bluuebunny/crossref_metadata_2025_split huggingface dataset:
A KNOWLEDGE TRANSLATION INITIATIVE TO ENHANCE EVIDENCE-INFORMED CLINICAL MANAGEMENT OF ACHILLES TENDINOPATHY: THE PURPOSE, PROCESS AND OUTCOMES OF THE BC TENDINOPATHY TOOLKIT
Authors: Hoens A M , Ezzat A , Anthony J , Scott A , Yates M , Justesen J R , Hughes D 
Published: May 2013

IntroductionTranslation of knowledge to practice in health care is a significant challenge.1–3 This presentation describes the purpose, process and preliminary outcomes of a knowledge translation (KT) initiative undertaken by a unique partnership of physical therapy researchers, educators and expert clinicians to address the gap between evidence and practice in the management of Achilles tendinopathy.MethodsPhysiotherapy clinicians in British Columbia requested evidence-informed guidance on the management of tendinopathy. To address this need, the provincial Physical Therapy Knowledge Broker assembled a team of researchers, educators and expert clinicians with the mandate to develop, disseminate and implement a toolkit of decision aids to guide clinical decision-making for Achilles Tendinopathy.The process to develop the toolkit involved the following components: (1) identification of the purpose and scope of the project (2) agreement on the processes for selection of content and format (3) creation of a mechanism for resolution of conflicting opinion (4) an iterative feedback process with stakeholders and (4) the incorporation of concepts and strategies from the knowledge translation and implementation science literature to support the stages of knowledge synthesis, dissemination and implementation.1–4ResultsThe ‘Tendinopathy Toolkit’ included: (1) a tabulated summary of the evidence for manual therapy, exercise, low level laser therapy, ultrasound, extracorporeal shock wave therapy, iontophoresis using dexamethasone, taping, orthotics, night splints and braces, heel raise inserts, needling techniques, and the appropriate outcome measures for this population (targeted ‘take home messages’ and clinical implications for each were also included); (2) an algorithm to guide the sequence of interventions; (3) and appendices including (a) exercise programmes (b) low level laser dosage calculation (c) tabulated details for each article reviewed and (d) a review of common medical interventions.The second phase of the initiative—utilization of strategies to enhance implementation and uptake of the toolkit—is currently being undertaken.DiscussionClinicians want to provide evidence-informed management of tendinopathy but many struggle with accessing, appraising and synthesising the vast array of literature available on this topic. This KT initiative highlights the need for, challenges associated with, evidence-informed process for and positive response to the development of decision aids synthesising the current evidence to guide clinical management of this patient population.
JUMPING ABILITY AND CHANGE OF JUMPING ABILITY AS RISK FACTORS FOR DEVELOPING JUMPER'S KNEE
Authors: Visnes H , Aandahl H , Bahr R 
Published: May 2013

IntroductionThe ‘jumper's knee paradox’, where symptomatic athletes appear to perform better in a counter movement jump (CMJ) compared to asymptomatic controls in previous case-control studies, is not fully understood. The aim was to examine the relationship between jumping ability and change of jumping ability as potential risk factors for developing jumper's knee.MethodsA 5-year prospective cohort study among elite volleyball players, aged 16–18 was performed. Jump tests were done on a portable force plate at the time of inclusion and semi-annually. Jumper's knee was diagnosed based on a standardised clinical examination.Results150 students (68 males and 82 females) were included and 28 developed jumper's knee (22 males and 6 females). At the time of inclusion, male athletes who went on to develop jumper's knee had significantly better results in CMJ (38.0±5.8 cm) compared to asymptomatic males(34.6±5.5 cm, p=0.03), while no difference was detected in standing jump (SJ: jumper's knee: 30.3±7.4 cm, asymptomatic: 28.1±6.1 cm, p=0.23). In a multivariate logistic regression analysis corrected for gender and previous volleyball training, the OR was 2.09 (1.03–4.25) per cm difference in CMJ at the time of inclusion. Our results did not reveal any significant differences in the change in jumping ability between the groups, although both groups improved their jump performance.ConclusionVolleyball players with a natural ability for jumping high are at an increased risk for developing jumper's knee.
NEW BIOMECHANICAL MODEL TO EXPLAIN THE INJURY SITE OF PATELLAR TENDINOPATHY: AN ULTRASONOGRAPHY STUDY
Authors: Jaén T F , Rey G A , Vicente I G , García P G 
Published: May 2013

IntroductionThe deep and proximal face of the patellar tendon is the most frequently injured site. Up to now, we have been thinking that this could be a result of two factors: mechanism of compression (impingement) produced by inferior patellar pole, and a hypovascularized site. We have elaborated a new biomechanical model to show that this pathology may be caused by a traction mechanism and not by compression. The insertion area of tendon on patella is a weak transition site between tendon and bone; while the anatomical tendon-to-bone insertion in the proximal end shows a perpendicular angle, at the distal end at the tibial level, it shows an oblique angle.MethodsWith ultrasound, we have measured the maximum length of the superficial and deep faces, bone to bone. These measurements were done in two positions: in maximal extension and 90° flexion. All samples were right knees, and there were 10 patients. Measurements were taken by the same technician (figure 1).Figure 1.Sagittal knee view.ResultsMeasurements were as follows: in maximal extension for the deep face, the mean value was 4.15cm (range 3.40–5.05) and for the superficial face, the mean value was 4.857cm (range 4.57–5.20). Alternatively, in 90° flexion, the deep face showed a mean value of 3.938 cm (range 2.77–4.64) while for the superficial face it was 4.916 (range 4.27–5.11). Variations in face lengths when we changed the knee position were 1.21% for the superficial face and 5.38% for deep face.DiscussionThese results have demonstrated that the deep face had a greater percent increase in length than the superficial face when the knee changed position from extension to flexion. This study has some limitations- it was performed at only 90° flexion because the longitudinal probe is limited, and there are a low number of subjects. In conclusion, traction forces are probably more intense in the deep face than in the superficial face.
PROTEASE-ACTIVATED RECEPTORS ARE EXPRESSED IN HUMAN TENDON TISSUE AND MAY EXPLAIN EXCESSIVE PAIN-SIGNALLING IN TENDINOPATHY
Authors: Andersson G , Alfredson H 
Published: May 2013

IntroductionSeveral painful conditions throughout the human body—such as interstitial cystitis, Dupuytren's contracture, and complex regional pain syndrome—have been shown to exhibit tissues with an increase in mast cell population. One such painful condition—where the pain is not considered proportionate to the tissue changes—is tendinopathy. One study has shown that activation via protease-activated receptor 4 (PAR4) can lead to an increased nociception in joints, and similar mechanisms may be at play in tendinopathy, where substances released by mast cells may activate the PARs. Mast cells are also known mediators of inflammatory responses to injury, but have also been found to regulate cell proliferation and vasodilation in certain tissues via PARs, and tendinopathies are known to exhibit tissue characteristics involving hypercellularity and vascular changes.The aim of this study was to determine whether tissues surrounding the Achilles tendon exhibit PAR4, as a basis for further studies on interactions between the tendon, vascularity and nerves, and the mast cell population found in tendinopathy tendons.MethodsBiopsies of about 5×5 mm were taken from the ventral part of the Achilles tendon and the paratendinous tissues of this area, from two groups. One group consisted of patients suffering from mid-portion tendinopathy with tendinosis (n=8). Normal controls (n=2) donated biopsies from the same area. Both procedures were guided by ultrasound and performed through a minimal skin incision. These biopsies were later sectioned and immunocytochemistry was used to study the expression patterns of PAR4.Double-staining with PAR4and substance P (SP) was performed.ResultsThe sections showed strong reactivity for PAR4in the blood vessels both in the tendon tissue proper as well as in the more abundant vascular areas ventral to the tendon in biopsies from both normal tendons and those from patients diagnosed with tendinosis. Tenocytes expressed PAR4to a varying degree (figure 1), with it being expressed more in cells with a rounded nuclei, primarily in tendons from the tendinosis group. PAR4was expressed on SP-positive nerve fibres in the paratendinous tissue (figure 2).Figure 1.(a) Tenocytes show reactions for PAR4(in red). Counterstained with DAPI. (b) Vessels positive for PAR4.Figure 2.(a) A nerve fibre and vessel positive for PAR4. In b the nerve fibre shows reactivity for substance P.DiscussionThese findings give basis for further studies into the interactions of SP-positive nerves and mast cells in tendon pathology. Earlier studies have shown regulation of vascular permeability and dilation, as well as fibroblast proliferation through activation of PARs. The PAR4may, through activation of proteases released from mast cells, to some extent be responsible not only for tenocyte proliferation and vascular regulation, but also for an enhanced pain signalling in tendinopathy through SP-positive afferents.
TENDON RESPONSE IN ACHILLES TENDON OF AUSTRALIAN FOOTBALL PLAYERS USING ULTRASOUND TISSUE CHARACTERISATION
Authors: Rosengarten S , Docking S I , van Schie J T M , Daffy J , Cook J L 
Published: May 2013

IntroductionThe Achilles tendon is an elastic storage tendon that converts kinetic energy into mechanical energy and reduces the metabolic cost of high-speed locomotion. Numerous studies have shown that the tendon is responsive to mechanical stimuli with changes in CSA and collagen synthesis both in the short- and long-term.1 2 This mechano-responsiveness of the tendon has been implicated in the development of tendinopathy and detecting early and/or short-term changes may have a role in managing tendinopathy. Ultrasound tissue characterisation (UTC) uses contiguous ultrasound images to render a 3-dimensional image that allows semi-quantitative analysis of tendon structure. This novel ultrasound technique has been used to show short-term changes in tendon structure in response to maximal exercise in thoroughbred horses.3 This study aims to investigate short-term changes in the Achilles tendon in Australian football players in response to loading during competitive games.Methods22 elite male Australian football players, some with history of tendinopathy (six and three players with a history of patellar and Achilles tendinopathy, respectively) were recruited. Players were scanned prior to the game and days 1, 2 and 4 post-game using UTC. A 1cm region at the midsubstance of the tendon was selected and the ultra-structure quantified into four echo-types based on the stability of the echopattern. Changes in the echopattern were compared over the 4 days using a related samples Friedmans two-way analysis of variance. If a significant difference in the median was observed, post-hoc (Wilcoxon signed rank test) analysis was performed to identify the differences between days 1, 2 and 4 and day 0.ResultsPreliminary data analysis showed differences in baseline tendon structure in players with and without a history of lower limb tendinopathy. Further analysis will examine differences between groups in change over the 4 days, and examine intrinsic (age, mass) and extrinsic factors (game load, GPS data) that are associated with change in UTC parameters.ConclusionsThis study demonstrated the changes seen in the Achilles tendons of athletes after intense loading. The factors that affect the magnitude of the response were elucidated.
GREATER TROCHANTERIC PAIN SYNDROME: DEFINING THE SYNDROME
Authors: Fearon A M , Scarvell J M , Cook J L , Neeman T , Cormick W , Smith P N 
Published: May 2013

IntroductionEffective treatment of hip pain leads to improved quality of life and population health. This is dependent on accurate differential diagnosis. While hip osteoarthritis (OA) diagnosis is well defined,1 the diagnosis of greater trochanteric pain syndrome (GTPS) is not. The aim of this study was to clinically define GTPS.MethodsForty one people with GTPS, ranging from mild to severe (11 not seeking treatment and 10 awaiting surgery), 20 with severe hip OA, and 23 age and sex matched asymptomatic participants (ASC) were recruited from public and private hospitals, and the community. Inclusion and exclusion criteria assured mutually exclusive groups. Assessment included the Harris Hip Score (HHS), a battery of passive and resisted tests (recording reproduction and location of pain), and the single leg stance test. Statistical analyses used include Fisher exact test, ANOVA, and recursive partitioning to develop two classification trees. The first classification tree was based on an undifferentiated hip pain response and the second was based on a clearly identified lateral hip pain response.ResultsThe HHS domains of maximum walking distance and the ability to manipulate shoes and socks were the only domains to differentiate between the two symptomatic groups, (ANOVA: p=0.010 and p<0.001 respectively). Dichotomising these data resulted in OR (95% CI) of 3.47 (1.09 to 10.93)—for the ability to walk >30/60; and of 0.06 (0.00 to 0.26)—for the ability to manipulate shoes and socks, of having GTPS versus hip OA. The first classification tree resulted in a four branch tree for diagnosing GTPS, with a mean (se) sensitivity and specificity of 0.78 (0.058) and 0.28 (0.080) respectively. These branches included a positive Ober and passive to active medial rotation ratios. The second tree resulted in one branch, FABER, for diagnosing GTPS with a mean (se) sensitivity and specificity of 0.81 (0.019) and 0.82 (0.044) respectively. The single leg stance test did not differentiate between the two symptomatic groups.DiscussionThree features differentiated people with GTPS from those with hip OA without reference to our inclusion criteria. These results provide clinicians with markers to aid with the sometimes difficult diagnosis of GTPS.2 When combined with greater trochanter palpation, this combination of features is likely to be more sensitive and specific than the FABER test result. We recommend that the clinical syndrome of GTPS be defined as a history of lateral hip pain in the absence of difficulty with manipulating shoes and socks, together with an examination of findings of pain reproduction on palpation of the greater trochanter (a previously recognised sign) and lateral hip pain with a FABER test. In patients who cannot differentiate the site of their pain, multiple pathologies should be considered. For research purposes or in cases of poor response to treatment, multiple pathologies should be considered and a hip x-ray should be undertaken to exclude joint pathology.
DOES SENSITISATION PLAY A ROLE IN THE PAIN OF PATIENTS WITH CHRONIC PATELLAR TENDINOPATHY?
Authors: Zwerver J , Konopka K H , Keizer D , Dekker R , van Wilgen C P 
Published: May 2013

IntroductionThe aetiology and pain mechanisms of tendinopathies are not completely understood. Currently, little is known regarding whether, or to which degree, somatosensory changes within the nervous system may contribute to the pain in tendinopathies.The aim of this study was to investigate whether somatosensory changes represent a plausible explanation for pain in patients with chronic patellar tendinopathy.MethodsA patient controlled study in which the standardised QST protocol developed by the German Research Network on Neuropathic Pain was used. This protocol consists of seven different tests that measure 13 somatosensory parameters and can be seen as the gold standard to measure somatosensory function.ResultsTwelve athletes with clinically diagnosed chronic patellar tendinopathy (PT) with a mean duration of 30 months (range 6–120) and 20 controls were included in the study. In two of the 13 QST parameters, namely Mechanical Pain Threshold (p<0.05) and Vibration Disappearance Threshold (p<0.5), injured athletes were significantly more sensitive for the applied stimuli. None of the athletes had signs of Dynamic Mechanical Allodynia.DiscussionReduced mechanical pain thresholds or pinprick allodynia reflects the involvement of central sensitisation upon the myelinated (Ad-fibre) nociceptive input. From this explorative study, we conclude that sensitisation may play a prominent role in the pain experienced during and after sports activity, by patellar tendinopathy patients.
TOPICAL GLYCERYL TRINITRATE TREATMENT OF CHRONIC PATELLAR TENDINOPATHY: A RANDOMISED, DOUBLE BLIND, PLACEBO CONTROLLED CLINICAL TRIAL
Authors: Zwerver J , Steunebrink M , Brandsema R , Groenenboom P , van den Akker-Scheek I , Weir A 
Published: May 2013

IntroductionFrom previous research on tendinopathy of the Achilles tendon, wrist extensors and the supraspinatus, it is known that topical glyceryl trinitrate (GTN) has a healing effect. To our knowledge, no studies have been published on the application of GTN in patients with PT.The aim of this study was to assess if continuous topical GTN treatment improved outcome in patients with chronic PT compared to placebo patches, both combined with heavy load eccentric training.MethodsA randomised double blind, placebo-controlled clinical trial was done, comparing a 12 week programme of using a GTN patch or placebo patch in combination with eccentric squats on a decline board. Measurements were performed at baseline, 6, 12 and 24 weeks. Primary outcome measure was the VISA-P questionnaire. Secondary outcome measures were patient satisfaction and pain scores during sports. Generalised Estimated Equation was used to analyse the treatment, time and treatment x time effect. Analyses were performed following the intention-to-treat principle.ResultsVISA-P scores for both groups improved over the study period to 75.0±16.2 and 80.7±22.1 at 24 weeks. Results showed a significant effect for time (p<0.01) but no effect for treatment x time (p=0.80). Mean VAS pain scores during sports for both groups increased over the study period to 6.6±3.0 and 7.8±3.1. Results showed a significant effect for time (p<0.01) but no effect for treatment x time (p=0.38). Patient satisfaction showed no difference between the GTN and the placebo group (p=0.25) after 24 weeks, but did show a significant difference over time (p=0.01). Three patients in the GTN group reported some rash.DiscussionContinuous topical GTN treatment in addition to an eccentric exercise programme does not improve clinical outcome compared to placebo patches and an eccentric exercise programme in patients with chronic patellar tendinopathy.
EVALUATION OF SCAFFOLDS IN VITRO FOR USE IN TENDON REGENERATION
Authors: Cornish J , Musson D S 
Published: May 2013

IntroductionInjuries to tendons can cause major morbidity in healthy, young active people as well as in the increasing aged population. Providing a scaffold that encourages appropriate cell attachment, growth, and ultimately tissue regeneration, could improve the clinical outcomes from injuries such as rotator cuff tears. Millions of dollars are spent annually on the development of biomaterial scaffolds and many are put into clinical use without proper cell compatibility and immunogenicity evaluation leading to many instances of unfavourable results with associate patient morbidity. The purpose of this study was to set-up an evaluation package to assess scaffold materials of both natural and synthetic origin for their potential utility in tendon regenerative medicine.MethodsTwo novel scaffolds were evaluated as biomaterials: Spidrex 543 (Oxford Biomaterials Ltd, UK), a spider-like silk fabric; and Endoform (Mesynthes, New Zealand), a decellularised ovine forestomach matrix then compared to three-dimensional (3D) collagen gels as a control and FiberWire (Athrex. Inc, USA), a polyethylene and polyester composite suture, which is currently utilised in orthopaedic surgery.Primary human dendrocytic cells were exposed to scaffolds, with cell-surface activation markers analysed using FACS to determine scaffold immunogenicity. Attachment and growth of primary tenocytes were analysed using live-dead staining and alamar Blue fluorescence. Phenotypic retention was assessed through morphological studies, while real-time PCR was employed to evaluate cell differentiation.ResultsFACS analysis determined that Spidrex 543, invoked a high immune response in the primary human dendrocytes, while Endoform and the 3D collagen gels provided relatively low immunogenicity. FiberWire, the synthetic suture material currently used in orthopaedic surgery produced relatively high immune activation within these cells.Tenocytes successfully adhered to and grew on the Endoform, Spidrex 543 and within the 3D collagen gels, whereas the orthopaedic suture material proved unsuitable for cell attachment/growth. Gene analysis and morphology in the three permissible scaffolds suggest cells retain their phenotype when cultured in them.Discussion3D culture systems support and amplify tenocyte proliferation and differentiation whilst gene expression data indicated increases of tenocyte-like markers, such as tenomodulin, scleraxis and collagen IA1We have developed an in vitro evaluation package to identify the biocompatibility of biomaterial scaffolds- whether the materials support and promote target cell growth and have potential for use in tendon regeneration. Much time and expense can be saved by such in vitro evaluation of biomaterials prior to embarking on in vivo studies.
EFFECTS OF MAST CELLS ON THE FUNCTION OF ISOLATED HUMAN TENOCYTES
Authors: Behzad H , Scott A 
Published: May 2013

IntroductionTendinopathy, a pathological condition caused by tendon overuse, adversely affects millions of people in athletic and occupational settings worldwide. The underlying molecular mechanisms in the development of tendinopathy are poorly understood, however, increased mast cell numbers have been detected in human patellar tendinopathy specimens. Mast cells are known to increase fibroblast proliferation and collagen production leading to fibrosis in some tissues. The present study was carried out to determine the effects of mast cells on isolated human tendon fibroblasts (tenocytes) and explore a possible role for mast cells in the development of tendinopathy.MethodsPrimary human tenocytes were isolated from hamstring tendons of healthy donors. Light and electron microscopy were used to examine a physical association between mast cells (HMC-1) and tenocytes, in vitro. Collagen gel contraction assay was used to examine the effects of mast cells on isolated tenocytes. Cell viability and proliferation was assessed by MTS assay. Gene expression was quantitated by qPCR.ResultsHMC-1 mast cells were shown by light and electron microscopy to physically bind to primary tenocytes through adherent junctions. Immunostaining for stem cell factor (SCF), a mast cell growth factor, showed homogeneous expression of this protein on the surface of tenocytes. Additionally, qPCR showed an increase in tenocyte SCF mRNA expression in the presence of mast cells. In other experiments, both mast cells and mast cell sonicates were shown to induce tenocyte mediated contraction of collagen gel, which appeared to be driven by TGF-β1. MTS assay showed a mast cell mediated increase in tenocyte survival and proliferation.DiscussionThese findings suggest that either through physical association with tenocytes and/or release of mediators, mast cells could play a role in the regulation and activation of tenocytes. Further studies are underway to investigate the molecular mechanisms of mast cell-tenocyte interactions and whether these could play a role in the pathogenesis of tendinopathy.