51
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Obst SJ, Heales LJ, Schrader BL, Davis SA, Dodd KA, Holzberger CJ, Beavis LB, Barrett RS. Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Review with Meta-analysis. Sports Med 2018; 48:2179-2198. [DOI: 10.1007/s40279-018-0956-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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52
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Mersmann F, Seynnes OR, Legerlotz K, Arampatzis A. Effects of tracking landmarks and tibial point of resistive force application on the assessment of patellar tendon mechanical properties in vivo. J Biomech 2018; 71:176-182. [PMID: 29463386 DOI: 10.1016/j.jbiomech.2018.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/01/2018] [Accepted: 02/04/2018] [Indexed: 12/20/2022]
Abstract
The different methods used to assess patellar tendon elongation in vivo may partly explain the large variation of mechanical properties reported in the literature. The present study investigated the effects of tracking landmark position and tibial point of resistive force application during leg extensions in a dynamometer. Nineteen adults performed isometric contractions with a proximal and distal dynamometer shank pad position. Knee joint moments were calculated employing an inverse dynamics approach. Tendon elongation was measured using the patellar apex and either the tibial tuberosity (T) or plateau (P) as tracking landmark. Using P for tracking introduced a bias towards greater values of tendon elongation at all force levels from 100 N to maximum tendon force (TFmax; p < 0.05). The differences between landmarks considering maximum tendon strain were greater at the proximal shank pad position (p < 0.05). Tendon stiffness was lower for P compared with T, but only in intervals up to 50% of TFmax (p < 0.05). The agreement between T and P for stiffness calculated between 50% and TFmax was acceptable with the distal, but poor with the proximal pad position. We demonstrated that using the tibia plateau and not the insertion as tracking landmark clearly affects the assessment of the force-elongation curve of the patellar tendon. However, using a distal point of resistive force application and calculating tendon stiffness between 50% and TFmax seems to yield an acceptable agreement between landmarks. These findings have important implications for the assessment of tendon properties in vivo and cross-study comparisons.
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Affiliation(s)
- Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin School of Movement Science, Berlin, Germany.
| | - Olivier R Seynnes
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Kirsten Legerlotz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin School of Movement Science, Berlin, Germany
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53
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Lin CY, Ooi CC, Chan E, Chew KT. Emerging Technological Advances in Musculoskeletal Ultrasound. PM R 2018; 10:112-119. [PMID: 29413117 DOI: 10.1016/j.pmrj.2017.08.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/21/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Cindy Y Lin
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Chin Chin Ooi
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Eric Chan
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Kelvin T Chew
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
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54
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Slane LC, Bogaerts S, Thelen DG, Scheys L. Nonuniform Deformation of the Patellar Tendon During Passive Knee Flexion. J Appl Biomech 2018; 34:14-22. [PMID: 28787221 DOI: 10.1123/jab.2017-0067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to evaluate localized patterns of patellar tendon deformation during passive knee flexion. Ultrasound radiofrequency data were collected from the patellar tendons of 20 healthy young adults during knee flexion over a range of motion of 50°-90° of flexion. A speckle tracking approach was used to compute proximal and distal tendon displacements and elongations. Nonuniform tissue displacements were visible in the proximal tendon (P < .001), with the deep tendon undergoing more distal displacement than the superficial tendon. In the distal tendon, more uniform tendon motion was observed. Spatial variations in percent elongation were also observed, but these varied along the length of the tendon (P < .002), with the proximal tendon remaining fairly isometric while the distal tendon underwent slight elongation. These results suggest that even during passive flexion the tendon undergoes complex patterns of deformation. Proximal tendon nonuniformity may arise from its complex anatomy where the deep tendon inserts onto the patella and the superficial tendon extends to the quadriceps tendon. Such heterogeneity is not captured in whole tendon average assessments, emphasizing the relevance of considering localized tendon mechanics, which may be key to understanding tendon behavior and precursors to injury and disease.
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55
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Mersmann F, Bohm S, Arampatzis A. Imbalances in the Development of Muscle and Tendon as Risk Factor for Tendinopathies in Youth Athletes: A Review of Current Evidence and Concepts of Prevention. Front Physiol 2017; 8:987. [PMID: 29249987 PMCID: PMC5717808 DOI: 10.3389/fphys.2017.00987] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/17/2017] [Indexed: 01/09/2023] Open
Abstract
Tendons feature the crucial role to transmit the forces exerted by the muscles to the skeleton. Thus, an increase of the force generating capacity of a muscle needs to go in line with a corresponding modulation of the mechanical properties of the associated tendon to avoid potential harm to the integrity of the tendinous tissue. However, as summarized in the present narrative review, muscle and tendon differ with regard to both the time course of adaptation to mechanical loading as well as the responsiveness to certain types of mechanical stimulation. Plyometric loading, for example, seems to be a more potent stimulus for muscle compared to tendon adaptation. In growing athletes, the increased levels of circulating sex hormones might additionally augment an imbalanced development of muscle strength and tendon mechanical properties, which could potentially relate to the increasing incidence of tendon overload injuries that has been indicated for adolescence. In fact, increased tendon stress and strain due to a non-uniform musculotendinous development has been observed recently in adolescent volleyball athletes, a high-risk group for tendinopathy. These findings highlight the importance to deepen the current understanding of the interaction of loading and maturation and demonstrate the need for the development of preventive strategies. Therefore, this review concludes with an evidence-based concept for a specific loading program for increasing tendon stiffness, which could be implemented in the training regimen of young athletes at risk for tendinopathy. This program incorporates five sets of four contractions with an intensity of 85–90% of the isometric voluntary maximum and a movement/contraction duration that provides 3 s of high magnitude tendon strain.
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Affiliation(s)
- Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Berlin, Germany
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56
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Coombes BK, Tucker K, Vicenzino B, Vuvan V, Mellor R, Heales L, Nordez A, Hug F. Achilles and patellar tendinopathy display opposite changes in elastic properties: A shear wave elastography study. Scand J Med Sci Sports 2017; 28:1201-1208. [PMID: 28972291 DOI: 10.1111/sms.12986] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
To compare tendon elastic and structural properties of healthy individuals with those with Achilles or patellar tendinopathy. Sixty-seven participants (22 Achilles tendinopathy, 17 patellar tendinopathy, and 28 healthy controls) were recruited between March 2015 and March 2016. Shear wave velocity (SWV), an index of tissue elastic modulus, and tendon thickness were measured bilaterally at mid-tendon and insertional regions of Achilles and patellar tendons by an examiner blinded to group. Analysis of covariance, adjusted for age, body mass index, and sex was used to compare differences in tendon thickness and SWV between the two tendinopathy groups (relative to controls) and regions. Tendon thickness was included as a covariate for analysis of SWV. Compared to controls, participants with Achilles tendinopathy had lower SWV at the distal insertion (Mean difference MD; 95% CI: -1.56; -2.49 to -0.62 m/s; P < .001) and greater thickness at the mid-tendon (MD 0.19; 0.05-0.33 cm; P = .007). Compared to controls, participants with patellar tendinopathy had higher SWV at both regions (MD 1.25; 0.40-2.10 m/s; P = .005) and greater thickness proximally (MD 0.17; 0.06-0.29 cm; P = .003). Compared to controls, participants with Achilles and patellar tendinopathy displayed lower Achilles tendon elastic modulus and higher patellar tendon elastic modulus, respectively. More research is needed to explore whether maturation, aging, or chronic load underlie these findings and whether current management programs for Achilles and patellar tendinopathy need to be tailored to the tendon.
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Affiliation(s)
- B K Coombes
- School of Biomedical Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - K Tucker
- School of Biomedical Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - B Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - V Vuvan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - R Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - L Heales
- School of Human, Health and Social Science, Division of Physiotherapy, Central Queensland University, Rockhampton, Qld, Australia
| | - A Nordez
- Faculty of Sport Sciences, Laboratory "Movement, Interactions, Performance" (EA 4334), University of Nantes, Nantes, France
| | - F Hug
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia.,Faculty of Sport Sciences, Laboratory "Movement, Interactions, Performance" (EA 4334), University of Nantes, Nantes, France.,Institut Universitaire de France (IUF), Paris, France
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57
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Sanz-López F, Berzosa C, Hita-Contreras F, Martínez-Amat A. Effects of eccentric overload training on patellar tendon and vastus lateralis in three days of consecutive running. Knee 2017; 24:570-579. [PMID: 28342723 DOI: 10.1016/j.knee.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/31/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The analysis of structural changes in patellar tendon and muscle of healthy subjects in response to mechanical loads provides useful insight into the mechanism underlying overuse injuries. METHODS Changes produced in tendon and muscles structures after eccentric overload training and three consecutive running days were examined. Twenty healthy subjects were recruited and divided into two groups. One group (ECC) performed eccentric overload squat training (six weeks). After such training, the ECC group performed three running sessions on consecutive days, as did the control group (CONT). The structure of their patellar tendons and vastus lateralis muscles was quantified using ultrasound and Doppler imaging. Images were obtained before and after eccentric training for the ECC group and on every day of running performance for both groups. RESULTS After eccentric training, the ECC group experienced an increase in cross-sectional area (CSA) of patellar tendon (P=0.012). After every day of running, the ECC group experienced a decrease in CSA (P=0.027). In the CONT group, after one day of running a significant increase was observed in anteroposterior width of their patellar tendon (P=0.028), as well as a decrease in pennation angle of vastus lateralis muscle (P=0.028) within three days of running sessions. CONCLUSIONS Eccentric overload training brought about changes in the patellar tendon consistent with an improvement in the quality of the tissue. The ECC group in our study showed a more normalised pattern than the CONT group in the running performance, in agreement with previous research. LEVEL OF EVIDENCE Level 3, controlled trial.
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Affiliation(s)
- Fernando Sanz-López
- ValorA Research Group, Health Sciences Faculty, Universidad San Jorge, Zaragoza, Spain.
| | - César Berzosa
- ValorA Research Group, Health Sciences Faculty, Universidad San Jorge, Zaragoza, Spain
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain; Research Group CTS-026: Study Group on Physical Activity, Physiotherapy and Health, Jaén, Spain
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain; Research Group CTS-026: Study Group on Physical Activity, Physiotherapy and Health, Jaén, Spain
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58
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Lee WC, Zhang ZJ, Masci L, Ng GYF, Fu SN. Alterations in mechanical properties of the patellar tendon is associated with pain in athletes with patellar tendinopathy. Eur J Appl Physiol 2017; 117:1039-1045. [PMID: 28353085 DOI: 10.1007/s00421-017-3593-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/19/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To compare tendon strain and stiffness between athletes with patellar tendinopathy and healthy controls, and explore whether the intensity of pain and dysfunction were related to the mechanical properties of the tendon. METHODS Thirty-four male athletes with patellar tendinopathy and 13 healthy controls matched by age and activity levels were recruited. The in vivo mechanical properties of the patellar tendon were examined by ultrasonography and dynamometry. In subjects with patellar tendinopathy, the intensities of self-perceived pain (maximal pain in the past 7 days and pain during a single-legged declined-squat test) using the visual analogue scale and the assessment of functional disability using the Victorian Institute of Sport Assessment-patellar questionnaire, were collected. RESULTS In subjects with patellar tendinopathy, tendon strain was significantly reduced by 22% (8.9 ± 3.7 vs. 14.3 ± 4.7%, P = 0.005) when compared with healthy controls. There was no significant group difference in tendon stiffness (P = 0.27). Significant negative correlations between tendon strain and the maximal self-perceived pain over 7 days (r = -0.37, P = 0.03), and pain during a single-legged declined-squat test (r = -0.37, P = 0.03) were detected. A trend of significant positive correlation was found between tendon stiffness and pain during a single-legged declined-squat test (r = 0.30, P = 0.09). CONCLUSION Our findings show that tendon strain is reduced in athletes with patellar tendinopathy, and a lower tendon strain is associated with a greater magnitude of pain perceived.
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Affiliation(s)
- W C Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Z J Zhang
- Department of Physical Therapy, Luoyang Orthopedic Hospital of Henan Province, Luoyang, Henan, China
| | - L Masci
- Pure Sports Medicine, London, UK
| | - G Y F Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
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59
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Abstract
OBJECTIVE To determine whether high-level athletes with patellar tendinopathy have diminished knee proprioceptive acuity. DESIGN Cross-sectional study. SETTING University research laboratory (institutional). PARTICIPANTS Twenty-one basketball and volleyball players with patellar tendinopathy (13 men and 8 women; mean age 24.5 ± 3.6; body mass index = 22.5 ± 2.0 kg/m) and an equal number of athletes without symptoms of patellar tendinopathy injury were included in this study. ASSESSMENTS Participants underwent knee proprioception assessments on a single day. Furthermore, age, sex, height, weight, VISA-P (Victorian Institute of Sport Assessment) questionnaire sports participation, medical history, knee injuries, previous treatment, and medication were obtained. MAIN OUTCOME MEASURES Knee proprioception was evaluated by assessing sense of resistance, using a weight discrimination protocol, and joint position sense (JPS). RESULTS No significant differences were observed in JPS at 30 and 60 degrees of knee flexion between groups (P = 0.165 and 0.481, respectively). In regard to the ability to discriminate weight, significant differences between the 2 groups were found with the tendinopathy group showing a higher percentage of error (P = 0.009), namely when the set of incremental weights varied by 10% from the standard weight. CONCLUSIONS Athletes with patellar tendinopathy have a diminished perception of force signals required for weight discrimination, whereas JPS remains unaffected in these athletes.
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60
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Wheeler PC. Neuropathic pain may be common in chronic lower limb tendinopathy: a prospective cohort study. Br J Pain 2016; 11:16-22. [PMID: 28386400 DOI: 10.1177/2049463716680560] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To identify the prevalence of neuropathic pain, through the use of the painDETECT questionnaire, in a cohort of patients with chronic lower limb tendinopathy conditions. METHODS Patients with chronic lower limb tendinopathy conditions treated within a Sport and Exercise Medicine hospital clinic were identified from clinical records. At the time of the clinical consultation, pain and painDETECT scores were recorded. RESULTS In total, 282 suitable patients with chronic lower limb tendinopathy conditions were identified who had completed a painDETECT questionnaire. There was a median age of 51.9 years, 35% of patients were male and a median duration of symptoms of 24.0 months. There was a median score of 7.0/10 for self-reported 'average' pain and 8.0/10 for self-reported 'worst' pain. There was a median painDETECT score of 14.0, 28% of respondents scored 19 or higher with painDETECT (neuropathic component to pain may be likely), 29% scored 13-18 (equivocal result) and 43% of respondents scored 12 or less (neuropathic pain component was unlikely). CONCLUSIONS This study suggests that neuropathic pain as identified by the painDETECT questionnaire may be common in patients with chronic lower limb tendinopathy conditions. It is unclear if patients with tendinopathy who have neuropathic pain may have poorer outcomes from initial treatments, contributing to the high proportion seen in secondary care. These are results from a single hospital clinic, and comparison with a control group is currently lacking. However, on the results to date, neuropathic pain should be considered in management strategies in patients with chronic tendinopathy.
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Affiliation(s)
- Patrick C Wheeler
- Department of Sport and Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK; School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK; National Centre for Sport and Exercise Medicine, Loughborough, UK
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61
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Fisker FY, Kildegaard S, Thygesen M, Grosen K, Pfeiffer-Jensen M. Acute tendon changes in intense CrossFit workout: an observational cohort study. Scand J Med Sci Sports 2016; 27:1258-1262. [DOI: 10.1111/sms.12781] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 02/02/2023]
Affiliation(s)
- F. Y. Fisker
- Department of Rheumatology; Aarhus University Hospital; Aarhus C Denmark
| | - S. Kildegaard
- Department of Rheumatology; Aarhus University Hospital; Aarhus C Denmark
| | - M. Thygesen
- Department of Rheumatology; Aarhus University Hospital; Aarhus C Denmark
| | - K. Grosen
- Department of Rheumatology; Aarhus University Hospital; Aarhus C Denmark
- Mech-Sense; Department of Gastroenterology; Aalborg University Hospital; Aalborg Denmark
| | - M. Pfeiffer-Jensen
- Department of Rheumatology; Aarhus University Hospital; Aarhus C Denmark
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62
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Mersmann F, Bohm S, Schroll A, Marzilger R, Arampatzis A. Athletic training affects the uniformity of muscle and tendon adaptation during adolescence. J Appl Physiol (1985) 2016; 121:893-899. [DOI: 10.1152/japplphysiol.00493.2016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/29/2016] [Indexed: 12/26/2022] Open
Abstract
With the double stimulus of mechanical loading and maturation acting on the muscle-tendon unit, adolescent athletes might be at increased risk of developing imbalances of muscle strength and tendon mechanical properties. This longitudinal study aims to provide detailed information on how athletic training affects the time course of muscle-tendon adaptation during adolescence. In 12 adolescent elite athletes (A) and 8 similar-aged controls (C), knee extensor muscle strength and patellar tendon mechanical properties were measured over 1 yr in 3-mo intervals. A linear mixed-effects model was used to analyze time-dependent changes and the residuals of the model to quantify fluctuations over time. The cosine similarity (CS) served as a measure of uniformity of the relative changes of tendon force and stiffness. Muscle strength and tendon stiffness increased significantly in both groups ( P < 0.01). However, the fluctuations of muscle strength were greater [A, 17 ± 7 (SD) N·m; C, 6 ± 2 N·m; P < 0.05] and the uniformity of changes of tendon force and stiffness was lower in athletes (CS A, −0.02 ± 0.5; C, 0.5 ± 0.4; P < 0.05). Further, athletes demonstrated greater maximum tendon strain (A, 7.6 ± 1.7%; C, 5.5 ± 0.9%; P < 0.05) and strain fluctuations (A, 0.9 ± 0.4; C, 0.3 ± 0.1; P < 0.05). We conclude that athletic training in adolescence affects the uniformity of muscle and tendon adaptation, which increases the demand on the tendon with potential implications for tendon injury.
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Affiliation(s)
- Falk Mersmann
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
| | - Sebastian Bohm
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
| | - Arno Schroll
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
| | - Robert Marzilger
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
| | - Adamantios Arampatzis
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
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63
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Choi RK, Smith MM, Martin JH, Clarke JL, Dart AJ, Little CB, Clarke EC. Chondroitin sulphate glycosaminoglycans contribute to widespread inferior biomechanics in tendon after focal injury. J Biomech 2016; 49:2694-2701. [PMID: 27316761 DOI: 10.1016/j.jbiomech.2016.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/28/2016] [Accepted: 06/01/2016] [Indexed: 11/24/2022]
Abstract
Both mechanical and structural properties of tendon change after injury however the causal relationship between these properties is presently unclear. This study aimed to determine the extent of biomechanical change in post-injury tendon pathology and whether the sulphated glycosaminoglycans (glycosaminoglycans) present are a causal factor in these changes. Equine superficial digital flexor tendons (SDF tendons) were surgically-injured in vivo (n=6 injured, n=6 control). Six weeks later they were harvested and regionally dissected into twelve regions around the lesion (equal medial/lateral, proximal/distal). Glycosaminoglycans were removed by enzymatic (chondroitinase) treatment. Elastic modulus (modulus) and ultimate tensile strength (UTS) were measured under uniaxial tension to failure, and tendon glycosaminoglycan content was measured by spectrophotometry. Compared to healthy tendons, pathology induced by the injury decreased modulus (-38%; 95%CI -49% to -28%; P<0.001) and UTS (-38%; 95%CI -48% to -28%; P<0.001) and increased glycosaminoglycan content (+52%; 95%CI 39% - 64%; P<0.001) throughout the tendon. Chondroitinase-mediated glycosaminoglycan removal (50%; 95%CI 21-79%; P<0.001) in surgically-injured pathological tendons caused a significant increase in modulus (5.6MPa/µg removed; 95%CI 0.31-11; P=0.038) and UTS (1.0MPa per µg removed; 95%CI 0.043-2; P=0.041). These results demonstrate that the chondroitin/dermatan sulphate glycosaminoglycans that accumulate in pathological tendon post-injury are partly responsible for the altered biomechanical properties.
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Affiliation(s)
- Rachel K Choi
- Murray Maxwell Biomechanics Laboratory (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia; Raymond Purves Bone and Joint Research Laboratories (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia
| | - Margaret M Smith
- Raymond Purves Bone and Joint Research Laboratories (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia
| | - Joshua H Martin
- Murray Maxwell Biomechanics Laboratory (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia
| | - Jillian L Clarke
- Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - Andrew J Dart
- Research and Clinical Training Unit, University Veterinary Teaching Hospital, University of Sydney, Camden, New South Wales, Australia
| | - Christopher B Little
- Raymond Purves Bone and Joint Research Laboratories (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia.
| | - Elizabeth C Clarke
- Murray Maxwell Biomechanics Laboratory (Institute of Bone and Joint Research), Kolling Institute, Royal North Shore Hospital (Sydney Medical School, University of Sydney), St Leonards, New South Wales, Australia
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64
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Vikmoen O, Raastad T, Seynnes O, Bergstrøm K, Ellefsen S, Rønnestad BR. Effects of Heavy Strength Training on Running Performance and Determinants of Running Performance in Female Endurance Athletes. PLoS One 2016; 11:e0150799. [PMID: 26953893 PMCID: PMC4783109 DOI: 10.1371/journal.pone.0150799] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 02/20/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose The purpose of the current study was to investigate the effects of adding strength training to normal endurance training on running performance and running economy in well-trained female athletes. We hypothesized that the added strength training would improve performance and running economy through altered stiffness of the muscle-tendon complex of leg extensors. Methods Nineteen female endurance athletes [maximal oxygen consumption (VO2max): 53±3 ml∙kg-1∙min-1, 5.8 h weekly endurance training] were randomly assigned to either normal endurance training (E, n = 8) or normal endurance training combined with strength training (E+S, n = 11). The strength training consisted of four leg exercises [3 x 4–10 repetition maximum (RM)], twice a week for 11 weeks. Muscle strength, 40 min all-out running distance, running performance determinants and patellar tendon stiffness were measured before and after the intervention. Results E+S increased 1RM in leg exercises (40 ± 15%) and maximal jumping height in counter movement jump (6 ± 6%) and squat jump (9 ± 7%, p < 0.05). This was accompanied by increased muscle fiber cross sectional area of both fiber type I (13 ± 7%) and fiber type II (31 ± 20%) in m. vastus lateralis (p < 0.05), with no change in capillary density in m. vastus lateralis or the stiffness of the patellar tendon. Neither E+S nor E changed running economy, fractional utilization of VO2max or VO2max. There were also no change in running distance during a 40 min all-out running test in neither of the groups. Conclusion Adding heavy strength training to endurance training did not affect 40 min all-out running performance or running economy compared to endurance training only.
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Affiliation(s)
- Olav Vikmoen
- Section for Sport Science, Lillehammer University College, Lillehammer, Norway
- * E-mail:
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Olivier Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kristoffer Bergstrøm
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Stian Ellefsen
- Section for Sport Science, Lillehammer University College, Lillehammer, Norway
| | - Bent R. Rønnestad
- Section for Sport Science, Lillehammer University College, Lillehammer, Norway
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65
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Kulig K, Chang YJ, Winiarski S, Bashford GR. Ultrasound-Based Tendon Micromorphology Predicts Mechanical Characteristics of Degenerated Tendons. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:664-673. [PMID: 26718836 DOI: 10.1016/j.ultrasmedbio.2015.11.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to explore the relationship between tendon micro-morphology quantified from a sonogram and tendon mechanical characteristics measured in vivo. Nineteen adults (nine with unilateral Achilles tendinosis) participated. A commercial ultrasound scanner was used to capture longitudinal B-mode ultrasound images from the mid-portion of bilateral Achilles tendons and a custom image analysis program was used to analyze the spatial frequency content of manually defined regions of interest; in particular, the average peak spatial frequency of the regions of interest was acquired. In addition, a dynamometer and a motion analysis system indirectly measured the tendon mechanical (stiffness) and material (elastic modulus) properties. The peak spatial frequency correlated with tendon stiffness (r = 0.74, p = 0.02) and elastic modulus (r = 0.65, p = 0.05) in degenerated tendons, but not healthy tendons. This is the first study relating the mechanical characteristics of degenerated human Achilles tendon using a non-invasive micro-morphology analysis approach.
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Affiliation(s)
- Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.
| | - Yu-Jen Chang
- Division of Physical Therapy, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Slawomir Winiarski
- Department of Biomechanics, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Gregory R Bashford
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Wearing SC, Hooper SL, Smeathers JE, Pourcelot P, Crevier-Denoix N, Brauner T. Tendinopathy alters ultrasound transmission in the patellar tendon during squatting. Scand J Med Sci Sports 2015; 26:1415-1422. [PMID: 26660902 DOI: 10.1111/sms.12602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
Measurement of loading patterns of the patellar tendon during activity is important in understanding tendon injury. We used transmission-mode ultrasonography to investigate patellar tendon loading during squatting in adults with and without tendinopathy. It was hypothesized that axial ultrasonic velocity, a surrogate measure of the elastic modulus of tendon, would be lower in tendinopathy. Ultrasound velocity was measured in both patellar tendons of adults with unilateral patellar tendinopathy (n = 9) and in healthy controls (n = 16) during a bilateral squat maneuver. Sagittal knee movement was measured simultaneously with an electrogoniometer. Statistical comparisons between healthy and injured tendons were made using two-way mixed-design ANOVAs. Axial ultrasound velocity in both symptomatic and asymptomatic patellar tendons in tendinopathy was approximately 15% higher than in healthy tendons at the commencement (F1,23 = 5.2, P < 0.05) and completion (F1,23 = 4.5, P < 0.05) of the squat. While peak velocity was ≈5% higher during both flexion (F1,23 = 5.4, P < 0.05) and extension (F1,23 = 5.3, P < 0.05) phases, there was no significant between-group difference at the midpoint of the movement. There were no significant differences in the rate and magnitude of knee movement between groups. Although further research is required, these findings suggest enhanced baseline muscle activity in patellar tendinopathy and highlight fresh avenues for its clinical management.
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Affiliation(s)
- S C Wearing
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Division of Neurophysiology in the Center of Rare Diseases, Ulm University, Ulm, Baden-Württemberg, Germany
| | - S L Hooper
- Office of Health & Medical Research, Queensland Health, Brisbane, Queensland, Australia
| | - J E Smeathers
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - P Pourcelot
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.,INRA, Maisons-Alfort, France
| | - N Crevier-Denoix
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.,INRA, Maisons-Alfort, France
| | - T Brauner
- Faculty of Sports & Health Sciences, Technische Universität München, Munich, Germany
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67
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Wilson JJ, Lee KS, Chamberlain C, DeWall R, Baer GS, Greatens M, Kamps N. Intratendinous injections of platelet-rich plasma: feasibility and effect on tendon morphology and mechanics. J Exp Orthop 2015; 2:5. [PMID: 26914873 PMCID: PMC4545464 DOI: 10.1186/s40634-014-0018-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/15/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Intratendinous injections may have important effects on the properties of collagen microarchitecture, morphology, and subsequent mechanical properties of the injected tendon. The purpose of this study was to examine the effects of intratendinous PRP injections; the injectant retention within tendons, the distribution of intratendinous injectant, and whether intratendinous injection or needle fenestration alters tendon morphology or mechanics. METHODS DESIGN Controlled Laboratory Study. INTERVENTIONS In the first part of the study, 18 lamb extensor tendons were selected to receive methylene blue-containing PRP injection (PRP/MB), methylene blue only injection (MB), or needle fenestration. The volume of retained injectant was measured and injectant distribution and tendon morphology were examined microscopically. In the second portion of the study, 18 porcine flexor tendons were divided into control, needle fenestration, or saline injection groups. Young's Modulus was then determined for each tendon under 0-4% strain. MAIN OUTCOME MEASURES 1) Injectant volume retained; 2) Injectant distribution; 3) Post-injection/fenestration alterations in morphology, biomechanics. RESULTS Intratendinous injectant is retained within the tendon. The difference between PRP and PRP/MB groups was not significant (p = 0.78). Intratendinous spread of the injectant solution within the tendon occurs primarily in the proximodistal direction, with very little cross-sectional penetration. Intratendinous injections resulted in microscopic morphology disruption (e.g., separation and disorganization of both the collagen bundles and cellular distribution). There were significant differences in Young's Modulus between control (Ectrl = 2415.48) and injected tendons (Einj = 1753.45) at 4% strain (p = 0.01). There were no differences in Young's Modulus between fenestrated and control tendons. CONCLUSIONS Intratendinous PRP injections are retained within the tendon, and primarily distributes longitudinally with minimal cross-sectional spread. Intratendinous injections may alter tendon morphology and mechanics.
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Affiliation(s)
- John J Wilson
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, Wisconsin, 53705, USA.
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53705, USA.
| | - Connie Chamberlain
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, Wisconsin, 53705, USA.
| | - Ryan DeWall
- Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53705, USA.
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, 53705, USA.
| | - Geoffrey S Baer
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, Wisconsin, 53705, USA.
| | - Marcus Greatens
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, Wisconsin, 53705, USA.
| | - Nicole Kamps
- Division of Sports Medicine, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, Wisconsin, 53705, USA.
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Abstract
Synopsis Tendinopathy has become the accepted term to describe a spectrum of changes that occur in damaged and/or diseased tendons. Over the past 2 decades, there have been new insights into tendon pathophysiology of relevance to clinicians, including (1) better characterization of the overuse injury process and the resultant structural and functional disruption in chronically painful tendons, (2) improved understanding of the pathomechanics associated with chronic tendon injury, and (3) greater knowledge about the influence of lifestyle factors and drugs on tendon pathology. The implications of these new insights are discussed. J Orthop Sports Phys Ther 2015;45(11):833-841. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5884.
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69
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Stanton R, Kean CO, Scanlan AT. My Jump for vertical jump assessment. Br J Sports Med 2015; 49:1157-8. [PMID: 26124470 DOI: 10.1136/bjsports-2015-094831] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Robert Stanton
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Crystal O Kean
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Aaron T Scanlan
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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Cortes DH, Suydam SM, Silbernagel KG, Buchanan TS, Elliott DM. Continuous Shear Wave Elastography: A New Method to Measure Viscoelastic Properties of Tendons in Vivo. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1518-29. [PMID: 25796414 PMCID: PMC4426016 DOI: 10.1016/j.ultrasmedbio.2015.02.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 01/27/2015] [Accepted: 02/04/2015] [Indexed: 05/09/2023]
Abstract
Viscoelastic mechanical properties are frequently altered after tendon injuries and during recovery. Therefore, non-invasive measurements of shear viscoelastic properties may help evaluate tendon recovery and compare the effectiveness of different therapies. The objectives of this study were to describe an elastography method for measuring localized viscoelastic properties of tendons and to discuss the initial results in healthy and injured human Achilles and semitendinosus tendons. The technique used an external actuator to generate the shear waves in the tendon at different frequencies and plane wave imaging to measure shear wave displacements. For each of the excitation frequencies, maps of direction-specific wave speeds were calculated using local frequency estimation. Maps of viscoelastic properties were obtained using a pixel-wise curve fit of wave speed and frequency. The method was validated by comparing measurements of wave speed in agarose gels with those obtained using magnetic resonance elastography. Measurements in human healthy Achilles tendons revealed a pronounced increase in wave speed as a function of frequency, which highlights the importance of tendon viscoelasticity. Additionally, the viscoelastic properties of the Achilles tendon were larger than those reported for other tissues. Measurements in a tendinopathic Achilles tendon indicated that it is feasible to quantify local viscoelastic properties. Similarly, measurement in the semitendinosus tendon revealed substantial differences in viscoelastic properties between the healthy and contralateral tendons. Consequently, this technique has the potential to evaluate localized changes in tendon viscoelastic properties caused by injury and during recovery in a clinical setting.
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Affiliation(s)
- Daniel H Cortes
- Biomedical Engineering Program, University of Delaware, Newark, Delaware, USA.
| | - Stephen M Suydam
- Mechanical Engineering Department, University of Delaware, Newark, Delaware, USA
| | | | - Thomas S Buchanan
- Mechanical Engineering Department, University of Delaware, Newark, Delaware, USA
| | - Dawn M Elliott
- Biomedical Engineering Program, University of Delaware, Newark, Delaware, USA
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71
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Pearson SJ, Hussain SR. Region-specific tendon properties and patellar tendinopathy: a wider understanding. Sports Med 2015; 44:1101-12. [PMID: 24838651 DOI: 10.1007/s40279-014-0201-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patellar tendinopathy is a common painful musculoskeletal disorder with a very high prevalence in the athletic population that can severely limit or even end an athletic career. To date, the underlying pathophysiology leading to the condition remains poorly understood, although reports suggesting that patellar tendinopathy most frequently concerns the proximal posterior region of the tendon has prompted some researchers to examine region-specific tendon properties for a better understanding of the etiology and potential risk factors associated with the condition. However, to date, research concerning the in vivo region-specific tendon properties in relation to patellar tendinopathy is very scarce, perhaps due to the lack of validated techniques that can determine such properties in vivo. In recent years, a technique has been developed involving an automated tendon-tracking program that appears to be very useful in the determination of region-specific tendon properties in vivo. In terms of regional variations in tendon properties, previous research has demonstrated differences in structural, mechanical, and biochemical properties between the discrete regions of the patellar tendon, but the extent to which these regional variations contribute to patellar tendinopathy remains elusive. In addition, with respect to treatment strategies for patellar tendinopathy, previous research has utilized a wide range of interventions, but the use of eccentric exercise (EE) and/or heavy-slow resistance (HSR) training appear to be most promising. However, the optimal program design variables of EE and HSR training that induce the most favorable effects are yet to be determined. This review article provides a detailed discussion of all of the above to allow a better understanding of the etiology and potential risk factors associated with the condition as well as the most effective treatment strategies. First, a comprehensive literature review is provided with respect to region-specific structural, mechanical, and biochemical properties, in association with patellar tendinopathy. Second, the automated tendon-tracking methodology is outlined to assist future researchers in the determination of region-specific tendon properties. Finally, potential treatment strategies are discussed, particularly with regards to the use of EE and HSR training for the management of patellar tendinopathy.
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Affiliation(s)
- Stephen John Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Manchester, M6 6PU, UK,
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72
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Rosen AB, Ko J, Simpson KJ, Kim SH, Brown CN. Lower Extremity Kinematics During a Drop Jump in Individuals With Patellar Tendinopathy. Orthop J Sports Med 2015; 3:2325967115576100. [PMID: 26665034 PMCID: PMC4622361 DOI: 10.1177/2325967115576100] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Patellar tendinopathy (PT) is a common degenerative condition in physically active populations. Knowledge regarding the biomechanics of landing in populations with symptomatic PT is limited, but altered mechanics may play a role in the development or perpetuation of PT. Purpose: To identify whether study participants with PT exhibited different landing kinematics compared with healthy controls. Study Design: Controlled laboratory study. Methods: Sixty recreationally active participants took part in this study; 30 had current signs and symptoms of PT, including self-reported pain within the patellar tendon during loading activities for at least 3 months and ≤80 on the Victorian Institute of Sport Assessment Scale–Patella (VISA-P). Thirty healthy participants with no history of PT or other knee joint pathology were matched by sex, age, height, and weight. Participants completed 5 trials of a 40-cm, 2-legged drop jump followed immediately by a 50% maximum vertical jump. Dependent variables of interest included hip, knee, and ankle joint angles at initial ground contact, peak angles, and maximum angular displacements during the landing phase in 3 planes. Independent-samples t tests (P ≤ .05) were utilized to compare the joint angles and angular displacements between PT and control participants. Results: Individuals with PT displayed significantly decreased peak hip (PT, 59.2° ± 14.6°; control, 67.2° ± 13.9°; P = .03) and knee flexion angles (PT, 74.8° ± 13.2°; control, 82.5° ± 9.0°; P = .01) compared with control subjects. The PT group displayed decreased maximum angular displacement in the sagittal plane at the hip (PT, 49.3° ± 10.8°; control, 55.2° ± 11.4°; P = .04) and knee (PT, 71.6° ± 8.4°; control, 79.7° ± 8.3°; P < .001) compared with the control group. Conclusion: Participants with PT displayed decreased maximum flexion and angular displacement in the sagittal plane, at both the knee and the hip. The altered movement patterns in those with PT may be perpetuating symptoms associated with PT and could be due to the contributions of the rectus femoris during dynamic movement. Clinical Relevance: Based on kinematic alterations in symptomatic participants, rehabilitation efforts may benefit from focusing on both the knee and the hip to treat symptoms associated with PT.
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Affiliation(s)
- Adam B Rosen
- University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Jupil Ko
- University of Georgia, Athens, Georgia, USA
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73
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van Ark M, Docking SI, van den Akker-Scheek I, Rudavsky A, Rio E, Zwerver J, Cook JL. Does the adolescent patellar tendon respond to 5 days of cumulative load during a volleyball tournament? Scand J Med Sci Sports 2015; 26:189-96. [PMID: 25694241 DOI: 10.1111/sms.12426] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 12/15/2022]
Abstract
Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The critical tendon load that affects tendon structure is unknown. The aim of this study was to investigate patellar tendon structure on each day of a 5-day volleyball tournament in an adolescent population (16-18 years). The right patellar tendon of 41 players in the Australian Volleyball Schools Cup was scanned with ultrasound tissue characterization (UTC) on every day of the tournament (Monday to Friday). UTC can quantify structure of a tendon into four echo types based on the stability of the echo pattern. Generalized estimating equations (GEE) were used to test for change of echo type I and II over the tournament days. Participants played between eight and nine matches during the tournament. GEE analysis showed no significant change of echo type percentages of echo type I (Wald chi-square = 4.603, d.f. = 4, P = 0.331) and echo type II (Wald chi-square = 6.070, d.f. = 4, P = 0.194) over time. This study shows that patellar tendon structure of 16-18-year-old volleyball players is not affected during 5 days of cumulative loading during a volleyball tournament.
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Affiliation(s)
- M van Ark
- Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - S I Docking
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - I van den Akker-Scheek
- Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Rudavsky
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - E Rio
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - J Zwerver
- Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J L Cook
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
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Muscle and tendon stiffness assessment using the alpha method and ultrafast ultrasound. Eur J Appl Physiol 2015; 115:1393-400. [DOI: 10.1007/s00421-015-3112-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/14/2015] [Indexed: 01/06/2023]
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75
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WEARING SCOTTC, LOCKE SIMON, SMEATHERS JAMESE, HOOPER SUEL. Tendinopathy Alters Cumulative Transverse Strain in the Patellar Tendon after Exercise. Med Sci Sports Exerc 2015; 47:264-71. [DOI: 10.1249/mss.0000000000000417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jafari L, Vachon P, Beaudry F, Langelier E. Histopathological, biomechanical, and behavioral pain findings of Achilles tendinopathy using an animal model of overuse injury. Physiol Rep 2015; 3:3/1/e12265. [PMID: 25602018 PMCID: PMC4387767 DOI: 10.14814/phy2.12265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Animal models of forced running are used to study overuse tendinopathy, a common health problem for which clear evidence for effective and accessible treatments is still lacking. In these models, pain evaluation is necessary to better understand the disease, help design and evaluate therapies, and ensure humane treatment of the animals. Therefore, the main objective of this study was to evaluate pain and pathologic findings in an animal model of moderate Achilles tendinopathy induced by treadmill running. Air puffs, instead of electrical shocks, were used to stimulate running so that pain associated with stimulation would be avoided. Pressure pain sensitivity was evaluated in vivo using a new instrumented plier, whereas spinal cord peptides were analyzed ex vivo with high‐performance liquid chromatography tandem mass spectrometry. Tendon histologic slides were semiquantitatively evaluated, using the Bonar score technique and biomechanical properties, using the traction test. After 8 weeks of treadmill running (2 weeks for adaptation and 6 weeks for the lesion protocol), the protocol was stopped because the air puffs became ineffective to stimulate running. We, nevertheless, observed some histologic changes characteristic of overuse tendinopathy as well as decreased mechanical properties, increased Substance P and dynorphin A peptides but without pressure pain sensitivity. These results suggest that air‐puffs stimulation is sufficient to induce an early stage tendinopathy to study new therapeutic drugs without inducing unnecessary pain. They also indicate that pain‐associated peptides could be related with movement evoked pain and with the sharp breakdown of the running performance. The main objective of this study was to correlate pain and pathologic findings in an animal model of moderate Achilles tendinopathy induced by treadmill running. We observed some histologic changes characteristic of overuse tendinopathy as well as decreased mechanical properties, increased Substance P and dynorphin A peptides but without pressure pain sensitivity.
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Affiliation(s)
- Leila Jafari
- Département de génie mécanique, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Pascal Vachon
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Francis Beaudry
- Département de Biomédecine Vétérinaire, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Eve Langelier
- Département de génie mécanique, Université de Sherbrooke, Sherbrooke, Québec, Canada
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77
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Zhang ZJ, Ng GYF, Lee WC, Fu SN. Changes in morphological and elastic properties of patellar tendon in athletes with unilateral patellar tendinopathy and their relationships with pain and functional disability. PLoS One 2014; 9:e108337. [PMID: 25303466 PMCID: PMC4193737 DOI: 10.1371/journal.pone.0108337] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/05/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patellar tendinopathy (PT) is one of the most common knee disorders among athletes. Changes in morphology and elasticity of the painful tendon and how these relate to the self-perceived pain and dysfunction remain unclear. OBJECTIVES To compare the morphology and elastic properties of patellar tendons between athlete with and without unilateral PT and to examine its association with self-perceived pain and dysfunction. METHODS In this cross-sectional study, 33 male athletes (20 healthy and 13 with unilateral PT) were enrolled. The morphology and elastic properties of the patellar tendon were assessed by the grey and elastography mode of supersonic shear imaging (SSI) technique while the intensity of pressure pain, self-perceived pain and dysfunction were quantified with a 10-lb force to the most painful site and the Victorian Institute of Sport Assessment-patella (VISA-P) questionnaire, respectively. RESULTS In athletes with unilateral PT, the painful tendons had higher shear elastic modulus (SEM) and larger tendon than the non-painful side (p<0.05) or the dominant side of the healthy athletes (p<0.05). Significant correlations were found between tendon SEM ratio (SEM of painful over non-painful tendon) and the intensity of pressure pain (rho = 0.62; p = 0.024), VISA-P scores (rho = -0.61; p = 0.026), and the sub-scores of the VISA-P scores on going down stairs, lunge, single leg hopping and squatting (rho ranged from -0.63 to -0.67; p<0.05). CONCLUSIONS Athletes with unilateral PT had stiffer and larger tendon on the painful side than the non-painful side and the dominant side of healthy athletes. No significant differences on the patellar tendon morphology and elastic properties were detected between the dominant and non-dominant knees of the healthy control. The ratio of the SEM of painful to non-painful sides was associated with pain and dysfunction among athletes with unilateral PT.
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Affiliation(s)
- Zhi Jie Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- Guangdong-Hongkong Joint Sports Rehabilitation and Research Center, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Gabriel Yin-fat Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Wai Chun Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Siu Ngor Fu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
- * E-mail:
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Bohm S, Mersmann F, Marzilger R, Schroll A, Arampatzis A. Asymmetry of Achilles tendon mechanical and morphological properties between both legs. Scand J Med Sci Sports 2014; 25:e124-32. [DOI: 10.1111/sms.12242] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 12/19/2022]
Affiliation(s)
- S. Bohm
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
| | - F. Mersmann
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
| | - R. Marzilger
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
| | - A. Schroll
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
| | - A. Arampatzis
- Department of Training and Movement Sciences; Humboldt-Universität zu Berlin; Berlin Germany
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Bahr MA, Bahr R. Jump frequency may contribute to risk of jumper's knee: a study of interindividual and sex differences in a total of 11 943 jumps video recorded during training and matches in young elite volleyball players. Br J Sports Med 2014; 48:1322-6. [DOI: 10.1136/bjsports-2014-093593] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ekizos A, Papatzika F, Charcharis G, Bohm S, Mersmann F, Arampatzis A. Ultrasound does not provide reliable results for the measurement of the patellar tendon cross sectional area. J Electromyogr Kinesiol 2013; 23:1278-82. [PMID: 24021864 DOI: 10.1016/j.jelekin.2013.08.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study examined the reliability of patellar tendon cross sectional area (CSA) measurement using brightness mode ultrasonography. METHODS The patellar tendon CSA of fourteen participants was examined on two different days and at three different positions (proximal, median and distal). Five trials per day were conducted in each position, replacing the ultrasound probe on every trial. The images were examined by three different and equally experienced observers. We compared the mean of the five trials in each position to examine the day, observer and position effect. Further, Bland and Altman plots, root mean square (RMS) differences and intraclass correlation coefficients (ICC) were calculated. RESULTS There was a significant (p < 0.05) day, observer and position effect on the CSA, while the average ICC was 0.592. The Bland and Altman plots showed that differences between conditions or groups, should be in average lower than 37% or higher than 55% of the patellar tendon CSA to be important for clinical or intervention studies. CONCLUSION Our findings show low reliability of the method, which resulted from the low clarity and unclear visibility of tissue boundaries in the ultrasound images. Therefore, the measurement of the CSA of the patellar tendon using ultrasound does not provide accurate and reliable results.
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Affiliation(s)
- Antonis Ekizos
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany
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