Search Results (23)

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

The functional status of the plantaris muscle (PM) remains controversial and is historically dismissed as vestigial; yet, it is increasingly recognized for its structural and clinical complexity. This narrative review synthesizes current evidence from embryological development, adult morphological studies, comparative mammalian anatomy, and clinical case reports to reassess the role of the PM in humans. Developmental data reveal that the PM is consistently present during fetal life, with tendon morphology and insertion patterns emerging early and resembling adult anatomical variants. Rather than indicating postnatal regression, it suggests a stable polymorphism rooted in prenatal development. Across mammalian species, the PM varies in presence and function, correlating with locomotor specialization from proprioception in primates to propulsion in carnivores, and absence in ungulates. In humans, high proprioceptive fiber density and anatomical variability support the hypothesis that the PM may be undergoing functional repurposing from a contractile to a sensorimotor role. Clinically, its relevance is evident in imaging interpretation, surgical tendon harvesting, and the pathophysiology of Achilles tendinopathy. Recent discoveries, including the identification of the plantaris ligamentous tendon (PLT), further underscore the complexity of this region and support the need to reassess its structural and clinical significance. We conclude that the PM should not be regarded as a regressing remnant but as a dynamically adapting structure with potential neuromechanical function. Future studies involving electromyography and neuroanatomical mapping are essential to elucidate its evolving role. Full article

Background: Patellar tendinopathy is a musculoskeletal pain condition capable of impairing physical or sport activities. Preliminary evidence supports the efficacy of percutaneous electrolysis (PE) in reducing pain and related disability in patients with patellar tendinopathy. Objective: This study proposes a theoretical model for the application of a percutaneous electrolysis approach targeting the deep zone of the proximal and distal parts of the patellar tendon in both human (ultrasound-guided) and fresh cadaver (not ultrasound-guided) models. Methods: A filiform solid needle was inserted from the lateral side of the patellar tendon targeting two areas: 1, the deep proximal interface of the Hoffa’s fat pad; and 2, the distal insertion of the patellar tendon at the tibial tuberosity in 10 fresh cadavers and in 10 healthy individuals. The patellar tendon, the saphenous nerve, and the infrapatellar nerve and its branches were identified by dissecting fresh cadavers to determine the anatomical trajectory of the infrapatellar nerve branches in relation to the needle. Results: The cadaveric model shows an anatomical relationship between the patellar tendon and infrapatellar nerve branches at the medial part of the knee. Infrapatellar nerve branches ran subcutaneously obliquely from the medial to the anterior and lateral parts of the knee, crossing in front of the patellar tendon. In all cadavers, the superior and inferior infrapatellar branches ran through the superior or inferior parts of the medial knee area. Only in 2/10 knees infrapatellar nerve branches reached the lateral part of the knee, specifically the superior lateral part. No neurovascular bundle of infrapatellar nerve branches was pierced in any insertion when the needle was inserted from the lateral part of the knee. Conclusion: This anatomical model supports the use of a lateral approach as a potentially safe approach to apply in needling interventions, e.g., percutaneous electrolysis for patellar tendinopathies. The infrapatellar nerve branches are vulnerable to needle procedures applied through the anteromedial side of the knee. Full article

(1) Background: Patellar and Achilles tendon injuries have become increasingly prevalent, particularly among active populations and athletes, leading to significant functional impairments. While B-Mode ultrasound has been useful in the diagnosis of these injuries, its capacity to assess tendon mechanical properties, such as stiffness, is limited. Shear wave elastography (SWE) offers a promising alternative by measuring tissue stiffness, which may enhance the evaluation of tendon health. Previous studies have established that SWE can differentiate healthy tendons from those with pathological changes. However, reference values for specific tendon types, including the patellar and Achilles tendons, remain limited. This study aims to provide preliminary baseline SWE values for these tendons in a healthy cohort. (2) Methods: In this cross-sectional study, healthy volunteers aged 18–65, with no history of lower extremity injury, were assessed using a Samsung RS85 Prestige ultrasound system with a 14L-2 MHz transducer. SWE measurements were obtained from the patellar tendon at a single location and from the Achilles tendon at both the midportion and insertional sites. All assessments followed a standardized protocol to ensure consistency and minimize variability. (3) Results: A total of 54 healthy adult participants were included. The mean SWE value for the patellar tendon was 96.3 (SD = 10.9 kPa), with males showing significantly higher stiffness than females (99.3 kPa vs. 93.8 kPa, p = 0.009). A higher BMI was associated with lower stiffness in the patellar tendon. The mean SWE values for the Achilles tendon were 101.7 (SD = 16.2 kPa) at the insertion and 145.6 (SD = 18.8 kPa) at the midportion. (4) Conclusions: This study provides SWE values for the patellar and Achilles tendons in healthy individuals, which can serve as a foundation for future research and clinical applications. These values may help in the comparison of healthy and pathological tendons, particularly in the context of tendinopathies, tendon tears, and treatment monitoring. While shear wave elasticity shows promise as a tool for diagnosing and monitoring tendon injuries and degeneration, more research is required to establish its precise reliability and validity in clinical practice. Full article

Background: This paper examines the diverse etiologies of medial knee pain, emphasizing the prevalence of calcification-related pathologies, such as Pellegrini–Stieda Syndrome (PSS), particularly in the medial collateral ligament (MCL) and adjacent structures. Furthermore, we present a case of calcification of the distal adductor magnus tendon (DAMT) insertion into the femoral condyle of the knee and describe its treatment using ultrasound-guided percutaneous lavage (UGPL). A narrative review was conducted based on a single case; it underscores the importance of accurate diagnosis using magnetic resonance imaging (MRI) to differentiate between various calcific conditions, guiding appropriate treatment strategies. Case Presentation: A 70-year-old patient presenting with severe medial knee pain, with a duration of 4 days, and functional impotence underwent X-ray, ultrasound, and magnetic resonance imaging (MRI) examinations, revealing calcification in the DAMT. Treatment consisted of UGPL. The patient’s pain level was assessed using the visual analog scale (VAS) initially and after 30 days of treatment. Upon initial assessment, the patient reported a VAS score of 9 out of 10. After 30 days of completing the treatment, the symptoms ceased. Follow-up imaging (X-ray, ultrasound, and MRI) showed only very tiny fragments of calcification remaining. Conclusions: UGPL is an effective technique for treating calcific tendinopathy of the DAMT insertion into the medial femoral condyle of the knee, offering significant pain relief and functional improvement. This case highlights the importance of considering this rare condition in the differential diagnosis of medial knee pain. Full article

Introduction: Diabetes mellitus (DM) is associated with a high risk of chronic degenerative Achilles (AT) and Patellar (PT) tendinopathies and ruptures. Growth factors (GFs) synthesis in diabetics is substantially decreased in human connective tissues, including in tendons. Platelet Rich Plasma (PRP), which is enriched in GFs, might prove of great help in tendon healing. The aim of the study was to assess whether pre-existent DM or Impaired Glucose Tolerance (IGT) could influence the clinical outcome in subjects undergoing PRP treatment. Methods: Sixty subjects with diabetes/pre-diabetes and sixty euglycemic controls, matched for sex and age, were enrolled. Patients suffering from proximal insertional PT and mid-portion AT, treated with PRP therapy, were included in the study. To assess the basal status and the efficacy of the therapy after 3 and 6 months, the Victorian Institute of Sport Assessment (VISA) questionnaire and the Ultrasound methodology study were used. Patient satisfaction was assessed by means of the Likert Scale. Results: In the population study at 6 months, the mean VISA-score increased (8.92 ± 0.67; p-value < 0.001). The improvement in the diabetic group was less evident compared to the controls (−2.76 ± 0.95; p-value = 0.003). Even though the improvement was poor, it was still significant. MCID analysis revealed that diabetics had higher risk of therapeutic unsuccess. Logistic regression analysis was applied to assess factors associated with unsatisfactory results (Likert-scale) of PRP treatment: AT (O.R.: 3.05; 95%CI: 1.40–6.64; p-value = 0.005), higher BMI values (O.R.: 1.02; 95%CI: 1.01–1.04; p-value = 0.01), and lower VISA score values at baseline (O.R.: 0.95; 95%CI: 0.90–0.99; p-value = 0.04). Conclusions: PRP treatment in AT and PT chronic tendinopathies resulted in less favorable results in subjects with diabetes compared with euglycemic subjects. Moreover, the subjects with PT showed better results than those with AT. Full article

Objective quantification of tendon structural changes through imaging is only achieved by evaluating tendon structure using ultrasound tissue characterization (UTC) technology. This study compares the effects of bone marrow mesenchymal stromal cells (BM-MSC) and leukocyte-poor platelet-rich plasma (Lp-PRP) on tendon structure and clinical outcomes in male patients with patellar tendinopathy measured with UTC at 3, 6, and 12 months after treatment. This is a double-blinded clinical trial with a randomized active control study with 20 male patients diagnosed with patellar tendinopathy who underwent BM-MSC and Lp-PRP. Bilateral ultrasound tissue characterization scans of the patellar tendon were carried out after 3, 6, and 12 months, as well as tests for strength and pain. UTC patellar tendon was analyzed at the insertion, proximal, and mid-tendon. BM-MSC showed a greater capacity to promote further positive changes than Lp-PRP. Lp-PRP presented higher disorganized echo-type II in the mid-tendon (p = 0.04; ES = 1.06) and III (p = 0.02; ES = −1.47) after 3 months in the Lp-PRP group. Similar results were seen after 6 and 12 months. Pain and strength data show improvement in the treated tendon. BM-MSC treatment demonstrates a superior capacity to promote tendon regeneration and organization, restore strength, and reduce pain compared to Lp-PRP, after 3, 6, and 12 months in male patients with patellar tendinopathy. Full article

Background: The cortical desmoid (DFCI) of the posteromedial femoral condyle is considered an asymptomatic incidental finding in adolescents without clinical relevance. The aim of this study was to evaluate the clinical relevance of DFCI from both a tumor orthopedic and sports medicine point of view. Methods: n = 23 patients (13.74 ± 2.74 years; nineteen female, four male) with DFCI of the posteromedial femoral condyle were included. A localized posteromedial knee pain on exertion was differentiated from non-specific knee pain. Symptom duration, additional pathologies, number of MRIs, sports activity and training intensity, downtime, therapeutic modalities, and relief/remission of symptoms were documented. The Tegner activity scale (TAS) and Lysholm score (LS) were collected. The influence of specific posteromedial pain, MRI presence of paratendinous cysts, sports level as well as physiotherapy on downtime and LS/TAS was statistically analyzed. Results: 100% reported knee symptoms at initial presentation. A localized posteromedial pain was documented in 52%. In 16/23 (70%) additional functional pathologies were diagnosed. Patients were physically highly active with high training intensities (6.52 ± 5.87 h/week) and performance level (65% competitive vs. 35% recreational). Patients underwent 1.91 ± 0.97 MRIs (max four). Symptom duration was 10.48 ± 11.02 weeks. A follow-up examination was performed after 12.62 ± 10.41 months (n = two lost to follow-up). 17/21 had physiotherapy, on average 17.06 ± 13.33 units. Overall downtime was 13.39 ± 12.50 weeks, the return-to-sports (RTS) rate 81%. 100%/38% reported a relief/remission of complaints. LS was 93.29 ± 7.95, median TAS before onset of knee complaints/at follow-up 7 (6–7)/7 (5–7). Specific posteromedial pain, presence of paratendinous cysts, sports level and physiotherapy had no significant influence on downtime and outcome parameters (n.s.). Conclusions: DFCI as a pathognomonic finding is recurrently encountered in the MRIs of children and adolescents. This knowledge is essential to spare patients from overtreatment. Contrary to the literature, the present results implicate a clinical relevance of DFCI particularly in those who are physically highly active with localized pain on exertion. Structured physiotherapy as basic treatment is recommended. Full article

(1) Background: Achilles tendinopathy (AT) is characterized by load-induced tendon pain, stiffness, and functional impairment that may affect the tendon midportion or insertion. Platelet-rich fibrin matrix (PRFM) is a promising adjunctive therapy for AT. We analyzed 24-month pain and functional outcomes in a cohort of patients managed by tendon debridement and autologous PRFM application to determine whether the combined treatment ensured an early return to sports/work and satisfactory clinical outcomes and functional scores. (2) Methods: The 24-month outcomes of 32 sport-practicing patients with chronic midportion AT treated with debridement and autologous PRFM were evaluated in terms of time to return to sports/work. The AOFAS and VISA-A were computed preoperatively and at 6 and 24 months. Blazina scores were evaluated preoperatively and at 6 months; ankle range of motion was assessed at 1, 6, 12, 24 months; and patient satisfaction was assessed at 24 months. (3) Results: Altogether, all patients had resumed their sport(s) activity, at the same or higher level, after 25.41 days (±5.37). Regarding work, all patients were able to return to their jobs after 16.41 days (±2.43). Ankle dorsiflexion and plantarflexion increased significantly: the AOFAS rose from 54.56 (±6.47) to 97.06 (±4.06) and 98.88 (±2.21) at 6 and 12 months, respectively, and the mean VISA-A score rose from 69.16 (±7.35) preoperatively to 95.03 (±4.67) and 97.28 (±2.43) at 6 and 12 months, respectively, after treatment. There were no complications. Most (90.62%) patients were very satisfied. (4) Conclusions: In symptomatic midportion AT, surgical debridement and autologous PRFM ensured a fast return to sports/work (4 weeks), significantly improving AOFAS and VISA-A and Blazina scores already at 6 months and providing excellent clinical outcomes at 24 months. Full article

Background: This study aimed to compare the knotless internal brace technique and the knot-tying suture bridge technique via the medial approach in the treatment of calcific Achilles tendinopathy. Methods: The clinical data of 25 cases of calcific Achilles tendinopathy in which nonoperative treatments had failed were retrospectively collected. All the patients received Achilles tendon debridement and Haglund deformity excision through a medial approach, followed by repair using the knotless internal brace technique or the knot-tying suture bridge technique. Pain was evaluated by using the visual analog scale (VAS). The American Orthopedic Foot and Ankle Score (AOFAS) questionnaire was administered preoperatively and postoperatively. Results: The mean follow-up time was 2.6 (range 2–3.5) years. There were no wound complications and no Achilles tendon ruptures. At 1 year postoperatively, the internal brace group was superior to the suture bridge group in terms of the VAS scores (p = 0.003). However, no differences were noticed between the two groups in either the VAS or the AOFAS scores at 2 years postoperatively. Conclusions: The medial approach in combination with the suture bridge technique was effective in treating calcific Achilles tendinopathy. The knotless internal brace technique involved less pain compared to the knot-tying suture bridge technique only at the early postoperative stage. Full article

(1) Background: two forms of supraspinatus tendinopathy (ST) have been reported in dogs: mineralized and non-mineralized. Surgical treatment consists of longitudinal incisions (splitting) in the tendon of insertion of the supraspinatus muscle. The purpose of this retrospective study is to describe the diagnostic workout, the surgical procedure and the short and long term follow up of dogs treated for non-mineralized ST. (2) Methods: medical records (2010–2017) of dogs diagnosed with non-mineralized ST that underwent surgical treatment were reviewed. Data retrieved were: signalment, history, clinical signs, orthopaedic examination findings, diagnostic imaging findings, surgical treatment, histopathologic diagnosis and clinical outcome. (3) Results: A total of 27 dogs met the inclusion criteria. The most consistent clinical findings were intermittent lameness accompanied by pain on palpation of the insertion of the supraspinatus. Magnetic resonance imaging (MRI) of 27 shoulders distended sheaths of the biceps tendon (10/27), compression of the biceps brachii tendon sheaths (5/27) and enlargement of the supraspinatus tendon (3/27) were observed. The most prominent histologic finding was severe myxomatous degeneration in all 27 samples. Resolution of lameness was achieved in 80% of the cases surgically treated without any further lameness episodes in the long-term follow-up. (4) Conclusions: the surgical splitting of the non-mineralized supraspinatus tendon is an effective procedure with no intra-operative complications and a low incidence of minor (18%) and major (4%) complications. Full article

Distal biceps brachii tendinopathy is a musculoskeletal pain condition—comprising chronic intrasubstance degeneration with alterations of the tendon structure—that is difficult to treat. Preliminary evidence suggests a positive effect for pain and related disability of percutaneous electrolysis treatment in patients with tendinopathy. Ultrasound is an excellent diagnostic tool to identify tendon injuries, such as tendinopathy, and to guide treatment approaches. Different approaches using ultrasound evaluation of the biceps tendon have been described. Our aim was to determine the validity and safety of a percutaneous electrolysis approach, targeting insertion of the distal tendon of biceps brachii, in both human (ultrasound-guided) and Thiel-embalmed cadaver (not ultrasound-guided) models. There were two approaches evaluated: an anterior approach with the elbow in extension and the forearm in supination and a posterior approach with the elbow in flexion and the forearm in pronation. A needle was inserted following the tendon up to its insertion into the radial tuberosity. The anterior approach, both in cadaveric study and US-guided intervention, revealed a close relationship between the distal biceps tendon and the brachial artery. The mean distance of the depth of the biceps tendon distal to the brachial artery was 0.21 ± 0.021 cm in the cadavers and 0.51 ± 0.024 cm in subjects. It was also found that the anterior approach has a potential technical difficulty due to the anatomical location of the brachial artery. With the posterior approach, it was possible to safely identify the tendon insertion and the needle approach, since no important vascular and nervous structures were visualized in the window of insertion of the needle. The clinician rated the posterior approach as low difficulty in all subjects. Current results would support a posterior approach with US guidance as a safe approach for applying the percutaneous electrolysis technique for insertional tendinopathies of the distal biceps brachii tendon. The current study did not assess the effectiveness of the proposed intervention; accordingly, future studies investigating the clinical effectiveness of the proposed intervention are needed. Full article

Achilles tendinopathy (AT) is the most common injury of the Achilles tendon and represents 55–65% of all Achilles tendon clinical diagnoses. AT is characterized by pain, swelling, and impaired performance. ATs can be divided into two types, according to anatomical location—midportion AT (MAT) and insertional AT (IAT). MAT more often occurs in older, less active, and overweight populations, while IAT usually occurs in the more physically active population. Both types of AT can be treated by different treatments, such as surgery, conservative pharmacological treatments, and conservative nonpharmacological treatments. This umbrella review aims to assemble the evidence from all available systematic reviews and/or meta-analyses to determine which conservative nonpharmacological treatments are most commonly used and have the greatest effects. Three major electronic scientific databases (PubMed, Scopus, and Web of Science) were screened. The reference lists of several recent articles on AT were also searched. We found 50 articles that met the inclusion criteria. The methodological quality of the included articles was assessed using the AMSTAR 2 tool. Eccentric (ECC) exercise, isotonic (ISOT) exercise, and acupuncture treatment showed the greatest effects for treating MAT as a standalone therapy. Meanwhile, extracorporeal shockwave therapy and ECC exercise provided the best outcomes for treating IAT as individual treatments. However, an even greater pain decrease, greater function improvement, and greater patient satisfaction for treating either MAT or IAT were achieved with combined protocols of ECC exercise with extracorporeal shockwave therapy (in both cases), ECC exercise with cold air and high-energy laser therapy (in the case of IAT), or ECC exercise with ASTYM therapy (in the case of IAT). Full article

Achilles tendon tendinopathy (AT) is a musculoskeletal condition characterized by pain in the Achilles tendon and impaired physical performance or sport activities. AT is difficult to treat, and the results are variable. Preliminary evidence suggests a positive effect for pain of percutaneous electrolysis in patients with tendinopathy. Our aim was to determine the validity and safety of a percutaneous electrolysis approach targeting the interphase between the Achilles tendon and the Kager’s fat with ultrasound imaging in both healthy individuals and on a fresh cadaver model (not ultrasound guiding). A needle was inserted from the medial to the lateral side under the body of the Achilles tendon, just between the tendon and the Kager’s triangle, about 5 cm from the insertion of tendon in the calcaneus in 10 healthy volunteers (ultrasound study) and 10 fresh cadaver legs. An accurate needle penetration of the interphase was observed in 100% of the approaches, in both human and cadaveric models. No neurovascular bundle of the sural nerve was pierced in any insertion. The distance from the tip of the needle to the sural nerve was 5.28 ± 0.7 mms in the cadavers and 4.95 ± 0.68 mms in the volunteer subjects, measured in both cases at a distance of 5 cm from the insertion of the Achilles tendon. The results of the current study support that percutaneous electrolysis can be safely performed at the Kager’s fat–Achilles tendon interphase if it is US guided. In fact, penetration of the sural nerve was not observed in any needle approach when percutaneous needling electrolysis was performed by an experienced clinician. Future studies investigating the clinical effectiveness of the proposed intervention are needed. Full article

Calcific shoulder tendinopathy (CT) is a common condition involving the central part or insertion of the rotator cuff tendons (RC) or the subacromial-subdeltoid bursa (SASD). The calcific deposits consist of poorly crystallized calcium hydroxyapatite but the mechanism of their formation still remains unclear. CT can be divided into three distinct stages, as reported by Uthhoff et al. Clinically, this condition varies with the extent of the calcification and the phase of the condition. In particular, the disorder is asymptomatic or may cause mild discomfort during the deposition of calcium, while it becomes acutely painful during the resorptive phase. US-PICT (ultrasound-guided percutaneous irrigation of calcific tendinopathy) is indicated in the acute phase (resorptive phase) of CT with significant pain relief and a very low rate of minor complications. The aim of this manuscript is to define the rationale of the ultrasound-guided percutaneous irrigation of calcific tendinopathy, correlating it with the sequence of biochemical processes that lead to the hydrolysis of hydroxyapatite. Furthermore, we will explain the reasons why we prefer using the three-needle technique for the dissolution of calcifications. Full article