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Background: The literature supports fusion as the surgical treatment of choice for stage III posterior tibial tendon dysfunction (PTTD). The present study reports the radiographic correction following a modified triple arthrodesis (fusions of the subtalar, talonavicular, and first tarsometatarsal joints) in patients with stage III PTTD. Methods: An institutional review board–approved retrospective study was performed to assess the radiographic outcome of a modified triple arthrodesis in 21 patients (22 feet). Pre- and postoperative weight-bearing radiographs were reviewed in a blinded fashion by clinicians of varying levels of training. The talo–first metatarsal, talocalcaneal, and talonavicular coverage angles were measured on anteroposterior views. On lateral views, the talo–first metatarsal (Meary’s), talocalcaneal, calcaneal pitch, and talar declination angles and the medial cuneiform to floor distance were measured. Statistical analysis was performed to compare pre- and postoperative measurements, assess the degree of correction, and determine interobserver reliability of the radiographic measurements. Results: All measurements improved significantly after treatment with a modified triple arthrodesis ( P ≤ .001). The medial cuneiform to floor distance (0.910), talonavicular coverage angle (0.896), and lateral talo–first metatarsal angle (0.873) were the most reproducible between observers. Postoperatively, 100% of feet were corrected to normal medial cuneiform to floor distance and talonavicular coverage angle, and 90.9% were corrected to a normal lateral talo–first metatarsal angle. Conclusion: The modified triple arthrodesis resulted in a reliable and reproducible correction of the deformity seen in rigid stage III PTTD. Level of Evidence: Level IV, case series.

Background: The flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon are routinely used in reconstructive foot and ankle surgery. The tendons cross in the chiasma plantare and show variable interconnections. This can complicate harvesting of the tendons. Previous anatomical studies were inconclusive and did not reference the connections to surgically relevant landmarks. The purpose of this study was to integrate these conflicting results, introduce a thorough classification system, and analyze the position of the interconnections relative to the surgically relevant bone landmarks. Methods: Sixty embalmed feet of 30 cadavers were analyzed anatomically with respect to the individual cross-links in the planta pedis. All feet were photo documented. The interconnections were classified in a modified classification system and distances to surgically relevant anatomic landmarks measured. Results: A proximal to distal connection from the FHL to the FDL was found in 95% of the feet (types I and III), in 3% there was a proximal to distal connection from the FDL to the FHL (type II) tendon only, and in 30% a crossed connection (type III) was found. The average point of branching of the FHL and FDL tendon was 5.3 and 4.6 cm distal to the medial malleolus, respectively. Conclusion: Our modified classification system accommodated all found variations. In over 90% of the feet, a proximal to distal connection from the FHL to the FDL was found, which might contribute to the residual function of the lesser toes after FDL transfer. Clinical Relevance: The exact knowledge of the anatomy of the crossing of FDL and FHL in the plantar foot is essential to facilitate tendon harvesting, reduce morbidity and explain possible postoperative functional loss.

Tendon disorders are associated with increased morbidity and a reduction in the quality of life, especially in people of working age. Recently, a new approach, cell-based therapy, offers promising potential to treat tendon injuries. Mesenchymal stem cells are the most suitable candidates for such therapies due to their capacity to differentiate into cells of mesodermal origin, their paracrine properties and their potential use in autologous transplantation. This review summarizes experimental as well as clinical data focusing on the use of mesenchymal stem cells to treat tendinophaties.

Drug-induced tendon disorders are an often underestimated risk factor. The range from detrimental effects on the tendon include tendinopathy as well as potentially tendon rupture. As for today, four main drug classes have been reported to be associated with potentially deteriorated tendon properties: 1. Corticosteroids, 2. Chinolon antibiotics, 3. Aromatase inhbitors, 4. Statins as HMG-CoA-reductase inhibitors. Most often, the Achilles tendon is affected in terms of tendinopathy and/or subsequent tendon rupture. However, nearly every tendon of the entire body might be affected in a detrimental way by one or a combination of the aformentioned agents.

1. Tendon disorders are common disorders in the foot and ankle. The disease pathology may range from inflammatory and degenerative to traumatic or even neurological in nature. 2. A thorough history and examination is important to identify the nature of the insult, determine the degree of injury, and establish the extent of disruption to patients’ function and lifestyle. 3. Various pathologies and management of peroneal tendon disorders are illustrated in this chapter coupled with preferred surgical techniques and steps. 4. Approach to tendon transfers in the foot and ankle is described together with illustrated techniques. 5. Tips and potential complications of tendon transfers in the foot and ankle are described.

Painful and non-healing musculoskeletal disorders, eg. tendinopathy, pose a tremendous burden on society and the quality of life for patients. New advances in the understanding of connective tissue disorders such as tendinopathy reveal that common health problems such as obesity, atherosclerosis, hormonal dysfunctions and diabetes mellitus are closely linked to the metabolism of components of the musculoskeletal system, particularly tendons. As tendons function as multi-component “organ systems” (Muscle-TMJ-Tendon-Enthesis to Bone), tendons can be influenced directly, or indirectly via, for instance, alterations to muscle. However, this volume/set of chapters focus mainly on the tendon.

Background: Haglund's deformity is an enlargement of the posterosuperior prominence of the calcaneus, which is frequently associated with insertional Achilles tendinitis. To our knowledge, no study has been done successfully correlating the characteristics of a Haglund's deformity with insertional Achilles tendinitis. The purpose of our study was to analyze the characteristics of a Haglund's deformity in patients with and without insertional Achilles tendinitis to see if there was a correlation. Methods: The study was a retrospective radiographic review of a single surgeon's patients with insertional Achilles tendinitis from 2005 to 2008. Our study population consisted of 44 patients, 48 heels (22 male, 22 female) with insertional Achilles tendinitis, with a mean age of 52 (range, 23 to 79) years. Our control population consisted of 50 patients (25 males, 25 females) and 50 heels without insertional Achilles tendinitis with a mean age of 55.6 (range, 18 to 89) years. We introduced two new measurements of the Haglund's deformity in this study: the Haglund's deformity height and peak angle. A standing lateral foot or ankle radiograph was analyzed for each patient and the following measurements were made: Haglund deformity height and peak angle; Bohler's angle; Fowler-Philip angle; and parallel pitch sign. We also looked for the presence of calcification in the study group and the length and width of the calcification. Unpaired t-test was used to analyze the measurements between the groups. Ten patients’ radiographs were re-measured and correlation coefficients were obtained to assess the reliability of the measuring techniques. Results: For the insertional Achilles tendinitis group, the mean Haglund's deformity height was 9.6 (range, 5.3 to 15.3) mm and the mean Haglund's deformity peak angle was 105 (range, 87 to 123) degrees. Calcification was present in 35 of 48 or (73%) of patients with a mean length of 13.3 (range, 3.2 to 41.9) mm and mean width of 4.5 (range, 1.0 to 10.4) mm. In the control group, the mean Haglund's deformity height was 9.0 (range, 5.2 to 12.1) mm and the peak angle was 105 (range, 91 to 124) degrees. Bohler's angle and Fowler-Philip angle were also similar between the groups and the positive parallel pitch sign was actually more prevalent in the control group (60% versus 41.7%). None of the differences in measurements between the groups achieved statistical significance. Conclusion: A Haglund's deformity was not indicative of insertional Achilles tendinitis and was present in asymptomatic patients. Also, a majority of the insertional Achilles tendinitis patients had calcification at the tendon insertion. We believe it is possible removing the Haglund's deformity may not be necessary in the operative treatment of insertional Achilles tendinitis. Level of Evidence: III, Retrospective Comparative Study

A wide range of muscle and tendon conditions are seen in small animals. An article in the January issue of In Practice (volume 34, pages 22–26) reviewed some general aspects of managing tendon and muscle disorders together with conditions affecting the forelimb. This article describes conditions affecting the hindlimb as well as digital flexor tendon injuries that affect both the fore- and hindlimbs.

Muscle and tendon injuries and diseases are common causes of lameness in dogs and occasional causes of lameness in cats. This article reviews the general management of these disorders and provides an overview of specific conditions affecting the forelimb (thoracic limb). A second article, to be published in the February issue of In Practice , will consider conditions affecting the hindlimb (pelvic limb) and digital flexor tendon injuries.

After reading this article, the participant should be able to: 1. Make decisions on flexor tendon repair based on current evidence. 2. Perform some important tendon transfers after viewing Dr. Kozin's videos. 3. Inject local anesthesia for wide-awake flexor tendon repair after viewing the appropriate videos in the article. 4. Use relative motion extension splints for the postoperative management of extensor tendon injuries.This article provides a practical, clinically useful overview of some of the current best techniques and evidence available to the plastic surgeon in the treatment of flexor and extensor tendon injuries, tendon transfers, trigger fingers, mallet fingers, boutonniere deformities, and De Quervain tenosynovitis. Twelve short movies and drawings emphasize important points of diagnosis and treatment of tendon disorders.

Background. Earlier studies have reported positive results from eccentric training in patients with tendon disorders. The reasons for the beneficial clinical effects of eccentric training are not known. Vascularization followed by regression of the vasculature enhances the healing response of injured tendons. Eccentric exercise induces a more beneficial healing response than concentric exercise. Methods. Sixty rats with patellar tendon injuries were divided into three groups: nonexercise controls (group N; n = 20); concentric exercise group (group C; n = 20); eccentric exercise group (group E; n = 20). Each rat was taught to run uphill or downhill for 14 days. Patellar tendons were removed 1, 4, 7, 10, and 14 days following injury. Vascular endothelial growth factor (VEGF), angiopoietin-1, and angiopoietin-2 were measured by reverse transcription polymerase chain reaction. Results. In group C, VEGF mRNA was increased 1 and 4 days following injury but was decreased on days 7, 10, and 14. In group E, VEGF mRNA was elevated only on day 1. In group N, VEGF mRNA remained at a low level throughout all 14 days. The angiopoietin-2/angiopoietin- 1 ratio was higher for group C than for group E. Conclusions. In the presence of VEGF, angiopoietin-1 promotes vessel stability, whereas angiopoietin-2 has the opposite effect. Eccentric exercise contributes to stabilized angiogenesis during the early phase of tendon injury. Conversely, concentric exercise, which induces destabilized angiogenesis, leads to a delayed healing response. Initiation of eccentric exercise immediately after tendon injury may help improve healing by reducing vascularity. © 2008 The Japanese Orthopaedic Association.

Purpose of reviewAchilles tendon disorders are a common clinical entity presenting to the orthopedic surgeon and may present a challenge to treatment. This review will focus on identifying the etiology of Achilles tendon disorders, present the associated physiological and biological processe

Sports and physical activity are becoming more important and more emphasized in the lives of the average person as the health benefits of maintaining an active lifestyle are recognized. In the past most people were primarily active in sports during their time in school. The trend is for more people to continue vigorous activity through middle age and beyond. In addition, as high level athletes continue to reach higher levels of performance more amateur athletes attempt to reach similar levels of intensity, which they may not be able to handle with their level or method of training. This has led to an increase in overuse injuries and chronic tendon injuries. It has been estimated that overuse type injuries account for 30-50% of sports injuries (1).

Background: Chronic insertional Achilles tendinopathy is a common pathology that can be difficult to manage. Some experts have advocated augmentation with the flexor hallucis longus (FHL) tendon in patients over age 50 and those with more severe tendon disease. We hypothesized that FHL augmentation would be associated with superior clinical outcome scores and greater ankle plantar flexion strength compared with Achilles debridement alone. Methods: Consecutive patients older than 50 years who had failed nonoperative treatment for chronic insertional Achilles tendinopathy were randomly assigned to Achilles decompression and debridement alone (control group) or Achilles decompression and debridement augmented with FHL transfer (FHL group). Outcome measures included American Orthopaedic Foot & Ankle Society (AOFAS) ankle/hindfoot score, visual analog scale (VAS) for pain, ankle and hallux plantar flexion strength, and a patient satisfaction survey. A total of 39 enrolled patients had a minimum 1-year follow-up, 18 in the control group and 21 in the FHL transfer group. The average patient age was 60.5 years. Results: AOFAS and VAS scores improved in both groups at 6 months and 1 year with no difference between groups. There was greater ankle plantar flexion strength in the FHL group at 6 months and at 1 year compared with the control group ( P < .05). There was no difference between the 2 groups in hallux plantar flexion strength preoperatively and at 1 year after surgery. Some 87% of patients were satisfied with the outcome of their procedure. There was no significant increase in wound complications in the FHL group ( P < .05). Conclusion: We found no differences in pain, functional outcome (as measured by the AOFAS ankle/hindfoot scale), and patient satisfaction when comparing patients treated with Achilles debridement alone versus FHL augmentation for chronic Achilles tendinopathy. Ankle plantar flexion strength appeared to be improved with FHL transfer, with no loss of hallux plantar flexion strength. Although FHL transfer was a safe adjunct to tendon debridement and partial ostectomy for insertional Achilles tendinopathy in older patients with little compromise in function, it may not be necessary for primary cases. Level of Evidence: Level 1, prospective randomized trial.

Level of Evidence:Level V, expert opinion.

Tendon disorders are commonly seen in clinical practice. Their successful treatment is difficult and patients often experience symptoms for prolonged periods of time. At present the aetiology of tendon disorders remains unclear, with several factors having been implicated. An improved understanding of tendon injury and healing is essential to enable focused treatment strategies to be devised.

Study design Randomised, double-blind, placebo-controlled study. Background Chronic tendon disorder is a major problem for many athletes and conservative treatment varies substantially. A treatment method with essential fatty acids and antioxidants combined with physiotherapy has attracted some attention and is evaluated in this study. Methods and measures In a randomised, double-blind, placebo-controlled trial 40 volunteers active in recreational sports with chronic tendon disorders were assigned to the study. The subjects were divided in two groups, one consuming a daily dosage of essential fatty acids and antioxidants and one consuming similar placebo. Furthermore, the subjects received 16 sessions of ultrasound treatment over 32 days. Evaluation was pain scores, rated on a visual analogue scale and quantification of normal sports activity during treatment. Results In the treatment group there was a significant reduction of pain compared with the placebo group ( P Conclusions The results suggest beneficial effect of essential fatty acids and antioxidants in combination with physiotherapy treating chronic tendon disorders.

We performed histologic and electron microscopy studies with tendon specimens of 12 patients with different tendon disorders. 6 patients suffering from achiloldynia, 6 Achilles tendon and two Quadriceps tendon injuries were investigated. Histopathological evaluation of tendon biopsies, obtained from the regions showing pathology at surgery revealed altered fiber structures, focal variations in cellularity due to acute or chronic injuries (disorders). Electron microscopic evaluation showed degenerative alterations, such as multiple vacuoles and vesicles in cytoplasm an loss of cell-matrix interaction. While histopathological pictures correlated well with the clinical findings those of electron microscopy didn't. Chronical and acute injuries tendon disorders in patients under quinolon or immunosuppressive therapy after local application of cortisol presented similar pictures in electron microscopy. Different causes of tendon disorders in patients are discussed.

The idea for this special number of Journal of Ultrasound arose from the Editor in chief of the journal, Ferdinando Draghi, and myself as a result of our longstanding friendship and previous publication in 2012 of a monothematic musculoskeletal number written by Italian authors and French speaking authors of the SIMS (Societe Imagerie Musculosqueletique). We choose the ankle and foot region since, because of the superficial position of most of their structures, it can be optimally explored by ultrasound (US). All the tendons, most of the nerves and vessels of this region can be accurately assessed, statically and dynamically, when using a high-definition modern US equipment by a well-trained examiner. Essential prerequisites for successful assessment include in depth knowledge of the normal anatomy and variations, realization of the US examination based on clinical findings and knowledge of intrinsic limits of US. The first article describes the sonographic anatomy of the ankle. Following articles deal with US appearance of a wide variety of pathologic conditions including ankle impingement syndrome, mid-portion Achilles tendon injury, tibialis anterior muscle and tendon disorders, peroneal tendon tear and, finally, evaluation of hindfoot disorders. All the articles have been written by well-renowned sonologits including not only radiologists but also clinicians (orthopedic surgeons and family medicine doctors). Authors are from Europe (Italy, France and England) and also from North America (USA and Canada) thus reflecting the widespread diffusion of Journal of Ultrasound. The articles were written with an effort to help the readers in their every day US practice. We hope you will appreciate our effort during scanning your next ankle and foot region! Have a good lecture.

Shoulder disorders, typically characterized by pain and diminished range of motion, is a common source of musculoskeletal pain in the elderly. Degenerative changes predominate in the elderly shoulder. Like younger patients rotator cuff and bicipital tendon disorders are common. Unlike younger patients elderly patients are more likely to suffer from shoulder pain as a consequence of a frozen shoulder, polymyalgia rheumatica, degenerative arthritis, referred pain-especially from visceral sources, and hemiplegic shoulder pain. The usefulness of high technological diagnostic tests such as magnetic resonance imaging (MRI) is very questionable in the elderly because it rarely influences management, which is invariably conservative in the elderly.

The knowledge about tendons and tenocyte biological behaviour during aging and, especially, oestrogen deficiency is limited. Women differ from men with regard to muscle and tendon, most likely due to differences in sex hormones activity and tissue response. To-date the interest in metabolic factors that may induce tendon disorders is growing. The aim of this paper is to elucidate the current findings in the correlation between oestrogen deficiency, aging and tendon pathology and to encourage future researches to ameliorate assessment and management of tendinopathies in postmenopausal women.

Tendons were long given little recognition by rheumatologists. Yet, their complex structure and distinctive functional characteristics have been demonstrated by an abundance of histological, biochemical, and biomechanical studies: clearly, tendons are not inert cords linking muscles to bones. The current wave of popularity of sporting activities has brought with it an epidemic of disorders of the tendons, thus focusing attention on these structures. At the same time, modern imaging techniques (particularly magnetic resonance imaging) have allowed clinicians to improve their knowledge of and classification schemes for tendon disorders. Several risk factors, including technical factors, have been identified, so that preventive treatment is now as important as curative treatment. Culture systems for tenocytes (the specialized fibroblasts found in tendons) are now available and have been used to develop experimental models, paving the way for significant advances in tendon repair techniques.

After reviewing this article, the participant should be able to: 1. Recognize and treat common tendinopathies such as trigger finger and de Quervain tenosynovitis. 2. Recognize and treat flexor tendon and extensor tendon injuries. 3. Define the different zones where flexor tendon and extensor tendon injuries occur and identify the surgical challenges related to each zone.Common tendon disorders in the hand range from simple trigger fingers to more complex zone II flexor tendon injuries. The goal of treatment in all cases is to aim for optimal early strength and to create conditions favorable for early rehabilitation to decrease the risk of tendon scarring and subsequent poor range of motion. This CME article reviews the presentation, evaluation, state-of-the-art treatment, and outcomes of the treatment of trigger finger, de Quervain tenosynovitis, and flexor tendon and extensor tendon injuries. New developments in the different areas are highlighted to inform the reader of emerging techniques in the treatment of tendon disorders of the hand.

Recent advances in ultrasound technology and the development of high-resolution ultrasound transducers have enabled detailed depiction of superficial musculoskeletal structures. While in the past considered as complementary to magnetic resonance (MR) imaging, modern ultrasound has clearly become competitive. It is now the imaging modality of choice for evaluating tendon pathology. The major advantages of ultrasound include dynamic evaluation of structures, low cost and wide availability. The main disadvantage is a high degree of operator dependency. This article discusses the current ultrasound characteristics of normal tendon, the artefacts that may mimic tendon disease and reviews the applications of ultrasound to the evaluation of tendon disorders, including tendon tears, tendinitis, tenosynovitis, ganglion cysts and bursitis.

Background: Tendon disorders are rare events associated with fluoroquinolone congestion. Skin reactions are more frequent than tendon disorders. We reported this case as the combination of ciprofloxacin-induced urticaria and tenosynovitis has been unreported in young women. Case: A 28-year-old woman without underlying disease developed urticarias and tendinopathy 4 days after the initiation of ciprofloxacin treatment for urinary infection. MRI of the left foot revealed increased synovial fluid surrounding the tendon of the flexor hallucis longus muscle representing tenosynovitis. Ciprofloxacin was ceased due to the possibility of ciprofloxacin-induced tendinopathy and urticaria. Complete resolution of her symptoms and findings occurred 3 days after discontinuation of ciprofloxacin without any additional treatment. Conclusion: Early discontinuation of fluoroquinolone therapy when tendinopathy is suspected is the basis of therapy. So, it should be kept in mind that fluoroquinolone-induced tendinopathy may occur in an otherwise healthy young patient with no risk factors and in a site other than the Achilles tendon.

A prospective study was performed on 28 patients who underwent surgery for tendon disorders around the ankle. Preoperatively, all patients had real-time, high resolution ultrasonography performed with a 7.5 or 10 mHz transducer. Twenty of these patients also had a preoperative magnetic resonance imaging (MRI) examination of the ankle. A total of 54 tendons were inspected intraoperativey, revealing a total of 24 intrasubstance or complete tendon tears. These surgical findings were compared with the ultrasound and MRI findings, from which the sensitivity, specificity, and accuracy were calculated for both modalities. Ultrasound produced results with a sensitivity measurement of 100%, specificity of 89.9%, and accuracy of 94.4%. MRI produced results with a sensitivity measurement of 23.4%, specificity of 100%, and accuracy of 65.75%. Ultrasound results were more sensitive and accurate than MRI in the detection of ankle tendon tears in our 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.

Most tendon disorders of the ankle occur in females, with the exception being Achilles disorders.

No abstract available

Background: Tendon disorders are among the most common musculoskeletal conditions in active patients. Platelet rich plasma (PRP) has been used in the treatment of tendon disorders, but little is known as to the mechanisms by which PRP acts. PRP contains numerous different growth factors and cytokines which activate various cellular signaling cascades, but it has been difficult to determine precisely which signaling pathways and cellular responses are activated following PRP treatment. Additionally, macrophages are important in modulating tendon regeneration, but the influence of PRP on determining whether macrophages assume a proinflammatory or antiinflammatory phenotype remains unknown. Our objectives were to use genome wide expression profiling, bioinformatics and protein analysis to determine the cellular pathways activated in fibroblasts treated with PRP, and to also evaluate the effect of PRP on macrophage polarization. Methods: Tendon fibroblasts or macrophages from rats were cultured and treated with either platelet poor plasma (PPP) or PRP. RNA or protein was isolated from cells and analyzed using microarrays, qPCR, immunoblot or bioinformatics techniques. Results: Bioinformatics analysis determined that the two signaling pathways predicted to be activated by PRP were the TNFα and NFκB pathways. PRP also downregulated several ECM genes, and induced the expression of autophagy related genes and reactive oxygen species (ROS) genes, as well as markers of protein oxidation in tendon fibroblasts. PRP failed to have a major impact on markers of macrophage polarization. Conclusions: PRP induces an inflammatory response in tendon fibroblasts which leads to the formation of ROS and activation of oxidative stress pathways. PRP does not appear to significantly modulate macrophage polarization. Clinical Relevance: PRP might act by inducing a transient inflammatory event which could then trigger a tissue regeneration response.

Background: The successful treatment of chronic mid-substance Achilles tendinopathy remains elusive. Approximately 25% to 50% of patients fail conservative treatment modalities. Scientific evidence has supported the use of platelet rich plasma (PRP) in the tendon healing process, however despite initial promise there is a paucity of clinical data to validate a role for PRP in the treatment of tendon disorders including chronic midsubstance Achilles tendinopathy. Methods: As an alternative to operative treatment, our practice offers patients with chronic midsubstance Achilles tendinopathy intratendinous injection of PRP. We retrospectively reviewed all patients treated for Achilles tendinopathy with PRP injection over a 2-year period. Baseline and post injection functional scores including the Foot and Ankle Ability Measure (FAAM), Foot and Ankle Ability Measure - Sports (FAAMS), and the Short Form health survey (SF-8) were examined. Patients also underwent post-injection magnetic resonance imaging (MRI), which were compared to available pre-injection MRI data. Results: Ten patients were identified for this study. Pre- and post-injection functional outcome scores were available for eight of ten patients. The average SF-8 score improved from 24.9 to 30.0, the average FAAM score improved from 55.4 to 65.8, and the average FAAMS score improved from 14.8 to 17.4. Complete MRI data was available for six patients. Only one in six Achilles tendons demonstrated qualitative MRI improvement post-injection. Conclusion: Patients who received PRP injection demonstrated modest improvement in functional outcome measures, however MRI appearance of diseased Achilles tendons remained largely unchanged following PRP injection. Level of Evidence: IV, Case Series

Real-time sonoelastography is a recently developed ultrasound-based technique that evaluates tissue elasticity in real time, and it is based on the principle that the compression of tissue produces a strain (displacement) that is lower in hard tissue and higher in soft tissue. Real-time sonoelastography provides information on tissue elasticity, in addition to the shape or vascularity, which is obtained via B-mode ultrasound. Similar to B-mode ultrasound, freehand manipulation with the transducer and real-time visualization are now available for real-time sonoelastography in actual clinical practice. Tissue elasticity not only varies among different tissues but also seems to reflect disease-induced alternations in tissue properties. Real-time sonoelastography was recently applied to the normal and pathologic tissues in muscle and tendon disorders, and it showed promising results and new potentialities. Therefore, it is expected to be a useful modality for providing novel diagnostic information in musculoskeletal diseases because tissue elasticity is closely related to its pathology. It can also be used as a research tool to provide insight into the biomechanics and pathophysiology of tissue abnormality.

Five dogs with unusual muscle and tendon disorders of the forelimb are described. In one dog, mineralisation of the tendon of insertion of the supraspinatus muscle was treated surgically but lameness returned following the resumption of exercise. Of two cases of avulsion of the origin of the extensor carpi radialis muscle, one was successfully managed conservatively while the other needed surgical intervention to resolve the lameness. A single case of chronic avulsion/rupture of the tendon of insertion of the extensor carpi radialis muscle was successfully managed conservatively while a case of medial displacement of the biceps brachii tendon was surgically corrected by repair of the transverse humeral ligament. The aetiology, diagnosis and management of the above conditions is discussed.

Quinolone antibacterial agents, which are broad-spectrum drugs with excellent antibacterial activity, have been used widely to treat various bacterial infections in the clinical setting. However, the adverse effects of these drugs on the musculoskeletal system have been observed at an incidence of 1% or less, and consist mainly of myalgia and arthralgia, although tendon disorders have also recently been reported.[1-4] This report highlights a case of rhabdomyolysis induced by levofloxacin.

This article describes tendon disorders in cattle and treatments for such disorders. Tendon injuries causing loss of a production animal or a decreased level of production result in significant economic loss to the cattle producer. Tendon disorders may be congenital or acquired. Congenital abnormalities may include tendon laxity, contracted tendons, or tendon displacement. Acquired tendon disorders may include tendon laxity, contracture, luxation, tendinitis, laceration, avulsion, rupture, and tenosynovitis.