Couniniotis Group (Greece)

BackgroundStrontium ranelate (StR) is an antiosteoporotic agent previously utilized for the enhancement of fracture union. We investigated the effects of StR on fracture healing using a rabbit model. Methods Forty adult female rabbits were included in the study and were divided in 2 equal groups, according to StR treatment or untreated controls. All animals were subjected to osteotomy of the ulna, while the contralateral ulna remained intact and served as a control for the biomechanical assessment of fracture healing. Animals in the study group received 600 mg/kg/day of StR orally. All animals received ordinary food. At 2 and 4 weeks, all animals were euthanatized and the osteotomy sites were evaluated for healing through radiological, biomechanical, and histopathological studies. Results The treatment group presented statistically significant higher callus diameter, total callus area, percentage of fibrous tissue (p < 0.001), vessels/mm2, number of total vessels, and lower osteoclast number/mm2 (p < 0.05) than the control group at 2 weeks. Additionally, the treatment group presented significantly higher percentages of new trabecular bone, vessels/mm2, osteoclast number/mm2, and lower values for callus diameter, as well as total callus area (p < 0.05), than the control group at 4 weeks. At 4 weeks, in the treatment group, force applied (p = 0.003), energy at failure (p = 0.004), and load at failure (p = 0.003) were all significantly higher in the forearm specimens with the osteotomized ulnae compared to those without. Radiological bone union was demonstrated for animals receiving StR at 4 weeks compared with controls (p = 0.045). Conclusion StR appears to enhance fracture healing but further studies are warranted in order to better elucidate the mechanisms and benefits of StR treatment.

A 17 year old female athlete presented with Achilles tendinopathy. A protocol of water and land based rehabilitation was designed to achieve non-weight bearing and pain free activity, so that she could rapidly return to her event (400 m hurdles). After three weeks, she returned to regular training, and after a further three weeks she successfully competed in a 400 m hurdle event. She has been able to compete at national level symptom free for the last 18 months. The Achilles tendon is the largest and strongest tendon in the human body and experiences high loads in all sporting activities. It has been shown to have a high capacity to withstand tensional forces.1 Chronic painful conditions located in the Achilles tendon are relatively common, especially in runners.2 The cause of such conditions is not known, but they are often associated with repetitive loading and overuse.3 Achilles tendinopathy is difficult to treat.1 Most recommend a conservative regimen as the initial strategy.4–6 Non-surgical treatments include a combination of rest, anti-inflammatory drugs, correction of malalignments, and stretching and strengthening exercises. There is sparse scientific evidence that these treatments are successful, and surgical treatment is required in about 25% of patients.1 In a recent prospective study, treatment with heavy load, eccentric calf muscle training showed very promising results and may reduce the need for surgical treatment of tendinopathy located in the mid-portion of the Achilles tendon.1 The short term results of surgery are often very good, but in the few studies with long term follow up there are signs of deterioration with time.1,7 In addition, over the last two decades there has been a considerable increase in the incidence of Achilles tendon rupture.8 Many athletic trainers propose an active land based rehabilitation training …