Suzan de Jonge1, Robert Rozenberg2, Bruno Vieyra2, Henk J Stam2, Henk-Jan Aanstoot3, Harrie Weinans1, Hans T M van Schie4, Stephan F E Praet2. 1. Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands. 2. MOVEFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands. 3. Diabeter, Center for Pediatric and Adolescent Diabetes Care and -Research, Rotterdam, The Netherlands. 4. Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands Department Scientific Research, UTC Imaging, Stein, The Netherlands.
Abstract
BACKGROUND: Musculotendinous overuse injuries are prevalent in people with type 2 diabetes. Non-enzymatic glycosylation of collagen resulting in tendon stiffening may play a role. In this case-control study we determined whether patients with diabetes had poorer ultrasonographic structure in their Achilles tendons compared to age-matched controls. METHODS: People with type 1 diabetes or type 2 diabetes, and age-matched controls, had computerised ultrasound tissue characterisation of both Achilles tendons. In contiguous ultrasonographic images of the tendon, echopatterns were quantified and categorised into four echo-types. Tendon abnormality was quantified as sum of echo-types III+IV. Furthermore, skin autofluorescence (AF) of the forearm (AF-value) was gathered. RESULTS: Twenty four type 2 diabetes patients, 24 controls, 24 type 1 diabetes patients and 20 controls were included. AF-value was higher in type 1 diabetes (1.55±0.17) than in their controls (1.39±0.18, p<0.001) and in type 2 diabetes (2.28±0.38) compared to their controls (1.84±0.32, p<0.001) Achilles tendons of type 2 diabetes patients contained more echo-types III+IV (14.1±7.9%) than matched controls (8.0±5.4%, p<0.001). There was a trend towards a difference in echo-types III+IV between type 1 diabetes patients (9.5±5.3%) and their controls (6.5±3.7%, p=0.055). In a stepwise linear regression analysis, body mass index (BMI) was moderately associated with tendon abnormality in patients with diabetes and controls (β=0.393, p<0.001). CONCLUSIONS: Type 2, and possibly type 1, diabetes patients showed poorer ultrasonographic Achilles tendon structure that may be a risk factor for tendinopathy. Although markers for accumulation of advanced glycation end products were elevated in both diabetes populations, only BMI was associated with these abnormalities. TRIAL REGISTRATION NUMBER: NTR2209. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND:Musculotendinous overuse injuries are prevalent in people with type 2 diabetes. Non-enzymatic glycosylation of collagen resulting in tendon stiffening may play a role. In this case-control study we determined whether patients with diabetes had poorer ultrasonographic structure in their Achilles tendons compared to age-matched controls. METHODS:People with type 1 diabetes or type 2 diabetes, and age-matched controls, had computerised ultrasound tissue characterisation of both Achilles tendons. In contiguous ultrasonographic images of the tendon, echopatterns were quantified and categorised into four echo-types. Tendon abnormality was quantified as sum of echo-types III+IV. Furthermore, skin autofluorescence (AF) of the forearm (AF-value) was gathered. RESULTS: Twenty four type 2 diabetespatients, 24 controls, 24 type 1 diabetespatients and 20 controls were included. AF-value was higher in type 1 diabetes (1.55±0.17) than in their controls (1.39±0.18, p<0.001) and in type 2 diabetes (2.28±0.38) compared to their controls (1.84±0.32, p<0.001) Achilles tendons of type 2 diabetespatients contained more echo-types III+IV (14.1±7.9%) than matched controls (8.0±5.4%, p<0.001). There was a trend towards a difference in echo-types III+IV between type 1 diabetespatients (9.5±5.3%) and their controls (6.5±3.7%, p=0.055). In a stepwise linear regression analysis, body mass index (BMI) was moderately associated with tendon abnormality in patients with diabetes and controls (β=0.393, p<0.001). CONCLUSIONS: Type 2, and possibly type 1, diabetespatients showed poorer ultrasonographic Achilles tendon structure that may be a risk factor for tendinopathy. Although markers for accumulation of advanced glycation end products were elevated in both diabetes populations, only BMI was associated with these abnormalities. TRIAL REGISTRATION NUMBER: NTR2209. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Florian Geburek; Florian Roggel; Hans T M van Schie; Andreas Beineke; Roberto Estrada; Kathrin Weber; Maren Hellige; Karl Rohn; Michael Jagodzinski; Bastian Welke; Christof Hurschler; Sabine Conrad; Thomas Skutella; Chris van de Lest; René van Weeren; Peter M Stadler Journal: Stem Cell Res Ther Date: 2017-06-05 Impact factor: 6.832
Authors: Dorthe Skovgaard; Rene B Svensson; Jean Scheijen; Pernilla Eliasson; Pernille Mogensen; Anne Mette F Hag; Michael Kjær; Casper G Schalkwijk; Peter Schjerling; Stig P Magnusson; Christian Couppé Journal: Physiol Rep Date: 2017-03
Authors: Lucas Maciel Rabello; I van den Akker-Scheek; Ireen F Kuipers; R L Diercks; Michel S Brink; J Zwerver Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-04-01 Impact factor: 4.342