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  • SAGE Publications  (3)
  • 1
    Online Resource
    Online Resource
    Partial Patellar Tendon Tears in Athletes: When Is Surgery Required?
    SAGE Publications ; 2019
    In:  Orthopaedic Journal of Sports Medicine Vol. 7, No. 7_suppl5 ( 2019-07), p. 2325967119S0030-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 7, No. 7_suppl5 ( 2019-07), p. 2325967119S0030-
    Abstract: Partial patellar tendon tears (PPTTs) can be a frustrating injury for athletes and physicians. Determining the location and size of the PPTT are fundamental in understanding prognosis and selecting the most effective treatment. With recent enhancements in MRI quality, the size and dimensions of the tear can be more easily and accurately estimated. While some PPTTs respond to therapy, medication, bracing, biologic injections, and/or ultrasound procedures, other PPTTs in do not respond and require surgical intervention. The goal of this study is to correlate PPTT size and location to clinical outcomes, in order to create a classification system to help guide treatment decisions for athletes with PPTT. Methods: 112 athletic patients (range: 15-45 y/o, mean 23.9+7.2 y/o) who underwent knee MRI were included in this study. 85 of those patients (mean 24.9+8.1 y/o) presented with history and physical examination concerning for recalcitrant patellar tendonitis or suspicion of a partial patellar tendon tear. The other 27 athletic patients (mean 25.6+6.3 y/o) underwent MRI for other pathology and were included as age-matched controls. MR scans were evaluated for patellar tendon tear size, thickness, and location with respect to the entire patellar tendon. Descriptive statistics were used to evaluate tendon size and tear distributions. Pearson correlation, univariate regressions, and logistic regression were performed to correlate tendon geometry and tear sizes. Tear geometry variables were compared to patient outcome measures (return to previous activity level, surgical treatment) using t-tests. Results: 56 out of 85 symptomatic patients had partial patellar tendon tears. 91% of PPTTs involved the posterior and posteromedial region of the proximal patellar tendon (Figure 1). On axial MRI imaging, patients with PPTT had mean tendon thickness of 10 mm compared to 5.9 mm for athletes with no PPTT, including healthy controls (p 〈 .0001). There was a significant correlation between patellar tendon thickness and PPTT size (R=0.85, p 〈 0.0001). Logistic regression analysis showed that athletes with patellar tendon thickness above 7.45 mm are likely to have PPTTs (100% sensitivity). Tear distributions according to MRI grading are shown in Table 1. 11 out of 56 patients underwent surgery for PPTT. All 11 of these patients had tear sizes on axial images 〉 50% of tendon thickness (mean thickness of tear 6.3 mm). Logistic regression showed that patellar tendon thickness 〉 8.8 mm, and/or tear size 〉 55% correlated with surgical intervention. Five of the surgical patients did not make a return to sport at the same level. No patient in this series had surgery for tear thickness less than 4.5 mm. Basketball, track and field and soccer were the most common sports involved in the study. Conclusion: PPTTs are located posterior/posteromedially in the proximal patellar tendon. The most sensitive metric for PPTTs are patellar tendon thickness (anterior to posterior), where thickness more than 8.8 mm is strongly predictive of having a partial tear in the tendon. Athletes with greater than a 55% tear thickness on axial MRI imaging or with a tear measuring more than 4.5 mm on axial cuts are less likely to respond to non-operative treatment. Tracking thickness changes on axial views, specifically in the posterior/posteromedial region, may predict effectiveness of non-operative therapy. [Table: see text][Figure: see text]
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967119S00308
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2706251-X
    SSG: 31
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    Online Resource
  • 2
    Online Resource
    Online Resource
    Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System
    SAGE Publications ; 2020
    In:  The American Journal of Sports Medicine Vol. 48, No. 2 ( 2020-02), p. 359-369
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 48, No. 2 ( 2020-02), p. 359-369
    Abstract: Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines. Purpose: To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)–based classification system for partial patellar tendon injuries. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models. Results: Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without ( P 〈 .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear 〉 50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness 〉 8.8 mm correlated with the presence of a partial tear, while tendon thickness 〉 11.45 mm and tear thickness 〉 55.7% predicted surgical management. Conclusion: Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness 〉 8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness 〉 11.5 mm and/or 〉 50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546519894333
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 3
    Online Resource
    Online Resource
    Enhanced Tendon-to-Bone Healing via IKKβ Inhibition in a Rat Rotator Cuff Model
    SAGE Publications ; 2021
    In:  The American Journal of Sports Medicine Vol. 49, No. 3 ( 2021-03), p. 780-789
    Details
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 49, No. 3 ( 2021-03), p. 780-789
    Abstract: More than 450,000 rotator cuff repairs are performed annually, yet healing of tendon to bone often fails. This failure is rooted in the fibrovascular healing response, which does not regenerate the native attachment site. Better healing outcomes may be achieved by targeting inflammation during the early period after repair. Rather than broad inhibition of inflammation, which may impair healing, the current study utilized a molecularly targeted approach to suppress IKKβ, shutting down only the inflammatory arm of the nuclear factor κB (NF-κB) signaling pathway. Purpose: To evaluate the therapeutic potential of IKKβ inhibition in a clinically relevant model of rat rotator cuff repair. Study Design: Controlled laboratory study. Methods: After validating the efficacy of the IKKβ inhibitor in vitro, it was administered orally once a day for 7 days after surgery in a rat rotator cuff repair model. The effect of treatment on reducing inflammation and improving repair quality was evaluated after 3 days and 2, 4, and 8 weeks of healing, using gene expression, biomechanics, bone morphometry, and histology. Results: Inhibition of IKKβ attenuated cytokine and chemokine production in vitro, demonstrating the potential for this inhibitor to reduce inflammation in vivo. Oral treatment with IKKβ inhibitor reduced NF-κB target gene expression by up to 80% compared with a nontreated group at day 3, with a subset of these genes suppressed through 14 days. Furthermore, the IKKβ inhibitor led to enhanced tenogenesis and extracellular matrix production, as demonstrated by gene expression and histological analyses. At 4 weeks, inhibitor treatment led to increased toughness, no effects on failure load and strength, and decreases in stiffness and modulus when compared with vehicle control. At 8 weeks, IKKβ inhibitor treatment led to increased toughness, failure load, and strength compared with control animals. IKKβ inhibitor treatment prevented the bone loss near the tendon attachment that occurred in repairs in control. Conclusion: Pharmacological inhibition of IKKβ successfully suppressed excessive inflammation and enhanced tendon-to-bone healing after rotator cuff repair in a rat model. Clinical Relevance: The NF-κB pathway is a promising target for enhancing outcomes after rotator cuff repair.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    URL: Article
    DOI: 10.1177/0363546520985203
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2063945-4
    SSG: 31
    Location Call Number Limitation Availability
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    Online Resource
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