The Association of. Hyperlipidemia with Achilles Tendinopathy. Foot & Ankle Section. Foot & Ankle Section

Size: px

Start display at page:

Download "The Association of. Hyperlipidemia with Achilles Tendinopathy. Foot & Ankle Section. Foot & Ankle Section"

Magdalene Daniel
6 years ago
Views:

1 The Association of Hyperlipidemia with Achilles Tendinopathy George B. Holmes, Jr., M.D. Joshua Wright-Chisem, MS-IV Rush University Medical Center Chicago, IL

2 DISCLOSURE NO CONFLICT TO DISCLOSE The Association of Hyperlipidemia with Achilles Tendinopathy George B. Holmes, Jr., M.D. Joshua Wright-Chisem, MS-IV Our disclosures are in the FINAL AOFAS Mobile App. We have no potential conflicts with this presentation. Arthrex: Royalties, Consultant

3 Achilles tendinopathy (tendinosis) has been theorized to be in part caused by microvascular pathology to the Achilles tendon The microvasculature of the Achilles tendon is thought to be susceptible to the same local and systemic influences that impact microcirculation to other end organ targets Normal Tendinopathy!!

4 Previous studies have described associations between Achilles tendinopathy and obesity, diabetes mellitus, hypertension, the supplemental use of estrogen as well as exposure to local and systemic steroids Because hyperlipidemia also has a known detrimental impact on end organ microcirculation, this study seeks to determine if there exists an association between Achilles tendinopathy and hyperlipidemia

5 Methods February 2010 to February patients were diagnosed with Achilles tendinopathy Diagnosis was confirmed by ICD-9 code (726.79) and by review of medical records, radiographs and MRI

6 Methods 28 males, 42 females Mean age 51 years (range 23-87) Patients were analyzed cumulatively and placed in subgroups by age and gender with respect to diabetes, hypertension, hyperlipidemia, obesity, steroid use and exposure to hormone replacement therapy and birth control pills (BCP s)

7 Methods Data was analyzed using Chi-squared 2x2 analysis, comparing the prevalence of the analyzed parameters in our patients with Achilles tendinopathy to those same parameters in the national population at large

8 with Achilles Tendinopathy Results Male Female Age HLD Total % Age HLD Total % TOTAL TOTAL

9 with Achilles Tendinopathy Results There was a statistically significant association of hyperlipidemia with Achilles tendinopathy in women aged and men aged with p-values of.0001 and , respectively

10 with Achilles Tendinopathy Discussion There is a well-documented relationship between end organ damage and hyperlipidemia Recent studies indicate Correlation between tendon pathology and hyperlipidemia Positive correlation between Achilles tendon thickness and elevated lipid panels Pathogenesis of this process is often debated, but is theorized to begin with endothelial damage

11 References 1. Khan, Karim M., Jill L. Cook, Fiona Bonar, Peter Harcourt, and Matsastrom. "Histopathology of Common Tendinopathies." Sports Medicine 27.6 (1999): Web. 2. Maffulli, Nicola, Pankaj Sharma, and Karen L Luscombe. Achilles Tendinopathy: Aetiology and Management. Journal of the Royal Society of Medicine (2004): Print. 3. MICHAEL F. MAZZONE, M.D., and TIMOTHY MCCUE, M.D., Medical College of Wisconsin, Waukesha, Wisconsin Am Fam Physician May 1;65(9): Kvist, M. H., M. U.k. Lehto, L. Jozsa, M. Jarvinen, and H. T. Kvist. "Chronic Achilles Paratenonitis: An Immunohistologic Study of Fibronectin and Fibrinogen." The American Journal of Sports Medicine 16.6 (1988): Web. 5. Maffulli, N., P. Sharma, and K. L. Luscombe. "Achilles Tendinopathy: Aetiology and Management." Jrsm (2004): Web. 6. Sharma, Pankaj. "Tendon Injury and Tendinopathy: Healing and Repair." The Journal of Bone and Joint Surgery (American) J Bone Joint Surg Am 87.1 (2005): 187. Web. 7. Arnoczky, Steven P., Michael Lavagnino, and Monika Egerbacher. "The Mechanobiological Aetiopathogenesis of Tendinopathy: Is It the Over-stimulation or the Under-stimulation of Tendon Cells?" International Journal of Experimental Pathology 88.4 (2007): Web. 8. Chen, Tony M., Warren M. Rozen, Wei-Ren Pan, Mark W. Ashton, Martin D. Richardson, and G. Ian Taylor. "The Arterial Anatomy of the Achilles Tendon: Anatomical Study and Clinical Implications." Clin. Anat. Clinical Anatomy 22.3 (2009): Web. 9. Holmes, GB, and J. Lin. "Etiologic Factors Associated with Symptomatic Achilles Tendinopathy." Foot & Ankle International (2006). Web. 10. Holmes, G. B., and R. A. Mann. "Possible Epidemiological Factors Associated with Rupture of the Posterior Tibial Tendon." Foot & Ankle International 13.2 (1992): Web. 11. Lind, Lars, and Hans Lithell. "Decreased Peripheral Blood Flow in the Pathogenesis of the Metabolic Syndrome Comprising Hypertension, Hyperlipidemia, and Hyperinsulinemia." American Heart Journal (1993): Web.

12 References 12. Joos, David, Nghi Tran, and Anish R. Kadakia. "Achilles Tendon Disorders." Presentation, Imaging and Treatment of Common Musculoskeletal Conditions Expert Consult (2012): Web. 13. Hess, G. W. "Achilles Tendon Rupture: A Review of Etiology, Population, Anatomy, Risk Factors, and Injury Prevention." Foot & Ankle Specialist 3.1 (2009): Web 14. Rodriguez, Craig P., Manish Goyal, and Daniel A. Wasdahl. "Atypical Imaging Features of Bilateral Achilles Tendon Xanthomatosis1." RadioGraphics 28.7 (2008): Web 15. Beeharry, D. "Familial Hypercholesterolaemia Commonly Presents with Achilles Tenosynovitis." Annals of the Rheumatic Diseases 65.3 (2006): Web 15. Pasterkamp, G., P. J. W. Wensing, M. J. Post, B. Hillen, W. P. T. M. Mali, and C. Borst. "Paradoxical Arterial Wall Shrinkage May Contribute to Luminal Narrowing of Human Atherosclerotic Femoral Arteries." Circulation 91.5 (1995): Web. 16. Insull, William. "The Pathology of Atherosclerosis: Plaque Development and Plaque Responses to Medical Treatment." The American Journal of Medicine (2009). Web. 17. Newby, Andrew C., Sarah J. George, Yasmin Ismail, Jason L. Johnson, Graciela B. Sala-Newby, and Anita C. Thomas. "Vulnerable Atherosclerotic Plaque Metalloproteinases and Foam Cell Phenotypes." Thromb Haemost Thrombosis and Haemostasis (2009). Web. 18. Napoli, C., F. P. D'armiento, F. P. Mancini, A. Postiglione, J. L. Witztum, G. Palumbo, and W. Palinski. "Fatty Streak Formation Occurs in Human Fetal Aortas and Is Greatly Enhanced by Maternal Hypercholesterolemia. Intimal Accumulation of Low Density Lipoprotein and Its Oxidation Precede Monocyte Recruitment into Early Atherosclerotic Lesions." Journal of Clinical Investigation J. Clin. Invest (1997): Web.

Watermark. Interaction between Neuropathy and PAD

Watermark. Interaction between Neuropathy and PAD Interaction between Neuropathy and PAD Javier La Fontaine, DPM, MS Associate Professor Department of Plastic Surgery UT Southwestern Medical Center Dallas, Texas Objectives Understand vascular disease