Hart David A, Ahmed Aisha S, Ackermann Paul
Department of Surgery, Faculty of Kinesiology, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Front Sports Act Living. 2023 Jan 6;4:1081129. doi: 10.3389/fspor.2022.1081129. eCollection 2022.
Tendons are dense connective tissues of the musculoskeletal system that link bones with muscles to foster mobility. They have complex structures and exist in varying biomechanical, metabolic and biological environments. In addition, tendon composition and mechanical properties can change over the lifespan as an individual ages. Many tendons function in high stress conditions with a low vascular and neuronal supply, conditions often leading to development of chronic tendinopathies, and in some cases, overt rupture of the tissues. Given their essential nature for human mobility and navigation through the environment, the effective repair and regeneration of different tendons after injury or damage is critical for quality of life, and for elite athletes, the return to sport participation at a high level. However, for mainly unknown reasons, the outcomes following injury are not always successful and lead to functional compromise and risk for re-injury. Thus, there is a need to identify those patients who are at risk for developing tendon problems, as well those at risk for poor outcomes after injury and to design interventions to improve outcomes after injury or rupture to specific tendons. This review will discuss recent advances in the identification of biomarkers prognostic for successful and less successful outcomes after tendon injury, and the mechanistic implications of such biomarkers, as well as the potential for specific biologic interventions to enhance outcomes to improve both quality of life and a return to participation in sports. In addition, the implication of these biomarkers for clinical trial design is discussed, as is the issue of whether such biomarkers for successful healing of one tendon can be extended to all tendons or are valid only for tendons in specific biomechanical and biological environments. As maintaining an active lifestyle is critical for health, the successful implementation of these advances will benefit the large number of individuals at risk.
肌腱是肌肉骨骼系统的致密结缔组织，连接骨骼和肌肉以促进运动。它们具有复杂的结构，存在于不同的生物力学、代谢和生物学环境中。此外，随着个体年龄增长，肌腱的组成和力学性能会在整个生命周期中发生变化。许多肌腱在高应力条件下发挥作用，其血管和神经供应较少，这种情况常导致慢性肌腱病的发生，在某些情况下，还会导致组织明显断裂。鉴于它们对人类在环境中活动和导航的重要性，不同肌腱在受伤或受损后的有效修复和再生对于生活质量至关重要，对于精英运动员而言，这关乎他们能否高水平重返体育赛事。然而，主要由于不明原因，受伤后的治疗效果并不总是成功的，会导致功能受损和再次受伤的风险。因此，有必要识别那些有发展为肌腱问题风险的患者，以及那些受伤后预后不良风险的患者，并设计干预措施以改善特定肌腱受伤或断裂后的治疗效果。本综述将讨论在识别肌腱损伤后预后成功和不太成功的生物标志物方面的最新进展，以及此类生物标志物的机制意义，以及特定生物干预措施改善治疗效果以提高生活质量和重返运动的潜力。此外，还将讨论这些生物标志物对临床试验设计的影响，以及一种肌腱成功愈合的生物标志物是否可以推广到所有肌腱，或者仅对特定生物力学和生物学环境中的肌腱有效。由于保持积极的生活方式对健康至关重要，这些进展的成功实施将使大量有风险的个体受益。
