Kaux Jean-François, Libertiaux Vincent, Leprince Pierre, Fillet Marianne, Denoel Vincent, Wyss Clémence, Lecut Christelle, Gothot André, Le Goff Caroline, Croisier Jean-Louis, Crielaard Jean-Michel, Drion Pierre
Physical Medicine, Rehabilitation and Sports Traumatology Department, SportS2, FIFA Medical Centre of Excellence, University and University Hospital of Liège, Liège, Belgium.
Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.
Am J Sports Med. 2017 May;45(6):1440-1446. doi: 10.1177/0363546517689872. Epub 2017 Mar 14.
The tendon is a dynamic entity that remodels permanently. Platelet-rich plasma (PRP) injection has been shown to have a beneficial effect on tendon healing after lesion in rats. Furthermore, eccentric exercise seems to improve the mechanical quality of the tendon.
A combination of PRP injection and eccentric training might be more effective than either treatment alone.
Controlled laboratory study.
Adult male rats were anesthetized, an incision was performed in the middle of their left patellar tendon and an injection of physiological fluid (PF) or homologous PRP was randomly made at the lesion level. The rats were then divided into 2 groups: the eccentric group, undergoing eccentric training 3 times a week, and the untrained group, without any training. Thus, 4 groups were compared. After 5 weeks, the tendons were removed and their ultimate tensile strength and energy were measured. Tendons were frozen for proteomic analyses when all biomechanical tests were completed. Statistical analysis was performed with linear mixed effect models.
No significant difference was found between the treatments using PF injection or PRP injection alone. However, the value of the ultimate tensile force at rupture was increased by 4.5 N (108% of control, P = .006) when eccentric training was performed. An intragroup analysis revealed that eccentric training significantly improved the ultimate force values for the PRP group. Proteomic analysis revealed that eccentric training led to an increase in abundance of several cytoskeletal proteins in the PF group, while a decrease in abundance of enzymes of the glycolytic pathway occurred in the PRP-treated groups, indicating that this treatment might redirect the exercise-driven metabolic plasticity of the tendon.
Eccentric training altered the metabolic plasticity of tendon and led to an improvement of injured tendon resistance regardless of the treatment injected (PF or PRP).
This study demonstrates the necessity of eccentric rehabilitation and training in cases of tendon lesion regardless of the treatment carried out.
肌腱是一个不断进行重塑的动态结构。富血小板血浆（PRP）注射已被证明对大鼠肌腱损伤后的愈合具有有益作用。此外，离心运动似乎能改善肌腱的力学性能。
PRP注射与离心训练相结合可能比单独任何一种治疗方法都更有效。
对照实验室研究。
成年雄性大鼠麻醉后，在其左髌腱中部做切口，并在损伤部位随机注射生理液（PF）或同源PRP。然后将大鼠分为两组：离心训练组，每周进行3次离心训练；未训练组，不进行任何训练。这样，共比较4组。5周后，取出肌腱并测量其极限抗拉强度和能量。在所有生物力学测试完成后，将肌腱冷冻用于蛋白质组学分析。采用线性混合效应模型进行统计分析。
单独使用PF注射或PRP注射治疗之间未发现显著差异。然而，进行离心训练时，破裂时的极限拉力值增加了4.5 N（为对照组的108%，P = 0.006）。组内分析显示，离心训练显著提高了PRP组的极限力值。蛋白质组学分析表明，离心训练导致PF组几种细胞骨架蛋白丰度增加，而PRP治疗组糖酵解途径的酶丰度降低，这表明该治疗可能改变了运动驱动的肌腱代谢可塑性。
无论注射何种治疗（PF或PRP），离心训练均可改变肌腱的代谢可塑性并提高损伤肌腱的抗力。
本研究表明，无论采取何种治疗措施，肌腱损伤病例均有必要进行离心康复训练。
