injuryupdate
02-03-2005, 03:26 PM
A recent study has shown, in rats, that Synvisc injections may be helpful in healing Achilles tendon lesions.
Synvisc costs a lot ($450 per course) and it hasn't been trialled in humans. However there are a lot of similarities between tendon and cartilage and maybe Synvisc can work for tendons as well.
On exactly the opposite tack, the Europeans use Aprotinin for knee osteoarthritis and describe good results.
The authors don't like cortisone for tendinopathy and in fact used cortisone to CAUSE tendon degeneration.
See the following two Pubmed abstracts:
Arch Phys Med Rehabil. 2004 Sep;85(9):1470-4. Effect of hylan G-F 20 in Achilles' tendonitis: an experimental study in rats. Tatari H, Skiak E, Destan H, Ulukus C, Ozer E, Satoglu S.
Department of Orthopaedics and Traumatology, Dokuz Eylul University, School of Medicine, Izmir, Turkey. hasan.tatari@deu.edu.tr
OBJECTIVE: To investigate the local effects of hylan G-F 20 on locally administered corticosteroid-induced experimental Achilles' tendonitis. DESIGN: Before-after trial. SETTING: Institutional practice. ANIMALS: Convenience sample of 18 male Wistar white rats (weight range, 322-375 g). INTERVENTIONS: After performing Achilles' degeneration with local corticosteroid injections, the rats were divided into 4 groups. The right Achilles' tendon of the rats served as the hylan injection group and the left tendon as the control group, which was injected with saline at 5-day intervals. The tendons and paratenons were excised at the end of 60 or 75 days and evaluated histopathologically and statistically. MAIN OUTCOME MEASURE: Histopathologic changes, including staining affinity, nuclear appearance, fibrillar appearance for tendon and thickness, occurrence of fibrosis and edema, capillary changes, and inflammation for paratenon, were assessed according to a semiquantitative scoring system. The Mann-Whitney U test was used for statistical analysis, with a P value of.05 or less considered statistically significant. RESULTS: Semiquantitative scoring of histopathologic changes showed that histologic appearances differed between the hylan and saline groups and between 2 hylan groups. Hylan-injected tendons and paratenons demonstrated significantly lower scores, especially after 75 days. CONCLUSIONS: Hylan G-F 20 has a promising curative effect on the tendon and paratenon and can be used in Achilles' tendonitis. This finding should be supported by biomechanical and biochemical studies.
AND:
Arch Orthop Trauma Surg. 2001 Jun;121(6):333-7. Deleterious effects of local corticosteroid injections on the Achilles tendon of rats. Tatari H, Kosay C, Baran O, Ozcan O, Ozer E.
Dokuz Eylul University, School of Medicine, Department of Orthopaedics and Traumatology, Inciralti, Izmir, Turkey. hasan.tatar@deu.edu.tr
The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon.
Synvisc costs a lot ($450 per course) and it hasn't been trialled in humans. However there are a lot of similarities between tendon and cartilage and maybe Synvisc can work for tendons as well.
On exactly the opposite tack, the Europeans use Aprotinin for knee osteoarthritis and describe good results.
The authors don't like cortisone for tendinopathy and in fact used cortisone to CAUSE tendon degeneration.
See the following two Pubmed abstracts:
Arch Phys Med Rehabil. 2004 Sep;85(9):1470-4. Effect of hylan G-F 20 in Achilles' tendonitis: an experimental study in rats. Tatari H, Skiak E, Destan H, Ulukus C, Ozer E, Satoglu S.
Department of Orthopaedics and Traumatology, Dokuz Eylul University, School of Medicine, Izmir, Turkey. hasan.tatari@deu.edu.tr
OBJECTIVE: To investigate the local effects of hylan G-F 20 on locally administered corticosteroid-induced experimental Achilles' tendonitis. DESIGN: Before-after trial. SETTING: Institutional practice. ANIMALS: Convenience sample of 18 male Wistar white rats (weight range, 322-375 g). INTERVENTIONS: After performing Achilles' degeneration with local corticosteroid injections, the rats were divided into 4 groups. The right Achilles' tendon of the rats served as the hylan injection group and the left tendon as the control group, which was injected with saline at 5-day intervals. The tendons and paratenons were excised at the end of 60 or 75 days and evaluated histopathologically and statistically. MAIN OUTCOME MEASURE: Histopathologic changes, including staining affinity, nuclear appearance, fibrillar appearance for tendon and thickness, occurrence of fibrosis and edema, capillary changes, and inflammation for paratenon, were assessed according to a semiquantitative scoring system. The Mann-Whitney U test was used for statistical analysis, with a P value of.05 or less considered statistically significant. RESULTS: Semiquantitative scoring of histopathologic changes showed that histologic appearances differed between the hylan and saline groups and between 2 hylan groups. Hylan-injected tendons and paratenons demonstrated significantly lower scores, especially after 75 days. CONCLUSIONS: Hylan G-F 20 has a promising curative effect on the tendon and paratenon and can be used in Achilles' tendonitis. This finding should be supported by biomechanical and biochemical studies.
AND:
Arch Orthop Trauma Surg. 2001 Jun;121(6):333-7. Deleterious effects of local corticosteroid injections on the Achilles tendon of rats. Tatari H, Kosay C, Baran O, Ozcan O, Ozer E.
Dokuz Eylul University, School of Medicine, Department of Orthopaedics and Traumatology, Inciralti, Izmir, Turkey. hasan.tatar@deu.edu.tr
The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon.