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A Passive Ankle Dorsiflexion Testing System for an In Vivo Model of Overuse-induced Tendinopathy
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Fluoroquinolone-associated tendinopathy.

Wen-Chung Tsai1, Yun-Ming Yang

  • 1Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan. tsaiwc@cgmh.org.tw

Chang Gung Medical Journal
|November 1, 2011
PubMed
Summary

Fluoroquinolones (FQs) can cause severe tendon problems like rupture, especially Achilles tendon issues. Physicians must recognize this risk, as FQ-associated tendinopathy is a serious, potentially disabling side effect.

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Area of Science:

  • Pharmacology
  • Orthopedics
  • Cell Biology

Background:

  • Fluoroquinolones (FQs) are broad-spectrum antibiotics with excellent absorption and tissue penetration.
  • Adverse effects, including tendinopathy and tendon rupture, are increasingly reported with FQ use, particularly in elderly patients or those with diabetes and renal failure.
  • These FQ-associated tendon issues are not widely recognized by physicians despite frequent clinical use.

Purpose of the Study:

  • To highlight the risk of fluoroquinolone-associated tendinopathy and tendon rupture.
  • To inform physicians about the potential for severe disability from these adverse effects.
  • To elucidate the molecular mechanisms underlying FQ-induced tendon damage.

Main Methods:

  • Review of clinical reports and histopathologic findings of FQ-associated tendinopathy.
  • Investigation of molecular mechanisms including cell proliferation, migration, and collagen degradation.
  • Analysis of management strategies for FQ-associated tendinopathy and tendon rupture.

Main Results:

  • Histopathologic findings reveal degenerative lesions, fissures, edema, necrosis, and neovascularization in affected tendons.
  • Molecular mechanisms involve ciprofloxacin-induced inhibition of tenocyte proliferation and migration, and enhanced matrix metalloproteinase-2 activity.
  • Achilles tendinopathy and rupture are significant side effects, with ciprofloxacin use showing a marked increase in reports.

Conclusions:

  • Fluoroquinolone-associated tendinopathy and tendon rupture represent a serious risk that requires physician awareness.
  • Understanding the molecular pathways provides insight into FQ-induced tendon damage.
  • Management involves FQ discontinuation, supportive care, and potentially surgery for rupture.