Metabolism and inflammatory mediators in the peritendinous space measured by microdialysis during intermittent isometric exercise in humans.
1. The metabolic processes that occur around the tendon during mechanical loading and exercise are undescribed in man. These processes are important for understanding the development of overuse inflammation and injury. 2. A microdialysis technique was used to determine interstitial concentrations of glycerol, glucose, lactate, prostaglandin E2 (PGE2) and thromboxane B2 (TXB2) as well as to calculate tissue substrate balance in the peritendinous region of the human Achilles tendon. Recovery of 48-62 % (range) at rest and 70-77 % during exercise were obtained for glycerol, glucose and PGE2. 3. Six young healthy humans were studied at rest, during 30 min of intermittent static plantar flexion of the ankle at a workload corresponding to individual body weight, and during 60 min of recovery. Microdialysis was performed in both legs with simultaneous determination of blood flow by 133Xe washout in the same area, and blood sampling from the radial artery. 4. With exercise, the net release of lactate as well as of glycerol from the peritendinous space of the Achilles tendon increased 2-fold (P < 0.05). Furthermore a 100 % increase in interstitial concentration of PGE2 and TXB2 was found, but it was only significant for TXB2(P < 0.05). As peritendinous blood flow increased 2- to 3-fold during intermittent static contractions, this indicates also that the output of these substances from the tissue increased during exercise. 5. This study indicates that both lipid and carbohydrate metabolism as well as inflammatory activity is accelerated in the peritendinous region of the human Achilles tendon with dynamic loading. (+info)
Amplitude of the human soleus H reflex during walking and running.
1. The objective of the study was to investigate the amplitude and modulation of the human soleus Hoffmann (H) reflex during walking and during running at different speeds. 2. EMGs were recorded with surface electrodes from the soleus, the medial and lateral head of the gastrocnemius, the vastus lateralis and the anterior tibial muscles. The EMGs and the soleus H reflex were recorded while walking on a treadmill at 4.5 km h-1 and during running at 8, 12 and 15 km h-1. 3. The amplitudes of the M wave and the H reflex were normalized to the amplitude of a maximal M wave elicited by a supramaximal stimulus just after the H reflex to compensate for movements of the recording and stimulus electrodes relative to the nerve and muscle fibres. The stimulus intensity was set to produce M waves that had an amplitude near to 25 % of the maximal M wave measured during the movements. As an alternative, the method of averaging of sweeps in sixteen intervals of the gait cycle was applied to the data. In this case the amplitude of the H reflex was expressed relative to the maximal M wave measured whilst in the standing position. 4. The amplitude of the H reflex was modulated during the gait cycle at all speeds. During the stance phase the reflex was facilitated and during the swing and flight phases it was suppressed. The size of the maximal M wave varied during the gait cycle and this variation was consistent for each subject although different among subjects. 5. The peak amplitude of the H reflex increased significantly (P = 0.04) from walking at 4.5 km h-1 to running at 12 and 15 km h-1 when using the method of correcting for variations of the maximal M wave during the gait cycle. The sweep averaging method showed a small but non-significant decrease (P = 0. 3) from walking to running at 8 km h-1 and a small decrease with running speed (P = 0.3). The amplitude of the EMG increased from walking to running and with running speed. 6. The relatively large H reflex recorded during the stance phase in running indicates that the stretch reflex may influence the muscle mechanics during the stance phase by contributing to the motor output and enhancing muscle stiffness. (+info)
Ankle arthrodesis using an anterior AO T plate.
We describe a surgical technique for ankle arthrodesis using an anterior approach to the ankle and internal fixation with an anteriorly-placed AO T plate. A total of 33 patients who had ankle arthrodeses have been followed retrospectively. Thirty-one (94%) of the ankles fused although two patients developed tibial stress fractures. Four patients had a superficial infection which did not prevent union. The surgical technique is simple, easily reproducible and gives excellent clinical results with a high rate of union. (+info)
Efficacy of sustained blood levels of interleukin-1 receptor antagonist in animal models of arthritis: comparison of efficacy in animal models with human clinical data.
OBJECTIVE: To determine the role of interleukin-1 receptor antagonist (IL-1Ra) in rat adjuvant arthritis and rat type II collagen-induced arthritis, and to compare the efficacy in rat models with that seen in human clinical trials of IL-1Ra. METHODS: Rats with developing adjuvant arthritis or established collagen-induced arthritis were treated with IL-1Ra by continuous infusion in order to determine and maintain efficacious blood levels of this IL-1 inhibitory protein in the rats for comparison with human clinical data. The effects of treatment in the rats were monitored by sequential caliper measurement of the ankle joints, determination of final paw weights, and histologic evaluation with particular emphasis on bone and cartilage lesions. The effects of IL-1Ra on joint swelling and radiographic bone damage in patients with rheumatoid arthritis (RA) in a 6-month trial were compared with the findings in rats. RESULTS: Dramatic differences in the profile of IL-1Ra activity were seen between the 2 groups of rats. Modest antiinflammatory effects were observed in the adjuvant arthritis rats treated with IL-1Ra. However, marked inhibition of bone resorption occurred, even at doses with which antiinflammatory activity was not seen. In contrast, IL-1Ra treatment of rats with established collagen-induced arthritis resulted in nearly complete suppression of all aspects of the disease when adequate blood levels of IL-1Ra were maintained. Treatment of RA patients with IL-1Ra (150 mg daily) resulted in modest inhibition of joint swelling and inhibition of radiographic progression of bone lesions. CONCLUSION: IL-1 appears to be of major importance in mediating the bone resorption that occurs in rat adjuvant arthritis, but is less important in the pathogenesis of periarticular inflammation in this disease. In contrast, IL-1 is of major importance in mediating all aspects of disease progression in rat collagen-induced arthritis. Similar to the response in adjuvant arthritic rats, RA patients treated with IL-1Ra showed only modest antiinflammatory activity, but had evidence of inhibition of progression of bone resorption. However, a comparison of the plasma levels of IL-1Ra in humans and rats suggests that the optimal level of dosing for continuous saturation of IL-1 receptors may not have been achieved in humans, although this was achieved in the rat studies. (+info)
The role of fibular length and the width of the ankle mortise in post-traumatic osteoarthrosis after malleolar fracture.
We assessed the role of fibular length and the width of the ankle mortise as risk factors in the occurrence of post-traumatic osteoarthritis of the ankle joint by comparison of radiographs of the affected and unaffected sides. A shortened fibular malleolus (P < 0.01), a wide ankle mortise (P < 0.01) and Weber type B fracture (P < 0.01) were significantly associated with the development of osteoarthrosis but an elongated fibular (P > 0.05) and a narrowing of the ankle mortise (P > 0.07) were not. (+info)
Altered reflex sensitivity after repeated and prolonged passive muscle stretching.
Experiments were carried out to test the effect of prolonged and repeated passive stretching (RPS) of the triceps surae muscle on reflex sensitivity. The results demonstrated a clear deterioration of muscle function immediately after RPS. Maximal voluntary contraction, average electromyographic activity of the gastrocnemius and soleus muscles, and zero crossing rate of the soleus muscle (recorded from 50% maximal voluntary contraction) decreased on average by 23.2, 19.9, 16.5, and 12.2%, respectively. These changes were associated with a clear immediate reduction in the reflex sensitivity; stretch reflex peak-to-peak amplitude decreased by 84. 8%, and the ratio of the electrically induced maximal Hoffmann reflex to the maximal mass compound action potential decreased by 43. 8%. Interestingly, a significant (P < 0.01) reduction in the stretch-resisting force of the measured muscles was observed. Serum creatine kinase activity stayed unaltered. This study presents evidence that the mechanism that decreases the sensitivity of short-latency reflexes can be activated because of RPS. The origin of this system seems to be a reduction in the activity of the large-diameter afferents, resulting from the reduced sensitivity of the muscle spindles to repeated stretch. (+info)
The consistent presence of the human accessory deep peroneal nerve.
Twenty-four human legs were dissected macroscopically to study the morphological details of the accessory deep peroneal nerve. This nerve arose from the superficial peroneal nerve and descended in the lateral compartment of the leg, deep to peroneus longus along the posterior border of peroneus brevis. Approaching the ankle joint, this nerve passed through the peroneal tunnels to wind around the lateral malleolus; it then crossed beneath the peroneus brevis tendon anteriorly to reach the dorsum of the foot. The accessory deep peroneal nerve was found in every case examined and constantly gave off muscular branches to peroneus brevis and sensory branches to the ankle region. In addition, this nerve occasionally had muscular branches to peroneus longus and extensor digitorum brevis, and sensory branches to the fibula and the foot. The anomalous muscles around the lateral malleolus were also innervated by this nerve. Neither cutaneous branches nor communicating branches with other nerves were found. The present study reveals that the accessory deep peroneal nerve is consistently present and possesses a proper motor and sensory distribution in the lateral region of the leg and ankle. It is not an anomalous nerve as has previously been suggested. (+info)
Thickness of human articular cartilage in joints of the lower limb.
OBJECTIVES: (a) To determine the topographical variations in cartilage thickness over the entire surfaces of cadaveric lower limb joints, and (b) to examine the correlations between: cartilage thickness and its site specific modulus; cartilage thickness and donor age, weight, height, and body mass index. METHODS: The cartilage thickness of 11 sets of cadaveric human joints each comprising an ankle, knee, and hip was measured using a needle probe technique. Statistical analysis was used to compare the cartilage thickness of the different lower limb joints and the differences in cartilage thickness over the surface of individual joints. It was further examined whether cartilage had a correlation with its stiffness, and any of the details of the specimen donors such as age, weight, height, and body mass index. RESULTS: The mean cartilage thickness of the knee was significantly greater than that of the ankle and hip (p < 0.001) in all 11 sets of joints, while the cartilage thickness of the hip was significantly greater than that of the ankle in 10 sets of joints (p < 0.001). The mass of specimen donors was found to correlate with the mean cartilage thickness of all three lower limb joints. A correlation was also found between the height of donors and the mean cartilage thickness of the knee and hip joints, while only in the ankle joint was a correlation found between the mean cartilage thickness and the body mass index of the specimen donors. A further correlation was found between cartilage thickness and its modulus; the thinner the cartilage, the higher the modulus. CONCLUSIONS: The thickness of articular cartilage seems to be related to the congruance of a joint; thin cartilage is found in congruent joints such as the ankle, whereas thick cartilage is found in incongruent joints such as the knee. The correlations in this study imply that the larger and heavier was a donor the thicker was the cartilage in the lower limb joints. The data further suggest the presence of an inverse relation between the mean cartilage thickness and mean compressive modulus in each of the joints examined. (+info)