Why Tendon Problems Behave Differently: A Glimpse Into Proteomics' Future​

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Why Tendon Problems Behave Differently: A Glimpse Into Proteomics' Future 

 

While genomics studies the full set of genes, proteomics studies the proteins those genes produce, which can more directly reflect a cell’s physiologic state. 

 

In this study, using proteomics, authors asked: Why do treatment responses differ between traditional tenopathy and tenopathy associated with diabetes?

 

The study

 

Researchers analyzed Achilles tendon tissue using mass spectrometry to quantify thousands of proteins, comparing patterns from three groups:

 

• Tendinopathy (n=8)

• Diabetes (n=5)

• Controls (n=5)

 

Key findings

 

Tendinopathy showed major changes: 

 

• 311 proteins altered

• Marked increases in inflammatory proteins and enzymes that break down tendon structure (e.g., MMPs, TIMPs)

• Degeneration scores much higher than controls

 

Diabetes caused smaller shifts: 

 

• 66 proteins changed

• Patterns suggested reduced Type I collagen and signs of metabolic/fibrotic stress

• Importantly, diabetic tendons did not show the structural damage typical of tendinopathy

 

What it means

 

• Tendinopathy: Represents active tissue breakdown and inflammation, which likely makes treatments targeting remodeling and inflammatory pathways.

• Diabetes produces subtler changes that may weaken tendon integrity but don’t generate classic tendinopathic degeneration, which likely increases injury risk rather than directly causing tendinopathy.

 

Clinical relevance

 

Proteomics is not yet clinic-ready, but these findings highlight distinctive biological “signatures” that could eventually: 

 

• Enable earlier diagnose

• Predict treatment response 

• Guide personalized therapy based on an individual patient’s tendon biology

 

In other words, this research points toward true precision medicine for tendon disorders.

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Synesmotic Stocking Stuffer

by Vince Vacketta, DPM

 

As winter sets in, for many of us, both snow and your patients may be falling. ‘Tis the season to review some recent literature on ankle fractures. 

 

Center-center clamp placement study: CT quality reduction without the hassle?

 

The study was a cadaveric investigation designed to identify the optimal position for clamp placement on fluoroscopy. It found that a fluoroscopic “center-center” view for clamp placement accurately aligns with established CT-based axes for syndesmosis reduction. 

 

Suture-button CT study: Understand the fixation “creep”

 

This retrospective CT study evaluated the behavior of suture button fixation. The findings showed that the syndesmosis is initially over-compressed after fixation but gradually “settles” toward normal alignment over six months under physiologic load.

 

Key takeaways

 

• The center-center view provides CT-level accuracy for clamp placement. Even for those who do not use clamps, this view can still serve as a reliable and efficient guide for syndesmosis reduction.

• With the suture-button fixation, don't be alarmed by initial intraoperative over-compression, as the construct gradually settles under loadbearing. Interpret early postoperative imaging cautiously, with final alignment best assessed at roughly six months.

 

 

Decide for Yourself, Don't Let Biases Decide for You

 

Strict BMI cutoffs for total ankle arthroplasty (TAA) may unintentionally restrict who gets surgery. 

 

A recent study of 1,215 TAA patients from the ACS-NSQIP database (2011–2020) found that applying common BMI eligibility cutoffs (<50, <45, <40, <35) disproportionately affected certain racial, ethnic, sex, and age groups. 

 

What they found

 

The analysis revealed notable disparities in eligibility across these demographic groups:

 

• The tighter the BMI cutoff, the bigger the disparities.

• Black patients were significantly less likely to qualify at BMI <35.

• Hispanic patients had lower eligibility across all cutoffs.

• White non-Hispanic and Asian/Pacific Islander patients were more likely to meet BMI thresholds.

• Women were consistently less likely to qualify  than men.

• Younger patients were more often excluded than older ones.

 

Bottom line

 

Rigid BMI rules may unintentionally restrict access to TAA, especially for Black, Hispanic, female, and younger patients.