Joints/Tendons/Bone

[Dr JIM]

Interesting, but for a variety of reason it's difficult to extrapolate these results to humans IMO.

Not surprising billionaire Mark Cuban is funding a ACL/GH study in human athletes, the results of which are expected in 2-3 years.

 

[Michael Scally MD]

[Dogs] Marques DRC, Marques D, Ibanez JF, et al. Effects of nandrolone decanoate on time to consolidation of bone defects resulting from osteotomy for tibial tuberosity advancement. Vet Comp Orthop Traumatol 2017;30(5). https://vcot.schattauer.de/contents/archivestandard/issue/special/manuscript/27782.html

STUDY DESIGN: Experimental study.

OBJECTIVE: The aim of this study was to evaluate the effect of nandrolone decanoate (ND) on the time taken for bone consolidation in dogs undergoing tibial tuberosity advancement surgery (TTA).

MATERIALS AND METHODS: Seventeen dogs that underwent TTA surgery were randomly divided into two groups: group C (TTA; 9 stifles), and group TTA+ND (TTA and systemic administration of ND; 8 stifles). Three observers (two radiologists and an orthopaedic surgeon), assessed bone consolidation by visual inspection of serial radiographs at intervals of 21 days following surgery.


RESULTS: There were no differences in median weight and age between groups, nor between the medians of the variables right and left stifle. Only weight and age values were normally distributed. The other variables, right and left stifle and time to consoldation, showed non-normal distribution. Meniscal injury was present in all animals in group C and all animals in group TTA+ND. There was a significant difference between time to consolidation in groups C and TTA+ND (p <0.05). One animal in the group TTA+ND showed increased libido. Kappa agreement among observers on radiographs was 0.87.

CONCLUSION: Administration of ND reduces time to bone consolidation in dogs undergoing TTA.

 

[Michael Scally MD]

Wu B, Lorezanza D, Badash I, et al. Perioperative Testosterone Supplementation Increases Lean Mass in Healthy Men Undergoing Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine 2017;5(8):2325967117722794. SAGE Journals: Your gateway to world-class journal research

Background: Rehabilitation after repair of the anterior cruciate ligament (ACL) is complicated by the loss of leg muscle mass and strength. Prior studies have shown that preoperative rehabilitation may improve muscle strength and postoperative outcomes. Testosterone supplementation may likewise counteract this muscle loss and potentially improve clinical outcomes.

Purpose: The purpose was to investigate the effect of perioperative testosterone administration on lean mass after ACL reconstruction in men and to examine the effects of testosterone on leg strength and clinical outcome scores. It was hypothesized that testosterone would increase lean mass and leg strength and improve clinical outcome scores relative to placebo.


Study Design: Randomized controlled trial; Level of evidence, 1.


Methods: Male patients (N = 13) scheduled for ACL reconstruction were randomized into 2 groups: testosterone and placebo. Participants in the testosterone group received 200 mg of intramuscular testosterone weekly for 8 weeks beginning 2 weeks before surgery. Participants in the placebo group received saline following the same schedule. Both groups participated in a standard rehabilitation protocol. The primary outcome was the change in total lean body mass at 6 and 12 weeks. Secondary outcomes were extensor muscle strength, Tegner activity score, and Knee injury and Osteoarthritis Outcome Score.

Results: There was an increase in lean mass of a mean 2.7 ± 1.7 kg at 6 weeks postoperatively in the testosterone group compared with a decrease of a mean 0.1 ± 1.5 kg in the placebo group (P = .01). Extensor muscle strength of the uninjured leg also increased more from baseline in the testosterone group (+20.8 ± 25.6 Nm) compared with the placebo group (–21.4 ± 36.7 Nm) at 12 weeks (P = .04). There were no significant between-group differences in injured leg strength or clinical outcome scores. There were no negative side effects of testosterone noted.

Conclusion: Perioperative testosterone supplementation increased lean mass 6 weeks after ACL reconstruction, suggesting that this treatment may help minimize the effects of muscle atrophy associated with ACL injuries and repair. This study was not powered to detect differences in strength or clinical outcome scores to assess the incidence of testosterone-related adverse events.

 

[Dr JIM]

Wu B, Lorezanza D, Badash I, et al. Perioperative Testosterone Supplementation Increases Lean Mass in Healthy Men Undergoing Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial. Orthopaedic Journal of Sports Medicine 2017;5(8):2325967117722794. SAGE Journals: Your gateway to world-class journal research


There were no significant between-group differences in injured leg strength or clinical outcome scores

.

Before someone cites this study as "proof" AAS improve ACL postoperative outcome make note of the above.

 

[Michael Scally MD]

Dunn JC, Kusnezov N, Fares A, et al. Triceps Tendon Ruptures: A Systematic Review. Hand (N Y). 2017;12(5):431-8. http://journals.sagepub.com/doi/10.1177/1558944716677338

BACKGROUND: Triceps tendon ruptures (TTR) are an uncommon injury. The aim of this systematic review was to classify diagnostic signs, report outcomes and rerupture rates, and identify potential predisposing risk factors in all reported cases of surgical treated TTR.

METHODS: A literature search collecting surgical treated cases of TTR was performed, identifying 175 articles, 40 of which met inclusion criteria, accounting for 262 patients. Data were pooled and analyzed focusing on medical comorbidities, presence of a fleck fracture on the preoperative lateral elbow x-ray film (Dunn-Kusnezov Sign [DKS]), outcomes, and rerupture rates.

RESULTS: The average age of injury was 45.6 years. The average time from injury to day of surgery was 24 days while 10 patients had a delay in diagnosis of more than 1 month.

Renal disease (10%) and ANABOLIC STEROID USE (7%) were the 2 most common medical comorbidities.

The DKS was present in 61% to 88% of cases on the lateral x-ray film. Postoperatively, 89% of patients returned to preinjury level of activity, and there was a 6% rerupture rate at an average follow-up of 34.6 months. The vast majority (81%) of the patients in this review underwent repair via suture fixation.

CONCLUSIONS: TTR is an uncommon injury. Risks factors for rupture include renal disease and anabolic steroid use. Lateral elbow radiographs should be scrutinized for the DKS in patients with extension weakness. Outcomes are excellent following repair, and rates of rerupture are low.

 

[Inquiring Mind]

Re: *EQ increases tendon strength*

I LOVE EQ. it works but you'll want to run it 12 weeks for optimal performance at any where between 400-600mg per week. You will feel it brother. I've ran it in so many of my cycles it's basically a staple for me. Some just plain don't like it though. To each his own.

I've always been intrigued by EQ, however, I'm also of the impression that there were better alternatives safety wise...most people will staple NPP or Masteron, this is the first time someone adamantly benchmarks EQ as a main compound of choice. In addition to what you mention above, can you elaborate further on your EQ experiences and how might your recommend someone incorporate EQ in future cycles?

 

[Dr JIM]

Dunn JC, Kusnezov N, Fares A, et al. Triceps Tendon Ruptures: A Systematic Review. Hand (N Y). 2017;12(5):431-8. http://journals.sagepub.com/doi/10.1177/1558944716677338

BACKGROUND: Triceps tendon ruptures (TTR) are an uncommon injury. The aim of this systematic review was to classify diagnostic signs, report outcomes and rerupture rates, and identify potential predisposing risk factors in all reported cases of surgical treated TTR.

METHODS: A literature search collecting surgical treated cases of TTR was performed, identifying 175 articles, 40 of which met inclusion criteria, accounting for 262 patients. Data were pooled and analyzed focusing on medical comorbidities, presence of a fleck fracture on the preoperative lateral elbow x-ray film (Dunn-Kusnezov Sign [DKS]), outcomes, and rerupture rates.

RESULTS: The average age of injury was 45.6 years. The average time from injury to day of surgery was 24 days while 10 patients had a delay in diagnosis of more than 1 month.

Renal disease (10%) and ANABOLIC STEROID USE (7%) were the 2 most common medical comorbidities.

The DKS was present in 61% to 88% of cases on the lateral x-ray film. Postoperatively, 89% of patients returned to preinjury level of activity, and there was a 6% rerupture rate at an average follow-up of 34.6 months. The vast majority (81%) of the patients in this review underwent repair via suture fixation.

CONCLUSIONS: TTR is an uncommon injury. Risks factors for rupture include renal disease and anabolic steroid use. Lateral elbow radiographs should be scrutinized for the DKS in patients with extension weakness. Outcomes are excellent following repair, and rates of rerupture are low.

Perhaps bc Triceps "tendonopathy" is quite uncommon, I don't recall ever seeing a Tri rupture.

 

[Ezekiel 25:17]

Thinking of running this for this exact reason.

Read an article by Mike Arnold who recommends running a gram+ to see its true benefits.

Boldenone – Realizing its full potential | IronMag Bodybuilding Blog

Any thoughts?

 

[Dr JIM]

OPINIONS about any AAS are rampant on PED forums, many relying upon the anecdotes of others as "proof" of benefit, and this commentary is no exception IMO

 

[Blake111]

Re: *EQ increases tendon strength*

Any advice to workout upper body while having tennis elbow bilaterally?

pauladrive, I have read this same article that you have posted on this forum too somewhere. Though the information is extremely interesting and informative, unfortunately there isn't any references to back the data in it, so you don't know how much information as which information to accurately believe from the article. IMO though, you should just stack nandrolone and testosterone together and forget about the boldenone. As for injuring yourself, as long as you use proper form and don't overtrain, I don't think you have anything to worry about. What doses do you normally use in your cycles and what doses do you plan on using in ur next cycle, Sir?

I du

 

[Michael Scally MD]

Guimaraes A, Butezloff MM, Zamarioli A, Issa JPM, Volpon JB. Nandrolone decanoate appears to increase bone callus formation in young adult rats after a complete femoral fracture. Acta cirurgica brasileira 2017;32:924-34. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-86502017001100924&lng=en&nrm=iso

PURPOSE: To evaluate the influence of nandrolone decanoate on fracture healing and bone quality in normal rats.

METHODS: Male rats were assigned to four groups (n=28/group): Control group consisting of animals without any intervention, Nandrolone decanoate (DN) group consisting of animals that received intramuscular injection of nandrolone decanoate, Fracture group consisting of animals with a fracture at the mid-diaphysis of the femur, and Fracture and nandrolone decanoate group consisting of animals with a femur fracture and treatment with nandrolone decanoate. Fractures were created at the mid-diaphysis of the right femur by a blunt trauma and internally fixed using an intramedullary steel wire. The DN was injected intramuscularly twice per week (10 mg/kg of body mass). The femurs were measured and evaluated by densitometry and mechanical resistance after animal euthanasia. The newly formed bone and collagen type I levels were quantified in the callus.

RESULTS: The treated animals had longer femurs after 28 days. The quality of the intact bone was not significantly different between groups. The bone callus did show a larger mass in the treated rats.

CONCLUSION: The administration of nandrolone decanoate did not affect the quality of the intact bone, but might have enhanced the bone callus formation.

 

[Michael Scally MD]

Surgical Treatment of Pectoralis Major Muscle Rupture

Objective: To assess the tendon reconstruction technique for total rupture of the pectoralis major muscle using an adjustable cortical button.

Methods: Prospective study of 27 male patients with a mean age of 29.9 (SD = 5.3 years) and follow-up of 2.3 years. The procedure consisted of autologous grafts taken from the semitendinosus and gracilis tendons and an adjustable cortical button. Patients were evaluated functionally by the Bak criteria.

Results: The surgical treatment of pectoralis major muscle tendon reconstruction was performed in the early stages (three weeks) in six patients (22.2%) and in 21 patients (77.8%), in the late stages. Patients operated with the adjustable cortical button technique obtained 96.3% excellent or good results, with only 3.7% having poor results (Bak criteria). Of the total, 85.2% were injured while performing bench press exercises and 14.8%, during the practice of Brazilian jiu-jitsu or wrestling.

All weight-lifting athletes had history of anabolic steroid use.

Conclusion: The early or delayed reconstruction of ruptured pectoralis major muscle tendons with considerable muscle retraction, using an adjustable cortical button and autologous knee flexor grafts, showed a high rate of good results.

Pochini AC, Rodrigues MSB, Yamashita L, Belangero PS, Andreoli CV, Ejnisman B. Surgical treatment of pectoralis major muscle rupture with adjustable cortical button. Revista brasileira de ortopedia 2018;53:60-6. Surgical treatment of pectoralis major muscle rupture with adjustable cortical button - ScienceDirect

 

[Dr JIM]

Surgical Treatment of Pectoralis Major Muscle Rupture

Objective: To assess the tendon reconstruction technique for total rupture of the pectoralis major muscle using an adjustable cortical button.

Methods: Prospective study of 27 male patients with a mean age of 29.9 (SD = 5.3 years) and follow-up of 2.3 years. The procedure consisted of autologous grafts taken from the semitendinosus and gracilis tendons and an adjustable cortical button. Patients were evaluated functionally by the Bak criteria.

Results: The surgical treatment of pectoralis major muscle tendon reconstruction was performed in the early stages (three weeks) in six patients (22.2%) and in 21 patients (77.8%), in the late stages. Patients operated with the adjustable cortical button technique obtained 96.3% excellent or good results, with only 3.7% having poor results (Bak criteria). Of the total, 85.2% were injured while performing bench press exercises and 14.8%, during the practice of Brazilian jiu-jitsu or wrestling.

All weight-lifting athletes had history of anabolic steroid use.

Conclusion: The early or delayed reconstruction of ruptured pectoralis major muscle tendons with considerable muscle retraction, using an adjustable cortical button and autologous knee flexor grafts, showed a high rate of good results.

Pochini AC, Rodrigues MSB, Yamashita L, Belangero PS, Andreoli CV, Ejnisman B. Surgical treatment of pectoralis major muscle rupture with adjustable cortical button. Revista brasileira de ortopedia 2018;53:60-6. Surgical treatment of pectoralis major muscle rupture with adjustable cortical button - ScienceDirect

I've watched a couple pectoral tears, yet have followed several and tear site (muscle, tendon, bony avulsion) critical with respect to outcome

Repairing a tear involving the muscle itself is like throwing stitches into hamburger meat as the sutures tend to "pull thru" muscle. The devices described in this article provide a broader base or buttress to which mechanical fasteners are anchored, which diminishes the "pull thru" phenomona and reduces tension on the once torn now reapproximated muscular segments.

Jim

 

[Michael Scally MD]

Case reports indicate that high levels of testosterone or synthetic derivatives of testosterone may enhance the risk of tendon and ligament injuries [95–98].

Furthermore, analysis of human patellar tendon morphology and mechanical properties indicates that adaptation to strength training is influenced by long-term use of androgenic anabolic steroids [99].

This is supported by animal data which suggests that anabolic androgenic steroids reverse the beneficial effect of exercise on Achilles tendon adaptation, thus resulting in inferior maximal stress values [100].

The higher risk of tendon rupture in anabolic steroid users may be directly caused by a direct effect on tendon or may also be indirectly related to the enhanced muscle hypertrophy and gain in muscle strength which is not balanced by a similar degree of adaptation in the connected tendon [101, 102].


95. Freeman BJ, Rooker GD (1995) Spontaneous rupture of the anterior cruciate ligament after anabolic steroids. Br J Sports Med 29:274–5.

96. Hill JA, Suker JR, Sachs K et al (1983) The athletic polydrug abuse phenomenon. A case report. Am J Sports Med 11:269–71.

97. Kramhoft M, Solgaard S (1986) Spontaneous rupture of the extensor pollicis longus tendon after anabolic steroids. J Hand Surg (Br) 11:87.

98. Kanayama G, DeLuca J, Meehan WP 3rd et al (2015) Ruptured tendons in anabolic-androgenic steroid users: a cross-sectional cohort study. Am J Sports Med 43:2638–44.

99. Seynnes OR, Kamandulis S, Kairaitis R et al (2013) Effect of androgenic-anabolic steroids and heavy strength training on patellar tendon morphological and mechanical properties. J Appl Physiol (1985) 115:84–9.

100. Tsitsilonis S, Chatzistergos PE, Mitousoudis AS et al (2014) Anabolic androgenic steroids reverse the beneficial effect of exercise on tendon biomechanics: an experimental study. Foot Ankle Surg 20:94–9.

101. Bhasin S, Storer TW, Berman N et al (1996) The effects of supraphysiologic doses of testosterone on muscle size and strength in normal men. N Engl J Med 335:1–7.

102. Bhasin S, Woodhouse L, Storer TW (2001) Proof of the effect of testosterone on skeletal muscle. J Endocrinol 170:27–38.


Hansen M, Kjaer M. Sex Hormones and Tendon. Advances in experimental medicine and biology 2016;920:139-49. Sex Hormones and Tendon In Metabolic Influences on Risk for Tendon Disorders. Editors Ackermann PW, Hart DA. Metabolic Influences on Risk for Tendon Disorders | SpringerLink

 

[Dr JIM]

..... may be directly caused by a direct effect on tendon or may also be indirectly related to the enhanced muscle hypertrophy and gain in muscle strength which is not balanced by a similar degree of adaptation in the connected tendon [101, 102].


Hansen M, Kjaer M. Sex Hormones and Tendon. Advances in experimental medicine and biology 2016;920:139-49. Sex Hormones and Tendon In Metabolic Influences on Risk for Tendon Disorders. Editors Ackermann PW, Hart DA. Metabolic Influences on Risk for Tendon Disorders | SpringerLink [/QUOTE]

EXCELLENT SUMMATION and reference list @Michael Scally MD

I cant help but wonder what impact glucocorticoid receptor antagonism has on AAS related tendonopathy

I ask bc this may be relevant from a therapeutic perspective since the effects of AAS on the GCR differ from one compound to the next.

Jim

 

[Michael Scally MD]

Jones Ian A, Togashi R, Rick Hatch George F, Weber Alexander E, Vangsness JRCT. Anabolic Steroids and Tendons: A Review of their Mechanical, Structural and Biologic Effects. Journal of Orthopaedic Research 2018. https://doi.org/10.1002/jor.24116

One of the suspected deleterious effects of androgenic-anabolic steroids (AAS) is the increased risk for tendon rupture. However, investigations to date have produced inconsistent results and it is still unclear how AAS influence tendons.

A systematic review of the literature was conducted to identify studies that have investigated the mechanical, structural or biologic effects that AAS have on tendons. In total, 18 highly heterogeneous studies were identified. Small animal studies made up the vast majority of published research, and contradictory results were reported frequently.

All of the included studies focused on the potential deleterious effects that AAS have on tendon, which is striking given the recent use of AAS in patients following tendon injury. Rather than providing strong evidence for or against the use of AAS, this review highlights the need for additional research.

Future studies investigating the use of AAS as a possible treatment for tendon injury/pathology are supported by reports suggesting that AAS may counteract the irreparable structural/functional changes that occur in the musculotendinous unit following rotator cuff tears, as well as studies suggesting that the purported deleterious effects on tendon may be transient. Other possible areas for future research are discussed in the context of key findings that may have implications for the therapeutic application of AAS.

 

[Michael Scally MD]

Conti Mica M, van Riet R. Triceps Tendon Repair. JBJS essential surgical techniques 2018;8:e4. Triceps Tendon Repair : JBJS Essential Surgical Techniques

Although triceps tendon ruptures can result from a traumatic incident, chronic overuse causing degenerative changes to the insertion and leading to a complete or partial rupture is more common. In our practice, we have found that anabolic steroid abuse by weightlifters is the most common predisposing factor. The initial diagnosis is often missed. A thorough clinical examination is imperative to avoid missing a partial or complete rupture. Ultrasound or magnetic resonance imaging can confirm the diagnosis. Early diagnosis increases the chance of a direct repair. Operative treatment with direct repair is usually indicated for full-thickness or large partial-thickness tears. Direct repair may be possible for selected chronic tears. Triceps tendon repair is performed with the following steps.

· Step 1: The patient is placed in lateral decubitus.
· Step 2: The stump is debrided, and retraction of the tendon is evaluated.
· Step 3: Two crossed bone tunnels are drilled, and an anchor is placed centrally in the olecranon.
· Step 4: The elbow is extended, and the tendon is reduced and sutured centrally to the anchor and medially and laterally with use of the sutures from the bone tunnels.
· Step 5: The elbow is flexed to evaluate tension. If gapping occurs, the repair should be reinforced with extra sutures. Tension-free range of motion will guide postoperative rehabilitation.
· Step 6: A posterior splint is applied in the operating room with the elbow extended.
· Step 7: A dynamic brace is applied on the first postoperative day. Extension is free but flexion is blocked at the tension-free range; 30° of extra flexion is permitted every 2 weeks. Full flexion is always allowed after 6 weeks. Strengthening starts at 3 months.

Pitfalls of the procedure include difficulty in differentiating between tendon and scar in subacute and chronic ruptures. It may not be possible to directly repair the triceps back to bone, and a graft may be needed to reconstruct the tendon. It is important to know where the ulnar nerve is and to release it if needed. It is important not to debride past the cortical surface of the olecranon if an anchor is used because, if this is done, fixation may be insufficient. The anchor should be predrilled as the cortical bone of the tip of the olecranon is very dense.

Reruptures occur in up to 21% of cases. A functional range of motion is usually achieved with an average loss of extension of 10° and average flexion to 136°. At 1 year, one can expect a peak strength of approximately 80% of that on the uninjured side and endurance strength of 99%1.

 

[DescartesBreh]

I read through this thread, but am still somewhat confused; if I were running a TestE only cycle (low dose 300 mg, weekly), would any other AAS or SARM help with the inevitable reduction in collagen synthesis?

 

[Dr JIM]

You are misinterpreting the effect of AAS on collagen bc in general anabolic agents tend to ENHANCE collagen synthesis. So what the ?

Because collagen the most abundant protein in humans the problem seems to be one of collagen deposition in those areas in need of repair.

Tendons are like rope and fray when stretched beyond their limit. Studies have shown AAS inhibit the reapproximation of degenerative connective tissue (most of which is collagen in one form or another). More importantly the influence of AAS, thru several mechanisms, are thought to result in a weaker repair when it does finally occur.

Ergo it's best to assume AAS are simply not good for tendons, ligaments or cartilage and that means an ounce of prevention is worth a pound pf cure. EASY AS IT GOES IN THE GYM FELLA

JIM

 

[Dr JIM]

An important side note Hyaline Cartilage is NOT replaceable per se.

What you have around the end of puberty is FIXED and once it's gone, it can only be repaired/replaced with fibrocartilage, a much weaker and thinner substrate.

jim