Tendon disorders are frequent and are responsible for substantial morbidity both in sports and in the workplace. Tendinopathy, as opposed to tendinitis or tendinosis, is the best generic descriptive term for the clinical conditions in and around tendons arising from overuse. Tendinopathy is a difficult problem requiring lengthy management, and patients often respond poorly to treatment. Preexisting degeneration has been implicated as a risk factor for acute tendon rupture. Several physical modalities have been developed to treat tendinopathy. There is limited and mixed high-level evidence to support the, albeit common, clinical use of these modalities. Further research and scientific evaluation are required before biological solutions become realistic options.

http://health120years.com/cn/pdf/hd_tendonopathy_tendinosis_healing_repair.pdf

Tendon injury and tendinopathy: healing and repair.

Study design Prospective, randomized, controlled study of patients with lumbar disc herniations, operated either in a full-endoscopic or microsurgical technique. Objective Comparison of results of lumbar discectomies in full-endoscopic interlaminar and transforaminal technique with the conventional microsurgical technique. Summary of background data Even with good results, conventional disc operations may result in subsequent damage due to trauma. Endoscopic techniques have become the standard in many areas because of the advantages they offer intraoperatively and after surgery. With the transforaminal and interlaminar techniques, 2 full-endoscopic procedures are available for lumbar disc operations. Methods One hundred seventy-eight patients with full-endoscopic or microsurgical discectomy underwent follow-up for 2 years. In addition to general and specific parameters, the following measuring instruments were used: VAS, German version North American Spine Society Instrument, Oswestry Low-Back Pain Disability Questionnaire. Results After surgery 82% of the patients no longer had leg pain, and 14% had occasional pain. The clinical results were the same in both groups. The recurrence rate was 6.2% with no difference between the groups. The full-endoscopic techniques brought significant advantages in the following areas: back pain, rehabilitation, complications, and traumatization. Conclusion The clinical results of the full-endoscopic technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique and reduced traumatization. With the surgical devices and the possibility of selecting an interlaminar or posterolateral to lateral transforaminal procedure, lumbar disc herniations outside and inside the spinal canal can be sufficiently removed using the full-endoscopic technique, when taking the appropriate criteria into account. Full-endoscopic surgery is a sufficient and safe supplementation and alternative to microsurgical procedures.

/pdf/full-endoscopic-interlaminar-and-transforaminal-lumbar-11pyc9rl5q.pdf

Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study.

http://dlweb01.tzuchi.com.tw/DL/AcdActive/content/research/document/tjc/chen/shockwave%20induced%20neovascularization%20at%20tendon%20bone%20junction---2003%20JOR.pdf

Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits.

Background: Platelet-rich plasma (PRP) has been shown to be a general stimulation for repair and 1-year results showed promising success percentages. Purpose: This trial was undertaken to determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis with a 2-year follow-up. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: The trial was conducted in 2 Dutch teaching hospitals. One hundred patients with chronic lateral epicondylitis were randomly assigned to a leukocyte-enriched PRP group (n = 51) or the corticosteroid group (n = 49). Randomization and allocation to the trial group were carried out by a central computer system. Patients received either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique. The primary analysis included visual analog scale (VAS) pain scores and Disabilities of the Arm, Shoulder and Hand (DASH) outcome scores. Results: The PRP group was more often successfully treated than the corticosteroid group (P\.0001). Success was defined as a reduction of 25% on VAS or DASH scores without a reintervention after 2 years. When baseline VAS and DASH scores were compared with the scores at 2-year follow-up, both groups significantly improved across time (intention-to-treat principle). However, the DASH scores of the corticosteroid group returned to baseline levels, while those of the PRP group significantly improved (as-treated principle). There were no complications related to the use of PRP. Conclusion: Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and increases function significantly, exceeding the effect of corticosteroid injection even after a follow-up of 2 years. Future decisions for application of PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.

/pdf/ongoing-positive-effect-of-platelet-rich-plasma-versus-212qfavttw.pdf

Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis: A Double-Blind Randomized Controlled Trial With 2-year Follow-up

Study design A prospective study of the accuracy of thoracic pedicle screw placement in patients with idiopathic scoliosis. Objectives To evaluate the accuracy of thoracic pedicle screw placement in the surgical management of idiopathic scoliosis and to establish its risks and benefits. Summary of background data Lumbar pedicle screw instrumentation has proven to be reliable and effective in the surgical management of scoliosis. No reports exist on the accuracy and benefits of pedicle screw instrumentation of the thoracic spine in scoliosis surgery. Methods One hundred and twenty thoracic pedicle screws in 32 consecutively treated patients with idiopathic scoliosis were investigated immediately after surgery by computed tomography scans that were analyzed by three examiners. Results Thirty (25%) of the screws penetrated the pedicle cortex or the vertebral body anterior cortex. Ten screws (8.3%) penetrated the medial cortex of the pedicle by an average of 1.5 mm and a maximum of 3.0 mm. Seventeen screws (14.2%) penetrated laterally by an average of 2.1 mm. There were two cases of caudad penetration. Three screws penetrated the anterior vertebral cortex, of which two also penetrated the pedicle cortex. Also, one of these three screws was replaced because of its direct proximity to the thoracic aorta. There were no neurologic complications. The correlation between the pedicle cortical penetration rate and the preoperative Cobb angle, vertebral rotation or level, or site of screw insertion was statistically insignificant (P > 0.05). Curve correction in the cases of mainly hook instrumentation averaged 52.5% versus 59.2% in the cases of mainly screw instrumentation. This difference was statistically insignificant (P > 0.05). Conclusions Pedicle or vertebral body cortical penetration occurred with 25% of the screws but with no neurologic compromise. Curve correction was slightly greater than with hooks, but not to a statistically significant extent.

Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis.

We report a controlled, prospective study to investigate the effect of treatment by low-energy extracorporeal shock waves on pain in tennis elbow. We assigned at random 100 patients who had had symptoms for more than 12 months to two groups to receive low-energy shock-wave therapy. Group I received a total of 3000 impulses of 0.08 mJ/mm 2 and group II, the control group, 30 impulses. The patients were reviewed after 3, 6 and 24 weeks. There was significant alleviation of pain and improvement of function after treatment in group I in which there was a good or excellent outcome in 48% and an acceptable result in 42% at the final review, compared with 6% and 24%, respectively, in group II.

/pdf/analgesic-effect-of-extracorporeal-shock-wave-therapy-on-4sezzac8bi.pdf

Analgesic effect of extracorporeal shock-wave therapy on chronic tennis elbow

We aimed to determine whether extracorporeal shock waves of varying intensity would damage the intact tendo Achillis and paratenon in a rabbit model. We used 42 female New Zealand white rabbits randomly divided into four groups as follows: group a received 1000 shock-wave impulses of an energy flux density of 0.08 mJ/mm2, group b 1000 impulses of 0.28 mJ/mm2, group c 1000 impulses of 0.60 mJ/mm2, and group d was a control group. Sonographic and histological evaluation showed no changes in group a, and transient swelling of the tendon with a minor inflammatory reaction in group b. Group c had formation of paratendinous fluid with a significant increase in the anteroposterior diameter of the tendon. In this group there were marked histological changes with increased eosin staining, fibrinoid necrosis, fibrosis in the paratenon and infiltration of inflammatory cells. We conclude that there are dose-dependent changes in the tendon and paratenon after extracorporeal shock-wave therapy and that energy flux densities of over 0.28 mJ/mm should not be used clinically in the treatment of tendon disorders.

Dose-related effects of shock waves on rabbit tendo Achillis A SONOGRAPHIC AND HISTOLOGICAL STUDY

We aimed to determine whether extracorporeal shock waves of varying intensity would damage the intact tendo Achillis and paratenon in a rabbit model. We used 42 female New Zealand white rabbits randomly divided into four groups as follows: group a received 1000 shock-wave impulses of an energy flux density of 0.08 mJ/mm2, group b 1000 impulses of 0.28 mJ/mm2, group c 1000 impulses of 0.60 mJ/mm2, and group d was a control group.

Sonographic and histological evaluation showed no changes in group a, and transient swelling of the tendon with a minor inflammatory reaction in group b. Group c had formation of paratendinous fluid with a significant increase in the anteroposterior diameter of the tendon. In this group there were marked histological changes with increased eosin staining, fibrinoid necrosis, fibrosis in the paratenon and infiltration of inflammatory cells.

We conclude that there are dose-dependent changes in the tendon and paratenon after extracorporeal shock-wave therapy and that energy flux densities of over 0.28 mJ/mm2 should not be used clinically in the treatment of tendon disorders.

Dose-related effects of shock waves on rabbit tendo Achillis

The operative results of 23 patients with a specific or unspecific spondylodiscitis were documented over 2 years after the focus of the inflammation had been eradicated, bone chip had been interposed and a CDH instrumentation had been performed by an anterior approach only. These outcomes were compared with the results of 32 patients in whom the focus had been removed and the defect had been filled with bone graft from an anterior approach, followed by stabilisation with CD instrumentation through an additional dorsal approach. In the cases where CDH instrumentation was applied, the range of fusion averaged 1.3 segments. This was clearly less extensive than in dorsoventral stabilisation, in which on average 3.5 segments were fused. In 47 of 55 cases mobilisation was achieved without orthesis. Eight months after the operations bony fusion could be observed radiologically in all patients. The mean preoperative kyphotic angle of the affected segments was 14.4°, compared to 4° after the operation. The mean loss of reposition was measured to be about 2.7° in both groups. Average operation time and blood loss were about 50% higher in the patients treated dorsoventrally. We conclude that even in the case of florid spondylodiscitis, a short-range anterior fusion of the affected spinal segment may be performed by use of a stable-angle implant without an increased risk of infection-related loosening.

Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study.

Question The long-term analgetic effect of low-energetic shock-wave therapy in heel spur for two different numbers of applicated impulses is investigated. Methods 50 patients with recalcitrant heel pain and a plantar calcaneal spur on the X-ray received in a controlled, prospective and randomized study low-energetic extracorporal shock-wave-therapy. The first group received 3 x 500 impulses and the second group 3 x 100 impulses of 0.08 mJ/mm2 with an experimental device. The follow-up was 1 1/2, 3 and by telephone after 12 months. Results There was clear improvement and relief of pain in both groups on manual pressure and while walking and an increase of the pain-free walking ability from 10 minutes before the treatment to 2 and 3 hours respectively after 12 months. We saw a significantly better results after the treatment with 3 x 500 impulses. Conclusion The extracorporal shock-wave therapy is an effective treatment in refractory heel pain. An amount of at least 3 x 500 impulses in the low energetic treatment is useful.

J.-D. Rompe

Papers

Analgesic effect of extracorporeal shock-wave therapy on chronic tennis elbow

Dose-related effects of shock waves on rabbit tendo Achillis A SONOGRAPHIC AND HISTOLOGICAL STUDY

Dose-related effects of shock waves on rabbit tendo Achillis

Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis? Results of a comparative study.

[Symptomatic low-energy shockwave therapy in heel pain and radiologically detected plantar heel spur].