تاندون، اختلالات تاندونی و سلول درمانی در تاندون
محورهای موضوعی : علوم جراحی دامپزشکی شامل جراحی های بافت های سخت و نرممهدی بهفر 1 , محمد حسین فرجاه 2
1 - دانشگاه ارومیه
2 - دانشگاه ارومیه
کلید واژه: تاندون, سلول درمانی, کلاژن ,
چکیده مقاله :
تاندون یا زردپی یک باند محکم و مستحکم از جنس بافت همبند فیبروزی است، که عضله را به استخوان متصل می کند. این ساختار توانایی انتقال نیرو های مکانیکی حاصل از انقباض ماهیچه ها به سیستم اسکلتی را دارد. تندینایتیس یک واژه ی عمومی است، که اغلب برای توصیف موقعیت های دردناک تاندون ناشی از کشیدگی های مداوم، استفاده ی بیش از حد، دژنره شدن و یا بیومکانیسم ضعیف تاندون به کار می رود. تندینوپاتی اغلب ناشی از تلاش های بی نتیجه بدن جهت احیای مجدد تاندون است که یک درگیری پاتولوژیکی منجر به نقص در عملکرد آن شده است. روش های مختلف درمانی برای مدیریت اختلالات تاندونی به کار رفته است. سلول های بنیادی به دو دسته تقسیم می شوند. سلول های جنینی ( که بسیار بالقوه هستند ولی به علت ملاحظات اخلاقی، مطالعات محدودی بر روی آن ها صورت گرفته است) و سلول های پس از تولد. سلول های پس از تولد خود به دو دسته تقسیم می شوند که شامل، سلول های بنیادی خون ساز و سلول های بنیادی مزانشیمی است. سلول های بنیادی مزانشیمی توانایی تمایز یافتن به سلول های متعددی از جمله تنوسیت، کندروسیت و فیبروبلاست را دارند. بنابراین این سلول ها یک جایگزین بالقوه برای درمان ضایعات تاندونی هستند. این مقاله نگاهی کلی به ساختمان، بیومکانیک و اختلالات تاندونی داشته و ضمن اشاره به درمان های رایج امروزی، با معرفی سلول های بنیادی و مطالعات گذشته نگر، امکان استفاده از این سلول ها در درمان بهینه ی اختلالات تاندونی را بررسی می کند.
The tendon is a firm fibrous band of connective tissue that connects muscle to bone. This structure has the ability to transfer mechanical forces resulting from muscle contraction to the skeletal system. Tendinitis is a general term, often used to describe painful tendon situations due to constant stretching, overuse, degeneration, or poor tendon biomechanism. Tendinopathy is often the result of useless attempts by the body to regenerate a tendon, which a pathological conflict has led to a malfunction. Various treatments have been used to manage tendon disorders. Stem cells are divided into two categories. Embryonic cells (which are very potential but due to ethical considerations, limited studies have been done on them) and postnatal cells. Postnatal cells are divided into two categories, which include; Hematopoietic stem cells and mesenchymal stem cells. Mesenchymal stem cells have the ability to differentiate into multiple cells, including tenocytes, chondrocytes, and fibroblasts. these cells are a potential alternative to treating tendon lesions. This article presentan overview of the structure, biomechanics and disorders of tendon and, while pointing to the common therapies today, introduces stem cells , retrospective studies and possibility of using these cells in the optimal treatment of tendon disorders.
1- Kannus P. Structure of the tendon connective tissue. Scandinavian journal of medicine & science in sports. 2000 Dec;10(6):312-20.
2- Ibsen C, Schiøttz-Christensen B, Vinther Nielsen C, Hørder M, Schmidt AM, Maribo T. Assessment of functioning and disability in patients with low back pain–the low back pain assessment tool. Part 1: development. Disability and rehabilitation. 2021 Jun 2:1-2.
3- McNeilly CM, Banes AJ, Benjamin M, Ralphs JR. Tendon cells in vivo form a three dimensional network of cell processes linked by gap junctions. Journal of anatomy. 1996 Dec;189(Pt 3):593.
4- Young M, Michael L. A review on postural realignment and its muscular and neural components. British Journal of Sports Medicine. 2002;9(12):51-76.
5- Sharma P, Maffulli N. Biology of tendon injury: healing, modeling and remodeling. Journal of musculoskeletal and neuronal interactions. 2006 Apr 1;6(2):181.
6- Thomopoulos S, Marquez JP, Weinberger B, Birman V, Genin GM. Collagen fiber orientation at the tendon to bone insertion and its influence on stress concentrations. Journal of biomechanics. 2006 Jan 1;39(10):1842-51.
7- Benjamin M, Kaiser E, Milz S. Structure‐function relationships in tendons: a review. Journal of anatomy. 2008 Mar;212(3):211-28.
8- Lephart SM, Pincivero DM, Giraido JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. The American journal of sports medicine. 1997 Jan;25(1):130-7.
9- Ackermann PW, Li J, Finn A, Ahmed M, Kreicbergs A. Autonomic innervation of tendons, ligaments and joint capsules. A morphologic and quantitative study in the rat. Journal of Orthopaedic Research. 2001 May;19(3):372-8.
10- Paxton JZ, Baar K. Tendon mechanics: the argument heats up. Journal of Applied Physiology. 2007 Aug 1.
11- Rees JD, Wilson AM, Wolman RL. Current concepts in the management of tendon disorders. Rheumatology. 2006 May 1;45(5):508-21.
12- Young RG, Butler DL, Weber W, Caplan AI, Gordon SL, Fink DJ. Use of mesenchymal stem cells in a collagen matrix for Achilles tendon repair. Journal of orthopaedic research. 1998 Jul;16(4):406-13.
13- Smith, R.K.W., Korda, M., Blunn, G.W. and Goodship, A.E., 2003. Isolation and implantation of autologous equine mesenchymal stem cells from bone marrow into the superficial digital flexor tendon as a potential novel treatment. Equine veterinary journal, 35(1), pp.99-102.
14- Smith RK, Webbon PM. Harnessing the stem cell for the treatment of tendon injuries: heralding a new dawn?. British journal of sports medicine. 2005 Sep 1;39(9):582-4.
15- Bass E. Tendinopathy: why the difference between tendinitis and tendinosis matters. International journal of therapeutic massage & bodywork. 2012;5(1):14.
16- Physioexperts , https://www.physioexperts.ca/what-is-the-difference-between-tendinitis/ , 2021 Apr.
17- Obaid H, Connell D. Cell therapy in tendon disorders: what is the current evidence?. The American journal of sports medicine. 2010 Oct;38(10):2123-32.
18- Khan KM, Cook JL, Bonar F, Harcourt P, Åstrom M. Histopathology of common tendinopathies. Sports medicine. 1999 Jun;27(6):393-408.
19- Ljung BO, Forsgren S, Fridén J. Substance P and calcitonin gene‐related peptide expression at the extensor carpi radialis brevis muscle origin: implications for the etiology of tennis elbow. Journal of orthopaedic research. 1999 Jul;17(4):554-9.
20- Soslowsky LJ, Thomopoulos S, Tun S, Flanagan CL, Keefer CC, Mastaw J, Carpenter JE. Neer Award 1999: Overuse activity injures the supraspinatus tendon in an animal model: A histologic and biomechanical study. Journal of Shoulder and Elbow Surgery. 2000 Mar 1;9(2):79-84.
21- Juncosa-Melvin N, Boivin GP, Gooch C, Galloway MT, West JR, Dunn MG, Butler DL. The effect of autologous mesenchymal stem cells on the biomechanics and histology of gel-collagen sponge constructs used for rabbit patellar tendon repair. Tissue engineering. 2006 Feb 1;12(2):369-79..
22- Kryger GS, Chong AK, Costa M, Pham H, Bates SJ, Chang J. A comparison of tenocytes and mesenchymal stem cells for use in flexor tendon tissue engineering. The Journal of hand surgery. 2007 May 1;32(5):597-605.
23- Soon MY, Hassan A, Hui JH, Goh JC, Lee EH. An analysis of soft tissue allograft anterior cruciate ligament reconstruction in a rabbit model: a short-term study of the use of mesenchymal stem cells to enhance tendon osteointegration. The American journal of sports medicine. 2007 Jun;35(6):962-71.
24- Goodship AE, Birch HL, Wilson AM. The pathobiology and repair of tendon and ligament injury. Veterinary Clinics of North America: Equine Practice. 1994 Aug 1;10(2):323-49.
25- McIlwraith CW. Diseases of joints, tendons, ligaments, and related structures. Adams' lameness in horses. 2002:459-79.
26- Wang JH. Mechanobiology of tendon. Journal of biomechanics. 2006 Jan 1;39(9):1563-82.
27- Young RG, Butler DL, Weber W, Caplan AI, Gordon SL, Fink DJ. Use of mesenchymal stem cells in a collagen matrix for Achilles tendon repair. Journal of orthopaedic research. 1998 Jul;16(4):406-13..
28- Awad HA, Boivin GP, Dressler MR, Smith FN, Young RG, Butler DL. Repair of patellar tendon injuries using a cell–collagen composite. Journal of orthopaedic research. 2003 May;21(3):420-31.
29- Hankemeier S, van Griensven M, Ezechieli M, Barkhausen T, Austin M, Jagodzinski M, Meller R, Bosch U, Krettek C, Zeichen J. Tissue engineering of tendons and ligaments by human bone marrow stromal cells in a liquid fibrin matrix in immunodeficient rats: results of a histologic study. Archives of orthopaedic and trauma surgery. 2007 Nov;127(9):815-21.
30- Connell D, Datir A, Alyas F, Curtis M. Treatment of lateral epicondylitis using skin-derived tenocyte-like cells. British journal of sports medicine. 2009 Apr 1;43(4):293-8.
31- Toma JG, Akhavan M, Fernandes KJ, Barnabé-Heider F, Sadikot A, Kaplan DR, Miller FD. Isolation of multipotent adult stem cells from the dermis of mammalian skin. Nature cell biology. 2001 Sep;3(9):778-84.
32- Bi Y, Ehirchiou D, Kilts TM, Inkson CA, Embree MC, Sonoyama W, Li L, Leet AI, Seo BM, Zhang L, Shi S. Identification of tendon stem/progenitor cells and the role of the extracellular matrix in their niche. Nature medicine. 2007 Oct;13(10):1219-27.
