Elevation of systemic matrix metalloproteinases 2 and 7 and tissue inhibitor of metalloproteinase 2 in patients with a history of Achilles tendon rupture: pilot study.
OBJECTIVE
In this study, serum levels of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) between patients with a history of Achilles tendon rupture and blood donor controls were compared, and their relation to mechanical properties of the tendons during healing were studied.


METHODS
More than 3 years after injury, serum levels of MMP-1, MMP-2, MMP-3, MMP-7, MMP-8, MMP-9 and MMP-13, TIMP-1 and TIMP-2 in eight patients who had Achilles tendon rupture were measured. Twelve blood donors served as controls. During the early phase of healing, the tendon modulus of elasticity was calculated from radiostereometric data and tendon cross-sectional area.


RESULTS
Patients with a history of Achilles tendon rupture had increased levels of MMP-2 (median difference 10%, p=0.01), MMP-7 (median difference 15%, p=0.02) and TIMP-2 (median difference 36%, p=0.02), compared with controls. Levels of MMP-7, measured 3 years after injury, correlated inversely to tendon modulus of elasticity (r(s)=20.83, p=0.02) and positively to tendon elongation (r(s)=0.74, p=0.05) during the early phase of healing. There was a trend towards positive correlation between MMP-7 and cross-sectional area during the early phase of healing (r(s)=0.67, p=0.08).


CONCLUSIONS
Patients with a history of Achilles tendon rupture appear to have elevated levels of MMP-2, MMP-7 and TIMP-2 in serum. In these pilot data, the view that the MMP-TIMP system is involved in tendinopathy is supported and that disturbances in proteolytic control might be generalised are suggested.
Pasternak
B
B
Orthopaedics and Sports Medicine, Department of Clinical and Experimental Medicine, Linköping University, SE-58185 Linköping, Sweden. pasternak@gmail.com
Schepull
T
T
Eliasson
P
P
Aspenberg
P
P
D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism*; D020783:Matrix Metalloproteinase 7 / Q000378:metabolism*; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012421:Rupture / Q000201:enzymology; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000378:metabolism*; D014945:Wound Healing / Q000502:physiology
D019716:Tissue Inhibitor of Metalloproteinase-2; D020783:Matrix Metalloproteinase 7; D020778:Matrix Metalloproteinase 2