肌腱病變是一種常見疾病，據統計，30-50％的運動相關傷害及約半數的職業疾病為肌腱病變。然而如此高盛行率的疾病，目前對其病理機轉仍未十分明瞭。動物模式有助於研究疾病機轉及評估療效，目前對於肌腱病變小動物模式的功能性評估多僅限於動作分析，缺乏對於步態的力學分析。玻尿酸為肌腱病變眾多可能治療方式之一，無論在臨床或動物實驗上，玻尿酸皆顯示對肌腱病變有其療效，然而對於不同分子量與濃度的效果並未著墨。而臨床上施打玻尿酸時，皆不採取肌腱內注射，但尚未有研究顯示肌腱內注射玻尿酸是否會產生傷害。。因此，本研究將以阿基里斯肌腱模式為主軸探討肌腱病變的評估與玻尿酸的治療方式：(1) 以自製力板軌道系統探討以膠原脢(collagenase)注射引起之肌腱病變模式的步態力學特徵，並對照組織學和超音波特徵；(2) 探討肌腱內注射玻尿酸引起的急性發炎反應； (3) 探討不同分子量及濃度的玻尿酸在肌腱病變中對於基質金屬蛋白酶1和3的表現。
本研究發現超音波引導大鼠阿基里斯腱肌腱內膠原脢注射確實為一有效的肌腱病變動物模式，除了比對照組有顯著對應的組織病理變化和超音波特徵外，注射後足較對側後足有顯著較小的動態負重，而對側前足則有代償性增加的動態負重。此一顯著步態力學變化從第一週持續至第八週，而靜態後肢負重比例則無法反應此一變化。對比於肌腱戳針(Sham group)，肌腱內注射玻尿酸或磷酸緩衝生理食鹽水皆會引起明顯的急性肌腱傷害和發炎反應－病理組織變化、ED1+和ED2+巨噬細胞聚集、IL-1β表現和血管新生。然而在上述各項指標裡，玻尿酸注射皆比磷酸緩衝生理食鹽水表現較為嚴重，因此應該避免肌腱內注射玻尿酸。而在IL-1β刺激的肌腱細胞中，高分子量玻尿酸 (HA3000)明顯的減弱基質金屬蛋白酶1和3的mRNA和蛋白質的表現，而此一效果與玻尿酸濃度成正比，且藉著先行處理OX-50來抑制CD44表現可明顯反轉此一較果。臨床上，高分子量玻尿酸的治療可明顯的降低患者的VAS分數和減弱基質金屬蛋白酶1和3的表現。因此，高分子量玻尿酸藉著降低基質金屬蛋白酶1和3的表現，可能是一個有效的肌腱病變治療方式。本研究結果希望可以較為完備小動物肌腱病變模式及玻尿酸於肌腱病變治療的立論基礎。

Tendinopathy is a high-prevalence common disease that accounts for 30-50% of sports injuries and around half of occupation-related diseases. However, the pathogenetic mechanism of tendinopathy is largely unknown. Animal models are thus essential to evaluate the disease mechanism and treatment efficacy. To date, only the results of motion analysis has been reported in the small-animal pain assessment of tendinopathy, and kinetic changes in gait cycle have received much less attention. Hyaluronate (HA), one of possible treatment modalities, has been reported to mitigate tendinopathy effectively in both clinical series and animal models. However, the impacts of molecular weight and concentration of HA are still unknown. Moreover, intratendinous injection of HA is anecdotally avoided, despite a lack of evidence that direct intratendinous injection leads to an acute injury. Therefore, this dissertation will assess the evaluation and HA treatment strategies in tendinopathy using a rat Achilles tendon model. The specifics of this work are as follows: (1) to elucidate the kinetic features in a collagenase-induced tendinopathy model using a customized corridor with multi-directional force sensors, and compare the features with the histopathological and ultrasonographical findings; (2) to elucidate the possible detrimental inflammation induced by intratendinous injection of HA; and (3) to examine the effects of HA with different molecular weights and different concentrations on matrix metalloproteinase (MMP)-1 and -3 expression.
Our results showed ultrasound (US)-guided intratendinous injection of collagenase into rat Achilles tendons is a validated animal model with corresponding higher histopathological scores and higher US features scores than the control tendons. Our customized corridor clearly revealed significantly less dynamic weight bearing in the injected hind limbs than in the contralateral hind limbs, and compensatorily higher dynamic weight bearing in the contralateral fore limbs from week 1 to week 8. The static weight bearing ratio could not reflect the tendinopathic changes. Compared with intratendinous needle puncture, intratendinous injection of either HA or phosphate buffered saline (PBS) induces acute tendon injury and inflammatory reactions: histopathological changes, ED1+ and ED2+ macrophages accumulation, IL-1β expression, and neovascularization. The injury induced by intratendinous injection of HA was more severe than that induced by PBS. Therefore, intratendinous injection of HA should be avoided. Furthermore, high-molecular-weight (HMW) HA (HA3000) significantly attenuated the mRNA and protein expression of MMP-1 and -3 in IL-1β stimulated tenocytes. These effects were dose-dependent and significantly reversed by pretreating tenocytes with OX-50 to inhibit CD44 expression. Clinically, HMW-HA treatment significantly reduced VAS scores and attenuated MMP-1 and -3 expression in patients with LHB tendinopathy. These findings indicate that HMW-HA might be an effective treatment for tendinopathy by attenuating MMP-1 and -3 expression. It is hoped that, this dissertation will contribute to pain-related assessments in the small-animal tendinopathy model and to further research into HA treatment with regard to tendinopathy.

Abate, M., K. G. Silbernagel, C. Siljeholm, A. Di Iorio, D. De Amicis, V. Salini, S. Werner and R. Paganelli.,2009. Pathogenesis of tendinopathies: inflammation or degeneration? Arthritis Res Ther 11(3): 235.
Andersson, G., L. J. Backman, A. Scott, R. Lorentzon, S. Forsgren and P. Danielson., 2011. Substance P accelerates hypercellularity and angiogenesis in tendon tissue and enhances paratendinitis in response to Achilles tendon overuse in a tendinopathy model. Br J Sports Med 45(13): 1017-1022.
Andres, B. M. and G. A. Murrell., 2008. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res 466(7): 1539-1554.
Balayssac, D., B. Ling, J. Ferrier, B. Pereira, A. Eschalier and N. Authier.,201).Assessment of thermal sensitivity in rats using the thermal place preference test: description and application in the study of oxaliplatin-induced acute thermal hypersensitivity and inflammatory pain models. Behav Pharmacol 25(2): 99-111.
Berglund, M., D. A. Hart and M. Wiig., 2007. The inflammatory response and hyaluronan synthases in the rabbit flexor tendon and tendon sheath following injury. J Hand Surg Eur Vol 32(5): 581-587.
Campo, G. M., A. Avenoso, A. D'Ascola, V. Prestipino, M. Scuruchi, G. Nastasi, A. Calatroni and S. Campo., 2012. Hyaluronan differently modulates TLR-4 and the inflammatory response in mouse chondrocytes. Biofactors 38(1): 69-76.
Campo, G. M., A. Avenoso, G. Nastasi, A. Micali, V. Prestipino, M. Vaccaro, A. D'Ascola, A. Calatroni and S. Campo., 2011. Hyaluronan reduces inflammation in experimental arthritis by modulating TLR-2 and TLR-4 cartilage expression. Biochim Biophys Acta 1812(9): 1170-1181.
Chang, K. V., W. S. Chen, T. G. Wang, C. Y. Hung and K. L. Chien., 2014. Associations of sonographic abnormalities of the shoulder with various grades of biceps peritendinous effusion (BPE). Ultrasound Med Biol 40(2): 313-321.
Chbinou, N. and J. Frenette., 2004. Insulin-dependent diabetes impairs the inflammatory response and delays angiogenesis following Achilles tendon injury. Am J Physiol Regul Integr Comp Physiol 286(5): R952-957.
Chou, W. Y., J. Y. Ko, F. S. Wang, C. C. Huang, T. Wong, C. J. Wang and H. E. Chang., 2010. Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study. J Shoulder Elbow Surg 19(4): 557-563.
Clarke, A. W., M. Ahmad, M. Curtis and D. A. Connell., 2010. Lateral elbow tendinopathy: correlation of ultrasound findings with pain and functional disability. Am J Sports Med 38(6): 1209-1214.
Clayton, H. M., H. C. Schamhardt, M. A. Willemen, J. L. Lanovaz and G. R. Colborne., 2000. Kinematics and ground reaction forces in horses with superficial digital flexor tendinitis. Am J Vet Res 61(2): 191-196.
Connell, D., A. Datir, F. Alyas and M. Curtis., 2009. Treatment of lateral epicondylitis using skin-derived tenocyte-like cells. Br J Sports Med 43(4): 293-298.
Coombes, B. K., L. Bisset and B. Vicenzino., 2010. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376(9754): 1751-1767.
Corps, A. N., R. L. Harrall, V. A. Curry, S. A. Fenwick, B. L. Hazleman and G. P. Riley., 2002. Ciprofloxacin enhances the stimulation of matrix metalloproteinase 3 expression by interleukin-1beta in human tendon-derived cells. A potential mechanism of fluoroquinolone-induced tendinopathy. Arthritis Rheum 46(11): 3034-3040.
Coulthard, P., S. U. Simjee and B. J. Pleuvry., 2003. Gait analysis as a correlate of pain induced by carrageenan intraplantar injection. J Neurosci Methods 128(1-2): 95-102.
Dallaudiere, B., M. Lempicki, L. Pesquer, L. Louedec, P. M. Preux, P. Meyer, A. Hess, M. H. Durieux, V. Hummel, A. Larbi, L. Deschamps, Y. Benayoun, C. Journe, A. Perozziello, E. Schouman-Claeys, J. B. Michel and J. M. Serfaty., 2013. Acceleration of tendon healing using US guided intratendinous injection of bevacizumab: first pre-clinical study on a murine model. Eur J Radiol 82(12): e823-828.
Dean, B. J., E. Lostis, T. Oakley, I. Rombach, M. E. Morrey and A. J. Carr., 2014. The risks and benefits of glucocorticoid treatment for tendinopathy: a systematic review of the effects of local glucocorticoid on tendon. Semin Arthritis Rheum 43(4): 570-576.
Del Buono, A., F. Oliva, U. G. Longo, S. A. Rodeo, J. Orchard, V. Denaro and N. Maffulli., 2012. Metalloproteases and rotator cuff disease.J Shoulder Elbow Surg 21(2): 200-208.
Dones, V. C., 3rd, K. Grimmer, K. Thoirs, C. G. Suarez and J. Luker.,2014. The diagnostic validity of musculoskeletal ultrasound in lateral epicondylalgia: a systematic review. BMC Med Imaging 14: 10.
Ferland, C. E., S. Laverty, F. Beaudry and P. Vachon., 2011. Gait analysis and pain response of two rodent models of osteoarthritis. Pharmacol Biochem Behav 97(3): 603-610.
Fernihough, J., C. Gentry, M. Malcangio, A. Fox, J. Rediske, T. Pellas, B. Kidd, S. Bevan and J. Winter., 2004. Pain related behaviour in two models of osteoarthritis in the rat knee. Pain 112(1-2): 83-93.
Filipe, V. M., J. E. Pereira, L. M. Costa, A. C. Mauricio, P. A. Couto, P. Melo-Pinto and A. S. Varejao.,2006. Effect of skin movement on the analysis of hindlimb kinematics during treadmill locomotion in rats. J Neurosci Methods 153(1): 55-61.
Fredberg, U. and K. Stengaard-Pedersen.,2008. Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports 18(1): 3-15.
Fu, S. C., K. M. Chan, L. S. Chan, D. T. Fong and P. Y. Lui.,2009.The use of motion analysis to measure pain-related behaviour in a rat model of degenerative tendon injuries. J Neurosci Methods 179(2): 309-318.
Fujisawa, T., T. Hattori, K. Takahashi, T. Kuboki, A. Yamashita and M. Takigawa., 1999. Cyclic mechanical stress induces extracellular matrix degradation in cultured chondrocytes via gene expression of matrix metalloproteinases and interleukin-1. J Biochem 125(5): 966-975.
Fukasawa, M., S. M. Bryant, R. M. Nakamura and G. S. diZerega., 1987. Modulation of fibroblast proliferation by postsurgical macrophages. J Surg Res 43(6): 513-520.
Galea-Lauri, J., J. M. Wilkinson and C. H. Evans., 1993. Characterization of monoclonal antibodies against rabbit CD44: evidence of a role for CD44 in modulating synoviocyte metabolism. Mol Immunol 30(15): 1383-1392.
Gaujoux-Viala, C., M. Dougados and L. Gossec., 2009. Efficacy and safety of steroid injections for shoulder and elbow tendonitis: a meta-analysis of randomised controlled trials. Ann Rheum Dis 68(12): 1843-1849.
Gelberman, R. H., D. Steinberg, D. Amiel and W. Akeson., 1991. Fibroblast chemotaxis after tendon repair. J Hand Surg Am 16(4): 686-693.
Han, J. S., G. C. Bird, W. Li, J. Jones and V. Neugebauer.,2005. Computerized analysis of audible and ultrasonic vocalizations of rats as a standardized measure of pain-related behavior. J Neurosci Methods 141(2): 261-269.
Hashizume, M. and M. Mihara.,2009. Desirable effect of combination therapy with high molecular weight hyaluronate and NSAIDs on MMP production. Osteoarthritis Cartilage 17(11): 1513-1518.
Hsu, J. E., K. E. Reuther, J. J. Sarver, C. S. Lee, S. J. Thomas, D. L. Glaser and L. J. Soslowsky., 2011. Restoration of anterior-posterior rotator cuff force balance improves shoulder function in a rat model of chronic massive tears.J Orthop Res 29(7): 1028-1033.
Huang, T. L., H. C. Hsu, K. C. Yang, C. H. Yao and F. H. Lin.,2010. Effect of different molecular weight hyaluronans on osteoarthritis-related protein production in fibroblast-like synoviocytes from patients with tibia plateau fracture. J Trauma 68(1): 146-152.
Ignotz, R. A. and J. Massague., 1986. Transforming growth factor-beta stimulates the expression of fibronectin and collagen and their incorporation into the extracellular matrix. J Biol Chem 261(9): 4337-4345.
Ismail, A. M., R. Balakrishnan, M. K. Rajakumar and K. Lumpur.,1969. Rupture of patellar ligament after steroid infiltration. Report of a case. J Bone Joint Surg Br 51(3): 503-505.
Jay, G. D., K. A. Elsaid, K. A. Kelly, S. C. Anderson, L. Zhang, E. Teeple, K. Waller and B. C. Fleming., 2012. Prevention of cartilage degeneration and gait asymmetry by lubricin tribosupplementation in the rat following anterior cruciate ligament transection. Arthritis Rheum 64(4): 1162-1171.
Julovi, S. M., T. Yasuda, M. Shimizu, T. Hiramitsu and T. Nakamura., 2004. Inhibition of interleukin-1beta-stimulated production of matrix metalloproteinases by hyaluronan via CD44 in human articular cartilage. Arthritis Rheum 50(2): 516-525.
Kannus, P., 1997. Tendons--a source of major concern in competitive and recreational athletes. Scand J Med Sci Sports 7(2): 53-54.
Kapetanos, G., 1982. The effect of the local corticosteroids on the healing and biomechanical properties of the partially injured tendon. Clin Orthop Relat Res(163): 170-179.
Kataoka, Y., W. Ariyoshi, T. Okinaga, T. Kaneuji, S. Mitsugi, T. Takahashi and T. Nishihara.,2013. Mechanisms involved in suppression of ADAMTS4 expression in synoviocytes by high molecular weight hyaluronic acid. Biochem Biophys Res Commun 432(4): 580-585.
Kobayashi, K., R. Imaizumi, H. Sumichika, H. Tanaka, M. Goda, A. Fukunari and H. Komatsu., 2003. Sodium iodoacetate-induced experimental osteoarthritis and associated pain model in rats. J Vet Med Sci 65(11): 1195-1199.
Krasinski, R. and H. Tchorzewski., 2007. [Hyaluronan-mediated regulation of inflammation]. Postepy Hig Med Dosw (Online) 61: 683-689.
Kumai, T., T. Muneta, A. Tsuchiya, M. Shiraishi, Y. Ishizaki, K. Sugimoto, N. Samoto, S. Isomoto, Y. Tanaka and Y. Takakura., 2014. The short-term effect after a single injection of high-molecular-weight hyaluronic acid in patients with enthesopathies (lateral epicondylitis, patellar tendinopathy, insertional Achilles tendinopathy, and plantar fasciitis): a preliminary study. J Orthop Sci 19(4): 603-611.
Lake, S. P., H. L. Ansorge and L. J. Soslowsky., 2008. Animal models of tendinopathy. Disabil Rehabil 30(20-22): 1530-1541.
Lakes, E. H. and K. D. Allen., 2016. Gait analysis methods for rodent models of arthritic disorders: reviews and recommendations. Osteoarthritis Cartilage.
Lane, L. B., R. S. Boretz and S. A. Stuchin., 2001. Treatment of de Quervain's disease:role of conservative management. J Hand Surg Br 26(3): 258-260.
Lee, M. H., J. G. Cha, W. Jin, B. S. Kim, J. S. Park, H. K. Lee and H. S. Hong., 2011. Utility of sonographic measurement of the common tensor tendon in patients with lateral epicondylitis. AJR Am J Roentgenol 196(6): 1363-1367.
Lesley, J., R. Hyman and P. W. Kincade., 1993. CD44 and its interaction with extracellular matrix. Adv Immunol 54: 271-335.
Lo, I. K., L. L. Marchuk, R. Hollinshead, D. A. Hart and C. B. Frank., 2004. Matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase mRNA levels are specifically altered in torn rotator cuff tendons. Am J Sports Med 32(5): 1223-1229.
Lui, P. P., L. S. Chan, S. C. Fu and K. M. Chan., 2010. Expression of sensory neuropeptides in tendon is associated with failed healing and activity-related tendon pain in collagenase-induced tendon injury. Am J Sports Med 38(4): 757-764.
Lui, P. P., L. S. Chan, Y. W. Lee, S. C. Fu and K. M. Chan.,2010. Sustained expression of proteoglycans and collagen type III/type I ratio in a calcified tendinopathy model. Rheumatology (Oxford) 49(2): 231-239.
Lui, P. P., N. Maffulli, C. Rolf and R. K. Smith., 2011. What are the validated animal models for tendinopathy? Scand J Med Sci Sports 21(1): 3-17.
Maffulli, N., S. W. Ewen, S. W. Waterston, J. Reaper and V. Barrass.,2000. Tenocytes from ruptured and tendinopathic achilles tendons produce greater quantities of type III collagen than tenocytes from normal achilles tendons. An in vitro model of human tendon healing. Am J Sports Med 28(4): 499-505.
Magra, M. and N. Maffulli., 2005. Matrix metalloproteases: a role in overuse tendinopathies. Br J Sports Med 39(11): 789-791.
Manning, C. N., N. Havlioglu, E. Knutsen, S. E. Sakiyama-Elbert, M. J. Silva, S. Thomopoulos and R. H. Gelberman., 2014. The early inflammatory response after flexor tendon healing: a gene expression and histological analysis. J Orthop Res 32(5): 645-652.
Marsolais, D., C. H. Cote and J. Frenette., 2001. Neutrophils and macrophages accumulate sequentially following Achilles tendon injury. J Orthop Res 19(6): 1203-1209.
Massimino, M. L., E. Rapizzi, M. Cantini, L. D. Libera, F. Mazzoleni, P. Arslan and U. Carraro., 1997. ED2+ macrophages increase selectively myoblast proliferation in muscle cultures. Biochem Biophys Res Commun 235(3): 754-759.
McLennan, I. S., 1993. Resident macrophages (ED2- and ED3-positive) do not phagocytose degenerating rat skeletal muscle fibres. Cell Tissue Res 272(1): 193-196.
Meloni, F., F. Milia, M. Cavazzuti, C. Doria, P. Lisai, S. Profili and G. B. Meloni., 2008. Clinical evaluation of sodium hyaluronate in the treatment of patients with sopraspinatus tendinosis under echographic guide: experimental study of periarticular injections. Eur J Radiol 68(1): 170-173.
Merolla, G., P. Bianchi and G. Porcellini., 2013. Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: a prospective comparative study with rehabilitation therapy. Musculoskelet Surg 97 Suppl 1: 49-56.
Millar, N. L., A. J. Hueber, J. H. Reilly, Y. Xu, U. G. Fazzi, G. A. Murrell and I. B. McInnes., 2010. Inflammation is present in early human tendinopathy. Am J Sports Med 38(10): 2085-2091.
Mitsui, Y., M. Gotoh, K. Nakama, T. Yamada, F. Higuchi and K. Nagata 2008. Hyaluronic acid inhibits mRNA expression of proinflammatory cytokines and cyclooxygenase-2/prostaglandin E(2) production via CD44 in interleukin-1-stimulated subacromial synovial fibroblasts from patients with rotator cuff disease. J Orthop Res 26(7): 1032-1037.
Mobasheri, A. and M. Shakibaei.,2013. Is tendinitis an inflammatory disease initiated and driven by pro-inflammatory cytokines such as interleukin 1beta? Histol Histopathol 28(8): 955-964.
Myerson, M. S. and W. McGarvey., 1999. Disorders of the Achilles tendon insertion and Achilles tendinitis. Instr Course Lect 48: 211-218.
Nago, M., Y. Mitsui, M. Gotoh, K. Nakama, I. Shirachi, F. Higuchi and K. Nagata., 2010. Hyaluronan modulates cell proliferation and mRNA expression of adhesion-related procollagens and cytokines in glenohumeral synovial/capsular fibroblasts in adhesive capsulitis. J Orthop Res 28(6): 726-731.
Nichols, A. W.,(2005. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med 15(5): 370-375.
Nissen, N. N., P. J. Polverini, A. E. Koch, M. V. Volin, R. L. Gamelli and L. A. DiPietro., 1998. Vascular endothelial growth factor mediates angiogenic activity during the proliferative phase of wound healing. Am J Pathol 152(6): 1445-1452.
Noble, P. W., 2002. Hyaluronan and its catabolic products in tissue injury and repair. Matrix Biol 21(1): 25-29.
Orchard, J. and A. Kountouris., 2011. The management of tennis elbow. Bmj 342: d2687.
Osti, L., M. Berardocco, V. di Giacomo, G. Di Bernardo, F. Oliva and A. C. Berardi., 2015. Hyaluronic acid increases tendon derived cell viability and collagen type I expression in vitro: Comparative study of four different Hyaluronic acid preparations by molecular weight. BMC Musculoskelet Disord 16: 284.
Poltawski, L., S. Ali, V. Jayaram and T. Watson., 2012. Reliability of sonographic assessment of tendinopathy in tennis elbow. Skeletal Radiol 41(1): 83-89.
Poltawski, L., V. Jayaram and T. Watson., 2010. Measurement issues in the sonographic assessment of tennis elbow. J Clin Ultrasound 38(4): 196-204.
Quadros, A. U., L. G. Pinto, M. M. Fonseca, R. Kusuda, F. Q. Cunha and T. M. Cunha., 2015. Dynamic weight bearing is an efficient and predictable method for evaluation of arthritic nociception and its pathophysiological mechanisms in mice. Sci Rep 5: 14648.
Raleigh, S. M., L. van der Merwe, W. J. Ribbans, R. K. Smith, M. P. Schwellnus and M. Collins., 2009. Variants within the MMP3 gene are associated with Achilles tendinopathy: possible interaction with the COL5A1 gene. Br J Sports Med 43(7): 514-520.
Ravanti, L. and V. M. Kahari.,2000. Matrix metalloproteinases in wound repair (review).Int J Mol Med 6(4): 391-407.
Riley, G. P., R. L. Harrall, C. R. Constant, M. D. Chard, T. E. Cawston and B. L. Hazleman., 1994. Tendon degeneration and chronic shoulder pain: changes in the collagen composition of the human rotator cuff tendons in rotator cuff tendinitis. Ann Rheum Dis 53(6): 359-366.
Sarver, J. J., M. I. Dishowitz, S. Y. Kim and L. J. Soslowsky., 2010. Transient decreases in forelimb gait and ground reaction forces following rotator cuff injury and repair in a rat model. J Biomech 43(4): 778-782.
Scutt, N., C. G. Rolf and A. Scutt.,2006. Glucocorticoids inhibit tenocyte proliferation and Tendon progenitor cell recruitment. J Orthop Res 24(2): 173-182.
Shibata, Y., K. Midorikawa, G. Emoto and M. Naito., 2001. Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg 10(3): 209-216.
Shive, C. L., J. C. Mudd, N. T. Funderburg, S. F. Sieg, B. Kyi, D. A. Bazdar, D. Mangioni, A. Gori, J. M. Jacobson, A. D. Brooks, J. Hardacre, J. Ammori, J. D. Estes, T. W. Schacker, B. Rodriguez and M. M. Lederman., 2014. Inflammatory cytokines drive CD4+ T-cell cycling and impaired responsiveness to interleukin 7: implications for immune failure in HIV disease. J Infect Dis 210(4): 619-629.
Stannard, J. P. and A. L. Bucknell.,1993. Rupture of the triceps tendon associated with steroid injections. Am J Sports Med 21(3): 482-485.
Sullo, A., N. Maffulli, G. Capasso and V. Testa., 2001. The effects of prolonged peritendinous administration of PGE1 to the rat Achilles tendon: a possible animal model of chronic Achilles tendinopathy. J Orthop Sci 6(4): 349-357.
Tatari, H., E. Skiak, H. Destan, C. Ulukus, E. Ozer and S. Satoglu., 2004. Effect of hylan G-F 20 in Achilles' tendonitis: an experimental study in rats. Arch Phys Med Rehabil 85(9): 1470-1474.
Toprak, U., B. Baskan, E. Ustuner, E. Oten, L. Altin, M. A. Karademir and H. Bodur., 2012. Common extensor tendon thickness measurements at the radiocapitellar region in diagnosis of lateral elbow tendinopathy. Diagn Interv Radiol 18(6): 566-570.
Torp-Pedersen, T. E., S. T. Torp-Pedersen, E. Qvistgaard and H. Bliddal., 2008. Effect of glucocorticosteroid injections in tennis elbow verified on colour Doppler ultrasonography: evidence of inflammation. Br J Sports Med 42(12): 978-982.
Tsuzaki, M., G. Guyton, W. Garrett, J. M. Archambault, W. Herzog, L. Almekinders, D. Bynum, X. Yang and A. J. Banes., 2003. IL-1 beta induces COX2, MMP-1, -3 and -13, ADAMTS-4, IL-1 beta and IL-6 in human tendon cells. J Orthop Res 21(2): 256-264.
Underhill, C., 1992. CD44: the hyaluronan receptor. J Cell Sci 103 ( Pt 2): 293-298.
United States, B. o. L. S., 1995. Occupational injuries and illnessescounts,rates and characteristics. The Bureau. Washington, DC.
Wang, C. T., Y. T. Lin, B. L. Chiang, Y. H. Lin and S. M. Hou., 2006. High molecular weight hyaluronic acid down-regulates the gene expression of osteoarthritis-associated cytokines and enzymes in fibroblast-like synoviocytes from patients with early osteoarthritis.Osteoarthritis Cartilage 14(12): 1237-1247.
Warden, S. J., 2007. Animal models for the study of tendinopathy. Br J Sports Med 41(4): 232-240.
Wei, A. S., J. J. Callaci, D. Juknelis, G. Marra, P. Tonino, K. B. Freedman and F. H. Wezeman., 2006. The effect of corticosteroid on collagen expression in injured rotator cuff tendon. J Bone Joint Surg Am 88(6): 1331-1338.
Wiggins, M. E., P. D. Fadale, H. Barrach, M. G. Ehrlich and W. R. Walsh.,1994. Healing characteristics of a type I collagenous structure treated with corticosteroids. Am J Sports Med 22(2): 279-288.
Wu, P. T., I. M. Jou, C. C. Yang, C. J. Lin, C. Y. Yang, F. C. Su and W. R. Su., 2014. The severity of the long head biceps tendinopathy in patients with chronic rotator cuff tears: macroscopic versus microscopic results. J Shoulder Elbow Surg 23(8): 1099-1106.
Yamamoto, E., D. Hata, A. Kobayashi, H. Ueda, P. Tangkawattana, M. Oikawa and K. Takehana.,2002. Effect of beta-aminopropionitrile and hyaluronic acid on repair of collagenase-induced injury of the rabbit Achilles tendon. J Comp Pathol 126(2-3): 161-170.
Yatabe, T., S. Mochizuki, M. Takizawa, M. Chijiiwa, A. Okada, T. Kimura, Y. Fujita, H. Matsumoto, Y. Toyama and Y. Okada., 2009. Hyaluronan inhibits expression of ADAMTS4 (aggrecanase-1) in human osteoarthritic chondrocytes. Ann Rheum Dis 68(6): 1051-1058.
Yoshida, M., H. Funasaki, M. Kubota and K. Marumo., 2015. Therapeutic effects of high molecular weight hyaluronan injections for tendinopathy in a rat model. J Orthop Sci 20(1): 186-195.
Zeisig, E., M. Fahlstrom, L. Ohberg and H. Alfredson., 2008. Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study. Br J Sports Med 42(4): 267-271.
Zhang, J., N. Ebraheim and G. E. Lause.,2011. Ultrasound-guided injection for the biceps brachii tendinitis: results and experience. Ultrasound Med Biol 37(5): 729-733.
Zhen, E. Y., I. J. Brittain, D. A. Laska, P. G. Mitchell, E. U. Sumer, M. A. Karsdal and K. L. Duffin., 2008. Characterization of metalloprotease cleavage products of human articular cartilage. Arthritis Rheum 58(8): 2420-2431.
Zhu, H., N. Mitsuhashi, A. Klein, L. W. Barsky, K. Weinberg, M. L. Barr, A. Demetriou and G. D. Wu.,2006. The role of the hyaluronan receptor CD44 in mesenchymal stem cell migration in the extracellular matrix. Stem Cells 24(4): 928-935.
Ziltener, J. L., S. Leal and P. E. Fournier.,2010. Non-steroidal anti-inflammatory drugs for athletes: an update. Ann Phys Rehabil Med 53(4): 278-282, 282-278.