Paper #158 Achilles and patellar tendinopathy shows similarity

ABSTRACTS tion as proliferation cell nuclear antigens (PCNA), procollagen I and decorin. In vitro studies on tendon fibroblast culture showed that hrBMP13 could increase cell proliferation and the gene expression of pro-collagen I and biglycan, but the gene expression of decorin was not affected. Our findings suggest that BMP13 may play a role in tendon healing. Paper #157 Treatment Of Chronic Tendonosis With Bipolar Radiofrequency Stimulation. James P. Tasto, Presenter, San Diego Sports Medicine and Orthopaedic Center, San Diego, CA, USA, William C. Eves, San Diego, CA, USA, Renee Valeu, San Diego, CA, USA, Wendy Winters, Sunnyvale, CA, USA, Shay Shabat, Kfar Saba, Israel, Y. Herzoni, Jerusalem, Israel, David Morgenstern, Kfar Saba, Israel, Naama Constantini, Netanya, Israel, Meir Nyska, Kfar Saba, Israel Purpose: The purpose of this study is to demonstrate the safety and document the effectiveness of bipolar radiofrequency for the treatment of chronic tendinosis. Study Design: Prospective, non-randomized, single center pilot study. Material and Methods: There were 24 patients in the study. Each had chronic tendinosis of the patellar tendon, Achilles tendon, or lateral or medial epicondyle. They all had symptoms for more than 6 months (average 16 months), and failed at least 3 conservative treatments. A pre-operative MRI and pain and function scores were recorded. The patients had open radiofrequency stimulation of the tendons involved using a bipolar Radiofrequency Topaz Wand TM (Arthrocare Corp., Sunnyvale, CA). The generator was set to power level of 4 (175V RMS). The wand was placed on the surface of the tendon and activated for 0.5 seconds at 5mm distance intervals around the symptomatic area. The tendon involved was stimulated 15-20 times over an area of 3.0 square cm. Post-operative pain and function scores were recorded at 7-10 days, 4 weeks, and 6 months. Post-operative MRI’s were performed at 4 weeks and 6 months. Results: Ninety two percent of patients had significant improvement in their pain and function at 6 months. The post-operative VAS pain scores were decreased by 55% at 7-10 days post operative, 75% at 4 weeks, and 85% at the 6 month evaluation. There was significant improvement (p ⬍ 0.05) in the SF-36, IKDC, Upper Limb DASH, and the AOFAS scores. Seventy-five percent of the pre-operative MRI’s had changes consistent with tendinosis. Post surgical and tendinosis changes were observed in 96% of patients at 4 weeks. At 6 months, only 21% had tendinosis changes on their MRI.

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Conclusion: Bipolar radiofrequency stimulation appears to be a safe and effective treatment of chronic tendinosis. Further research is needed in this area to better understand the biochemical processes by which bipolar radiofrequency stimulation leads to pain relief and potential tendon repair. Paper #158 Achilles And Patellar Tendinopathy Shows Similarity. Tomas Movin, Presenter, Departments of Orthopedics and Pathology, Huddinge University Hospital, Sweden, Tudor Cozma, Iasi, Romania, Eva Samnegård, Stockholm, Sweden, Per Lindblom, Stockholm, Sweden, Christer G. Rolf, Sheffield, United Kingdom, Nikos Papadogiannakis, Stockholm, Sweden We evaluated three histopathological parameters quantitatively (glycosaminoglycan (GAG) content, vessel density and cellularity), by using computer-assisted histomorphometry of surgical biopsies from patients with long-standing pain located to the mid-portion of the Achilles tendon and at the apex patella in the patellar tendon. The surgical result was evaluated with a pain and disability score. Patients and Methods: The patients with Achilles tendinopathy (n ⫽ 42), all with pain 3 to 7 cm proximal to the tendon insertion, had a median age of 40 years (range 24 - 65 years).The patellar tendinopathy patients (n ⫽ 12), all with pain at apex patellae, had a median age of 28 years (range 18 - 45 years). Tendon biopsies were obtained at surgery. Autopsy specimens from the Achilles tendon (n ⫽ 10) and open biopsies from asymptomatic patellar tendons obtained at anterior cruciate ligament reconstructions with patellar bone-tendon-bone autografts (n ⫽ 11) served as controls. The histomorphometric evaluation was blinded for the examiner and a computer-assisted histomorphometric technique was used to randomly quantify the assessed parameters GAG-content, cellularity and vascularity. A clinical follow up after in median 18 months used the same tendon evaluation protocol. Results: The GAG-content, cellularity and vascularity were significantly increased in tendinopathy tissue compared to the control tissue. The study could not demonstrate significant pathological differences of the three quantified histological parameters in Achilles versus patellar tendinopathy. The mean GAG- content (GAG to collagen ratio) was 0,44 (SD 0,31) in Achilles and 0,36 (SD 0,24) in patellar tendinopathy. The control values were 0,07 (SD 0,10) and 0,05 (SD 0,06), respectively. The mean cellularity in a standardized high power field was 5,8 (SD 3,1) in Achilles and 4,7 (SD 5,4) in patellar tendinopathy. The frequencies in the control

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material were 2,3 (SD 1,7) and 2,8 (SD 1,7). The mean vessel density was 14,6*10-3 (SD 25*10-3) in Achilles and 13,1*10-3 (SD 10,6*10-3) in patellar tendinopathy. The control tissue had mean vessel density values of 2,6*10-3 (SD 3,0*10-3) and 5,3*10-3 (SD 5,4*10-3). The outcome following surgical treatment after a median time of 18 months was categorized as satisfactory (excellent and good) in 82% of the Achilles tendinopathy patients and in 50% (6/12) in patellar tendinopathy patients. Discussion and Conclusion: The pathological tissue in painful tendinosis has been described having changes in fiber structure and arrangement, variation in cellularity, roundng of nuclei, increased non-collagen extracellular matrix (GAGs) and increased vascularity. In this study, we chose to evaluate the GAG content, the cellularity and vascularity because these parameters could be quantified. The study compared two common sport medicine tendon disorders with blinded unbiased methodology without significant differences of the studied histomorphmetric parameters. However, the outcome following open surgical treatment was better in Achilles tendinopathy. Paper #159 Overuse Soft Tissue Injuries As Related To The Body Mass Index (BMI) Of Infantry Recruits. Gideon Mann, Presenter, Wingate Institute, Netanya, Israel, Shay Shabat, Kfar Saba, Israel, Yonatan Matan, Jerusalem, Israel, Y. Barak, Jerusalem, Israel, Joseph Lowe, Jerusalem, Israel, Alex Finsterbush, Jerusalem, Israel, Meir Nyska, Kfar Saba, Israel, Alex Borowski, Jerusalem, Israel, Naama Constantini, Netanya, Israel, M. Perez, Jerusalem, Israel, R. Goldshmidt, Jerusalem, Israel, Y. Herzoni, Jerusalem, Israel, David Morgenstern, Kfar Saba, Israel, Moshe Suderer, Jerusalem, Israel Introduction: Overuse injures comprise the major cause of disability and loss of training days both in the athletic as in the military population. In this study, we evaluated in a prospective manner the effect of BMI on the occurrence of injuries in border police infantry recruits. Material and Methods: BMI is calculated by dividing a person’s weight by the square of his height. When using kg and centimeters the normal (“athletic”) male BMI is in the range of 20 to 25. In this study the BMI of 201 infantry recruits was prospectively compared to soft tissue overuse injures during a 4 month course of basic training. Results: 16% of the recruits were “underweight”, 7% were “overweight” and 77% were “normal”. Foot injuries showed a trend for more injuries in the underweight

and overweight recruits (p ⫽ 0.1). Achilles overuse injuries were also higher in the over and under weight groups (0.09). Shin splints were again lowest in the “normal” weight, slightly higher in the “underweight” and higher in the “overweight” (p ⫽ 0.04). PFJ pain showed the same tendency (p ⫽ 0.12). When calculating the total soft tissue overuse injuries it was shown that the “normal” or the “athletic” population was injured significantly less than the “under” or “over” weight groups. (p ⫽ 0.006). Conclusions: The “athletic” build or the “Mesomorph” population seems to have a lower tendency to suffer overuse soft tissue injuries than both the “Endomorph” with a higher BMI or the “Ectomorph” with a lower BMI than that accepted as normal. Paper #160 The Treatment Of Suppurative Arthritis With Debridement. Kanglai Tang, Presenter, Southwest Hospital, Chongqing, China Objective: To investigate the treatment of suppurative arthritis with debridement under arthroscopy and persistent irrigation after operation. Method: 36 patients with suppurative arthritis were treated by debridement under arthroscopy and persistently irrigated after operation. Result: All cases follow-up (range 3 to 18 months) results were cured, 31 of the cases were excellent, while 5 was fair. No patient relapsed. The average treatment time was 15.8 day. Conclusion: Debridement under arthroscopy and persistent irrigation after operation has better therapeutic effect than surgery during which the joint cavity was opened. It is less invasive, has better recovery, costs less time; So it is an ideal therapeutic method. Paper #161 Can Sport Massage Reduce Pain And Loss Of Function. Sven Jonhagen, Presenter, Karolinska Hospital, Stockholm, Sweden, Paul W. Ackermann, Stockholm, Sweden, Tonu Saartok, Visby, Sweden, Per A. Renstrom, Stockholm, Sweden The use of sports massage is increasing in the athletic community. The purpose with this study was to evaluate the effect of massage treatment on pain, muscular strength and function following hard eccentric exercise. We also studied if calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY), measured by microdialysis, were affected by sports massage. These peptides are involved in the modulation of pain. Method: 16 subjects performed 300 eccentric exercises of both quadriceps. Sports massage was given on one leg, and the other leg served as a control. Subjects