment-curvature nonlinear analysis method is used to develop analytical programs from stress increases in unbonded tendons at the ultimate limit state.Based on the results of model testing and simulation analysis,equations are proposed to predict the stress increase in tendons at the ultimate state in simple or continuous beams of partially prestressed concrete,considering the loading type,non-prestressed reinforcement index βp,prestressing reinforcement index βs,and span-depth ratio L/h as the basic parameters.Results of 380 beams studied here and test results for 35 simple beams obtained by the China Academy of Building Research were compared with those from prediction equations given in codes and other previous studies.The comparison reveals that the values predicted by the proposed equations agree well with experimental results.
文摘Prestressed concrete segmental box girder bridges are composed of short concrete segments that are either precast or cast in situ and then joined together by longitudinally post-tensioning internal,external,or mixed tendons.The objectives of this study are to monitor the construction process of the external prestressing tendons to strengthen the bridge structure and perform a field load test to measure the strain and the deflection of the anchorage devices of the external prestressing tendons to determine the state of these devices after tension forces are applied.The monitoring process of the external prestressing tendons construction includes inspecting the cracks in the diaphragm anchorage and the deviation block devices before the tension forces are applied to the external tendons;measuring the deformation of the steel deviation cross beam during the tension process;measuring the deformation of the box girder after different levels of tension forces are applied;measuring the elongation of the external tendons in each level of the tension;and measuring the natural frequency of the external tendons after the tension process is complete.The results of the monitoring process show that the measured values of the deformation,the elongation,and the natural frequency meet the requirements.Therefore,there is no damage during the construction and the tensioning of the external prestressing tendons.A field load test is performed to the anchorage beam,the steel deviation block devices,and the steel deviation cross beam.The field load test results of the anchorage devices show that the values of the strains,the stresses,and the deflection are less than the respective allowable limit values in the requirements.Therefore,the anchorage devices have sufficient strength,and the working state is good after the tension forces are applied to the external prestressing tendons.
基金supported by the Netherlands Organisation for Health Research and Development(ZonMW)(Grant No.50-53600-98-104)China Scholarship Council(CSC)(Grant No.202106100138)。
文摘Background:Achilles tendinopathy(AT)is a common problem among runners.There is only limited evidence for risk factors for AT,and most studies have not defined the AT subcategories.No study has compared the incidence and risk factors between insertional AT and midportion AT,though they are considered distinct.This study aimed to assess incidence and risk factors of AT based on data from a large prospective cohort.The secondary aim was to explore differences in risk factors between insertional and midportion AT.Methods:Participants were recruited from among registered runners at registration for running events.Questionnaires were completed at baseline,1 month before the event,1 week before the event,and 1 month after the event.Information concerning demographics,training load,registered events,and running-related injuries were collected at baseline.The follow-up questionnaires collected information about new injuries.A pain map was used to diagnose midportion and insertional AT.The primary outcome was the incidence of AT.Multivariable logistic regression analysis was applied to identify risk factors for the onset.Results:We included 3379 participants with a mean follow-up of 20.4 weeks.The incidence of AT was 4.2%.The proportion of insertional AT was 27.7%and of midportion AT was 63.8%;the remaining proportion was a combined type of insertional and midportion AT.Men had a significantly higher incidence(5%,95%confidence interval(95%CI):4.1%-6.0%)than women(2.8%,95%CI:2.0%-3.8%).AT in the past12 months was the most predominant risk factor for new-onset AT(odds ratio(OR)=6.47,95%CI:4.27-9.81).This was similar for both subcategories of AT(insertional:OR=5.45,95%CI:2.51-11.81;midportion:OR=6.96,95%CI:4.24-11.40).Participants registering for an event with a distance of 10/10.55 km were less likely to develop a new-onset AT(OR=0.59,95%CI:0.36-0.97)or midportion AT(OR=0.47,95%CI:0.23-0.93).Higher age had a significant negative association with insertional AT(OR=0.97,95%CI:0.94-1.00).Conclusion:The incidence of new-onset AT among recreational runners was 4.2%.The proportion of insertional and midportion AT was 27.7%and 63.8%,respectively.AT in the past 12 months was the predominant risk factor for the onset of AT.Risk factors varied between insertional and midportion AT,but we could not identify clinically relevant differences between the 2 subtypes.
文摘BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.
文摘The effectiveness of platelet-rich plasma(PRP)for the treatment of Achilles tendon disorders still needs to be evaluated through a series of prospective studies,but genomic analysis can reveal the existence of complementary PRP treatment options.Based on the 96 platelet activation-related genes in the Kyoto Encyclopedia of Genes and Genomes(KEGG)database,we performed Gene Ontology functional enrichment analysis and KEGG enrichment analysis,pathway correlation analysis,and enrichment mapping to determine the enrichment results of the gene set enrichment analysis and found that the cAMP signalling pathway may be the key to enhancing the effectiveness of PRP treatment.The cAMP signalling pathway interacts with the Rap1 signalling pathway and cGMPPKG signalling pathway to mediate the entire pathophy-siological process of Achilles tendon disease.Moreover,ADCY1-9 may be the key to the activation of the cAMP signalling network.Further based on the data in the Gene Expression Omnibus database,it was found that ADCY4 and ADCY7 may be the players that play a major role,associated with the STAT4-ADCY4-LAMA5 axis and the GRbeta-ADCY7-SEMA3C axis,which is expected to be a complementary target for enhancing the efficacy of PRP in the treatment of Achilles tendon disease.
文摘Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.
基金supported by the National Key Research and Development Program of China(2018YFC1105100)NSFC grants(81772418,81972099,81871764,82072463)+1 种基金Zhejiang Provincial Natural Science Foundation of China(LR20H060001)Fundamental Research Funds for the Central Universities.
文摘Abnormal tendons are rarely ever repaired to the natural structure and morphology of normal tendons.To better guide the repair and regeneration of injured tendons through a tissue engineering method,it is necessary to have insights into the internal morphology,organization,and composition of natural tendons.This review summarized recent researches on the structure and function of the extracellular matrix(ECM)components of tendons and highlight the application of multiple detection methodologies concerning the structure of ECMs.In addition,we look forward to the future of multi-dimensional biomaterial design methods and the potential of structural repair for tendon ECM components.In addition,focus is placed on the macro to micro detection methods for tendons,and current techniques for evaluating the extracellular matrix of tendons at the micro level are introduced in detail.Finally,emphasis is given to future extracellular matrix detection methods,as well as to how future efforts could concentrate on fabricating the biomimetic tendons.
文摘Aim: The ideal flexor tendon repair should be reliable, simple and strong enough without impairing the tendon healing. Based on these requirements, we have imagined the use of a single barbed intra-tendinous suture for stumps connection. The aim of our research is to quantify the stress that the suture and barbs should withstand in order to ensure perfect stumps connections. Methods: Seven different cross-section sutures were selected for the research study. One circular and 6 different elliptical shapes were defined according to the ratio of their minor and major axes (ρ = b/a). Barbs were designed with 3 different depths and 3 different cut angles. Thus, 9 different situations were considered for each suture geometry. Finally, 2 loading conditions were applied on each barb and tested in ANSYS Workbench using a finite element analysis technique. Results: Studies showed that a barbed suture with 0.18-mm depth, 150° cut angle and ρ = 3 produced the lowest stresses within the barb itself, while a barbed suture with 0.18-mm depth, 160° cut angle and ρ = 4 demonstrated lowest stress within the entire suture. Conclusion: The stress values in these two configurations are observed to be very close and both can fit a single barbed suture for tendon insertion and repair.
文摘BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniques that has been described in recent years.All-inside anterior cruciate ligament(ACL)reconstruction is based on a tibial socket instead of a full tunnel.This method has many potential advantages.AIM To compare clinical outcomes of knee ACL autograft reconstruction using allinside quadrupled semitendinosus(AIST)and traditional hamstring tendon(TBT)techniques.METHODS From January 2017 to October 2019,the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed,including 67 males and 13 females.The patients had an average age of 24.3±3.1 years(age range:18-33 years).The AIST technique was used in 42 patients and the TBT technique was used in 38 patients.The time between operation and injury,operative duration,postoperative visual analogue scale(VAS)score and knee functional recovery were recorded and compared between the two groups.The International Knee Documentation Committee(IKDC)and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.RESULTS Eighty patients were followed for 24-36 mo,with an average follow-up duration of 27.5±1.8 mo.There were no significant differences in the time between surgery and injury,operative duration,IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups.There were significant differences in VAS scores 1 d,3 d,7 d,2 wk and 1 mo after surgery(P<0.05).There was no significant difference in VAS score at 3 mo,6 mo and 1 year after operation.CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique,but the postoperative pain was less with the AIST technique.Thus,the AIST technique is an ideal treatment choice for ACL reconstruction.
