1
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Monte A, Skypala J, Vilimek D, Juras V, Jandacka D. Correlations between Achilles tendon material and structural properties and quantitative magnetic resonance imagining in different athletic populations. J Biomech 2023; 159:111796. [PMID: 37696235 DOI: 10.1016/j.jbiomech.2023.111796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
Achilles tendon stiffness (kAT) and Young's modulus (yAT) are important determinants of tendon function. However, their evaluation requires sophisticated equipment and time-consuming procedures. The goal of this study was twofold: to compare kAT and yAT between populations using the classical approach proposed in the literature (a combination of ultrasound and force data) and the MRI technique to understand the MRI's capability in determining differences in kAT and yAT. Furthermore, we investigated potential correlations between short and long T2* relaxation time, kAT and yAT to determine whether T2* relaxation time may be associated with material or structural properties. Twelve endurance and power athlete, and twelve healthy controls were recruited. AT T2* short and long components were measured using standard gradient echo MRI at rest, while kAT and yAT were evaluated using the classical method (combination of ultrasound and dynamometric measurements). Power athletes had the highest kAT (3064 ± 260, 2714 ± 260 and 2238 ± 189 N/mm for power athletes, endurance athletes and healthy control, respectively) and yAT (2.39 ± 0.28, 1.64 ± 0.22 and 1.97 ± 0.32 GPa for power athletes, endurance athletes and healthy control, respectively) and the lowest T2* short component (0.58 ± 0.07, 0.77 ± 0.06 and 0.74 ± 0.08 ms for power athletes, endurance athletes and healthy control, respectively). Endurance athletes had the highest T2* long component value. No correlations were reported between T2* long component, kAT or yAT in the investigated populations, whereas the T2* short component was negatively correlated with yAT. These results suggest that T2* short component could be used to investigate the differences in AT material properties in different populations.
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Affiliation(s)
- Andrea Monte
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic; Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Jiri Skypala
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic
| | - Dominik Vilimek
- Department of Cybernetics and Biomedical Engineering, Faculty of Electrical Engineering and Computer Science, VSB - Technical University of Ostrava, 17. listopadu 15, Ostrava - Poruba 70800, Czech Republic
| | - Vladimir Juras
- High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Daniel Jandacka
- Human Motion Diagnostic Center, Department of Human Movement Studies, University of Ostrava, 70200 Ostrava, Czech Republic
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2
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Malmgaard-Clausen NM, Kjaer M, Dakin SG. Pathological Tendon Histology in Early and Chronic Human Patellar Tendinopathy. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:2799665. [PMID: 38655164 PMCID: PMC11022758 DOI: 10.1155/2022/2799665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 04/26/2024]
Abstract
The present pilot study investigated the extent of histological tissue changes in both chronic tendinopathy and in individuals that display early clinical signs of tendinopathy. The study included 8 individuals of whom 3 were healthy without any tendon symptoms, 2 had early symptoms (1-2 months), and 3 had chronic symptoms (>3 months) from their patellar tendons. Percutaneous needle biopsy samples were obtained from the affected tendon tissue region. Biopsy samples were stained with Haematoxylin & Eosin, and multiplex immunofluorescence staining was performed for markers of inflammation and resolution. Both early and chronic stage patellar tendon biopsy samples from this small patient cohort exhibited expansion of the interfascicular matrix (IFM) and endotenon regions together with increased cellularity and vascularity. These histological observations were moderate in early tendinopathy, whereas they were more pronounced and associated with marked disruption of tissue architecture in chronic tendinopathy. Early stage tendinopathic patellar tendons expressed markers associated with an activated phenotype of fibroblasts (CD90, CD34), macrophages (S100A8), and endothelial cells (ICAM1, VCAM1). These tissues also expressed enzymes implicated in inflammation (PTGS2, 15PGDH) and resolution (ALOX12) and the proresolving receptor ERV1. Immunopositive staining for these markers was predominantly located in the IFM regions. These preliminary findings suggest that mild to moderate structural histological changes including expansion of IFM and endotenon regions are pathological features of early tendinopathy, and support inflammatory and resolving processes are active in early-stage disease. Further investigation of the cellular and molecular basis of early-stage tendinopathy is required to inform therapeutic strategies that prevent the development of irreversible chronic tendon disease.
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Affiliation(s)
- Nikolaj Moelkjaer Malmgaard-Clausen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stephanie G Dakin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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3
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Grävare Silbernagel K, Malliaras P, de Vos RJ, Hanlon S, Molenaar M, Alfredson H, van den Akker-Scheek I, Antflick J, van Ark M, Färnqvist K, Haleem Z, Kaux JF, Kirwan P, Kumar B, Lewis T, Mallows A, Masci L, Morrissey D, Murphy M, Newsham-West R, Norris R, O'Neill S, Peers K, Sancho I, Seymore K, Vallance P, van der Vlist A, Vicenzino B. ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy. Sports Med 2022; 52:613-641. [PMID: 34797533 PMCID: PMC8891092 DOI: 10.1007/s40279-021-01588-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. OBJECTIVE To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. DESIGN Systematic review. DATA SOURCES Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. RESULTS 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. CONCLUSION 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. PROSPERO REGISTRATION CRD42020156763.
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Affiliation(s)
- Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA.
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Shawn Hanlon
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Mitchel Molenaar
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jarrod Antflick
- Department of Bioengineering, School of Engineering, Imperial College, London, UK
| | - Mathijs van Ark
- Department of Physiotherapy, School of Health Care Studies, Hanze University of Applied Sciences and Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands
| | | | - Zubair Haleem
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Arsenal Football Club, London, UK
| | - Jean-Francois Kaux
- Department of Physical and Rehabilitation Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium
| | - Paul Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bhavesh Kumar
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Trevor Lewis
- Aintree University Hospital, Liverpool Foundation Trust, Liverpool, UK
| | - Adrian Mallows
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Lorenzo Masci
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Myles Murphy
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Richard Newsham-West
- School of Allied Health, Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
| | - Richard Norris
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Seth O'Neill
- School of Allied Health, University of Leicester, Leicester, UK
| | - Koen Peers
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Igor Sancho
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, University of Deusto, San Sebastian, Spain
| | - Kayla Seymore
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Patrick Vallance
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, VIC, Australia
| | - Arco van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
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4
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Matthews W, Ellis R, Furness J, Hing WA. The clinical diagnosis of Achilles tendinopathy: a scoping review. PeerJ 2021; 9:e12166. [PMID: 34692248 PMCID: PMC8485842 DOI: 10.7717/peerj.12166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. Methodology A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. Results A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. Conclusions There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.
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Affiliation(s)
- Wesley Matthews
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - James Furness
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wayne A Hing
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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5
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Devaprakash D, Obst SJ, Lloyd DG, Barrett RS, Kennedy B, Ball I, Adams KL, Collings TJ, Davico G, Hunter A, Vlahovich N, Pease DL, Pizzolato C. The Free Achilles Tendon Is Shorter, Stiffer, Has Larger Cross-Sectional Area and Longer T2 * Relaxation Time in Trained Middle-Distance Runners Compared to Healthy Controls. Front Physiol 2020; 11:965. [PMID: 32973544 PMCID: PMC7482361 DOI: 10.3389/fphys.2020.00965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/15/2020] [Indexed: 12/14/2022] Open
Abstract
Tendon geometry and tissue properties are important determinants of tendon function and injury risk and are altered in response to ageing, disease, and physical activity levels. The purpose of this study was to compare free Achilles tendon geometry and mechanical properties between trained elite/sub-elite middle-distance runners and a healthy control group. Magnetic resonance imaging (MRI) was used to measure free Achilles tendon volume, length, average cross-sectional area (CSA), regional CSA, moment arm, and T2* relaxation time at rest, while freehand three-dimensional ultrasound (3DUS) was used to quantify free Achilles tendon mechanical stiffness, Young’s modulus, and length normalised mechanical stiffness. The free Achilles tendon in trained runners was significantly shorter and the average and regional CSA (distal end) were significantly larger compared to the control group. Mechanical stiffness of the free Achilles tendon was also significantly higher in trained runners compared to controls, which was explained by the group differences in tendon CSA and length. T2* relaxation time was significantly longer in trained middle-distance runners when compared to healthy controls. There was no relationship between T2* relaxation time and Young’s modulus. The longer T2* relaxation time in trained runners may be indicative of accumulated damage, disorganised collagen, and increased water content in the free Achilles tendon. A short free Achilles tendon with large CSA and higher mechanical stiffness may enable trained runners to rapidly transfer high muscle forces and possibly reduce the risk of tendon damage from mechanical fatigue.
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Affiliation(s)
- Daniel Devaprakash
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Steven J Obst
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,School of Health, Medical, and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia
| | - David G Lloyd
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Rod S Barrett
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Ben Kennedy
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,QSCAN Radiology Clinics, Gold Coast, QLD, Australia
| | - Iain Ball
- Philips Healthcare, Australia and New Zealand, Sydney, NSW, Australia
| | | | - Tyler J Collings
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Giorgio Davico
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy.,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Adam Hunter
- Australian Institute of Sport, Canberra, ACT, Australia
| | | | - David L Pease
- Australian Institute of Sport, Canberra, ACT, Australia
| | - Claudio Pizzolato
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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6
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Pękala PA, Drzymała A, Kaythampillai L, Skinningsrud B, Mizia E, Rok T, Wojciechowski W, Tomaszewski KA. The influence of aging on the insertion of the Achilles tendon: A magnetic resonance study. Clin Anat 2020; 33:545-551. [DOI: 10.1002/ca.23431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/08/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Przemysław A. Pękala
- International Evidence‐Based Anatomy Working Group Kraków Poland
- Department of AnatomyJagiellonian University Medical College Kraków Poland
| | - Anna Drzymała
- Department of OrthopedicsChildren's University Hospital of Kraków Poland
| | | | - Bendik Skinningsrud
- International Evidence‐Based Anatomy Working Group Kraków Poland
- Department of AnatomyJagiellonian University Medical College Kraków Poland
| | - Ewa Mizia
- International Evidence‐Based Anatomy Working Group Kraków Poland
| | - Tomasz Rok
- Department of BiophysicsJagiellonian University Medical College Kraków Poland
| | - Wadim Wojciechowski
- Department of RadiologyJagiellonian University Medical College Kraków Poland
- Department of RadiologyComarch Healthcare S.A. Kraków Poland
| | - Krzysztof A. Tomaszewski
- Faculty of Medicine and Health SciencesAndrzej Frycz Modrzewski Kraków University Kraków Poland
- Department of Orthopedic SurgeryScanmed St. Raphael Hospital Kraków Poland
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7
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Tran PHT, Malmgaard-Clausen NM, Puggaard RS, Svensson RB, Nybing JD, Hansen P, Schjerling P, Zinglersen AH, Couppé C, Boesen M, Magnusson SP, Kjaer M. Early development of tendinopathy in humans: Sequence of pathological changes in structure and tissue turnover signaling. FASEB J 2019; 34:776-788. [PMID: 31914656 DOI: 10.1096/fj.201901309r] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/09/2019] [Accepted: 10/23/2019] [Indexed: 02/06/2023]
Abstract
Overloading of tendon tissue with resulting chronic pain (tendinopathy) is a common disorder in occupational-, leisure- and sports-activity, but its pathogenesis remains poorly understood. To investigate the very early phase of tendinopathy, Achilles and patellar tendons were investigated in 200 physically active patients and 50 healthy control persons. Patients were divided into three groups: symptoms for 0-1 months (T1), 1-2 months (T2) or 2-3 months (T3). Tendinopathic Achilles tendon cross-sectional area determined by ultrasonography (US) was ~25% larger than in healthy control persons. Both Achilles and patellar anterior-posterior diameter were elevated in tendinopathy, and only later in Achilles was the width increased. Increased tendon size was accompanied by an increase in hypervascularization (US Doppler flow) without any change in mRNA for angiogenic factors. From patellar biopsies taken bilaterally, mRNA for most growth factors and tendon components remained unchanged (except for TGF-beta1 and substance-P) in early tendinopathy. Tendon stiffness remained unaltered over the first three months of tendinopathy and was similar to the asymptomatic contra-lateral tendon. In conclusion, this suggests that tendinopathy pathogenesis represents a disturbed tissue homeostasis with fluid accumulation. The disturbance is likely induced by repeated mechanical overloading rather than a partial rupture of the tendon.
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Affiliation(s)
- Peter H T Tran
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj M Malmgaard-Clausen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rikke S Puggaard
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - René B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janus D Nybing
- Department of Radiology, Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
| | - Philip Hansen
- Department of Radiology, Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
| | - Peter Schjerling
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Amanda H Zinglersen
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Physical & Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mikael Boesen
- Department of Radiology, Bispebjerg-Frederiksberg Hospital, Frederiksberg, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Physical & Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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Lockard CA, Chang A, Clanton TO, Ho CP. T2* mapping and subregion analysis of the tibialis posterior tendon using 3 Tesla magnetic resonance imaging. Br J Radiol 2019; 92:20190221. [PMID: 31596118 DOI: 10.1259/bjr.20190221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Early detection of tibialis posterior tendon changes and appropriate intervention is necessary to prevent disease progression to flat-foot deformity and foot/ankle dysfunction, and the need for operative treatment. Currently, differentiating between early-stage tibialis posterior tendon deficiency patients who will benefit from conservative vs more aggressive treatment is challenging. The objective of this work was to establish a quantitative MRI T2* mapping method and subregion baseline values in the tibialis posterior tendon in asymptomatic ankles for future clinical application in detecting tendon degeneration. METHODS 26 asymptomatic volunteers underwent T2* mapping. The tendon was divided axially into seven subregions. Summary statistics for T2* within each subregion were calculated and compared using Tukey post-hoc pairwise comparisons. RESULTS Results are reported for 24 subjects. The mean tibialis posterior tendon T2* was 7 ± 1 ms. Subregion values ranged from 6 ± 1 to 9 ± 2 ms with significant between-region differences in T2*. Inter- and intrarater absolute agreement intraclass correlation coefficient (ICC) values were all "excellent" (0.75 < ICC=1.00) except for regions 5 through 7, which had "fair to good" interrater and/or and intrarater ICC values (0.4 < ICC=0.75). CONCLUSION A tibialis posterior tendon T2* mapping protocol, subregion division method, and baseline T2* values for clinically relevant regions were established. Significant differences in T2* were observed along the tendon length. ADVANCES IN KNOWLEDGE This work demonstrates that regional variation exists and should be considered for future T2*-based research on posterior tibias tendon degeneration and when using T2* mapping to evaluate for potential tibialis posterior tendon degeneration.
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Affiliation(s)
- Carly Anne Lockard
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000 Vail, Colorado 81657, United States
| | - Angela Chang
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000 Vail, Colorado 81657, United States
| | - Thomas O Clanton
- The Steadman Clinic, 181 West Meadow Drive, Suite 400 Vail, Colorado 81657, United States
| | - Charles P Ho
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000 Vail, Colorado 81657, United States
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9
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Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther 2018; 48:A1-A38. [PMID: 29712543 DOI: 10.2519/jospt.2018.0302] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.
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10
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Li Q, Ma K, Tao H, Hua Y, Chen S, Chen S, Zhao Y. Clinical and magnetic resonance imaging assessment of anatomical lateral ankle ligament reconstruction: comparison of tendon allograft and autograft. INTERNATIONAL ORTHOPAEDICS 2018; 42:551-557. [PMID: 29404669 DOI: 10.1007/s00264-018-3802-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/23/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare the results of anatomical lateral ankle ligament (LAL) reconstruction with tendon allograft and autograft using clinical scores and ultrashort echo time (UTE) sequence of MRI. METHODS A total of 26 patients with LAL reconstruction were recruited in this study, including 16 using semitendinosus allografts and 10 using semitendinosus autograft. All of them were diagnosed as chronic ankle instability and accepted anatomic reconstruction. The American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, and radiological evaluation using MRI UTE scanning were extracted from each patient. The comparative analysis of the clinical assessments and UTE-T2* values were performed between the patients using autografts and allografts. RESULTS For the allograft group, the mean AOFAS score improved from 69.9 ± 13.3 to 94.8 ± 5.4 (P = 0.000), and the mean Karlsson score improved from 70.3 ± 12.2 to 93.8 ± 5.6 (P = 0.000). For the autograft group, the mean AOFAS score improved from 68.4 ± 10.0 to 94.7 ± 5.0 (P = 0.000), and the mean Karlsson score improved from 64.5 ± 14.4 to 95.0 ± 5.8 (P = 0.000). No significant differences were found between the allograft and autograft neither before (AOFAS P = 0.756, Karlsson P = 0.285) nor after (AOFAS P = 0.957, Karlsson P = 0.574) surgery. While the UTE T2* values in allograft were higher than those of autograft group both in anterior talofibular ligament (8.3 ± 1.0 vs 7.6 ± 1.1 P = 0.027) and intra-tunnel graft (7.8 ± 0.6 vs 7.2 ± 0.8 P = 0.045). CONCLUSION Both allograft and autograft reconstructions could get an ideal patient satisfaction and clinical functional outcomes at the follow-up. Higher T2* values were found in allograft group which indicated that autograft had some superiorities in respect of revascularization process, collagen structure, water content, and tendon properties.
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Affiliation(s)
- Qianru Li
- Department of Sports Medicine, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Kui Ma
- Department of Sports Medicine, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Hongyue Tao
- Department of Sports Medicine, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
| | - Shuang Chen
- Department of Sports Medicine, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Yutong Zhao
- Dunn School, 2555 Highway 154, Los Olivos, CA, 93441, USA
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Abstract
OBJECTIVE The purposes of this article are to present a state-of-the-art routine protocol for MRI of the ankle, to provide problem-solving tools based on specific clinical indications, and to introduce principles for the implementation of ultrashort echo time MRI of the ankle, including morphologic and quantitative assessment. CONCLUSION Ankle injury is common among both athletes and the general population, and MRI is the established noninvasive means of evaluation. The design of an ankle protocol depends on various factors. Higher magnetic field improves signal-to-noise ratio but increases metal artifact. Specialized imaging planes are useful but prolong acquisition times. MR neurography is useful, but metal reduction techniques are needed whenever a metal prosthesis is present. An ultrashort echo time sequence is a valuable tool for both structural and quantitative evaluation.
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12
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Wilson KJ, Surowiec RK, Johnson NS, Lockard CA, Clanton TO, Ho CP. T2* Mapping of Peroneal Tendons Using Clinically Relevant Subregions in an Asymptomatic Population. Foot Ankle Int 2017; 38:677-683. [PMID: 28552042 DOI: 10.1177/1071100717693208] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Peroneal tendon evaluation is particularly demanding using current magnetic resonance imaging (MRI) techniques because of their curving path around the lateral malleolus. Quantifiable, objective data on the health of the peroneal tendons could be useful for improving diagnosis of tendon pathology and tracking post-treatment responses. The purpose of this study was to establish a method and normative T2-star (T2*) values for the peroneal tendons in a screened asymptomatic cohort using clinically reproducible subregions, providing a baseline for comparison with peroneal tendon pathology. METHODS Unilateral ankle scans were acquired for 26 asymptomatic volunteers with a 3-Tesla MRI system using a T2* mapping sequence in the axial and sagittal planes. The peroneus brevis and peroneus longus tendons were manually segmented and subregions were isolated in the proximity of the lateral malleolus. Summary statistics for T2* values were calculated. RESULTS The peroneus brevis tendon exhibited a mean T2* value of 12 ms and the peroneus longus tendon was 11 ms. Subregions distal to the lateral malleolus had significantly higher T2* values ( P < .05) than the subregions proximal in both tendons, in both the axial and sagittal planes. CONCLUSION Peroneal tendon regions distal to the inferior tip of the lateral malleolus had significantly higher T2* values than those regions proximal, which could be related to anatomical differences along the tendon. CLINICAL RELEVANCE This study provides a quantitative method and normative baseline T2* mapping values for comparison with symptomatic clinically compromised peroneal tendon patients.
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Affiliation(s)
| | | | | | | | | | - Charles P Ho
- 1 Steadman Philippon Research Institute, Vail, CO, USA
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13
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UTE-T2 ⁎ Analysis of Diseased and Healthy Achilles Tendons and Correlation with Clinical Score: An In Vivo Preliminary Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2729807. [PMID: 28154823 PMCID: PMC5244000 DOI: 10.1155/2017/2729807] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/24/2016] [Indexed: 01/20/2023]
Abstract
Objective. To compare T2⁎ value of healthy and diseased Achilles tendons (AT) with a recently introduced three-dimensional ultrashort echo time (3D-UTE) sequence and analyze the correlation between T2⁎ value and clinical scores. Methods. Ten patients with symptomatic Achilles tendon and ten healthy volunteers were investigated with 3D-UTE sequence on a 3T magnetic resonance (MR) scanner. T2⁎ values of four regions in Achilles tendons were calculated. The clinical outcomes of patients were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and Achilles Tendon Rupture Score (ATRS). An independent sample t-test was used to compare the differences of T2⁎ value and clinical scores between two groups. The Pearson correlation coefficient between clinical scores and T2⁎ values was assessed. Results. The T2⁎ values of Achilles tendon were statistically significantly different between patients and volunteers. The Pearson correlation coefficients between T2⁎ and AOFAS or ATRS scores of patients were r = −0.733 and r = −0.634, respectively. Conclusion. The variability of T2⁎ in healthy and pathologic AT can be quantified by UTE-T2⁎. T2⁎ may be a promising marker to detect and diagnose AT tendinopathy. UTE-T2⁎ could give a precise guidance to clinical outcome.
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Siriwanarangsun P, Statum S, Biswas R, Bae WC, Chung CB. Ultrashort time to echo magnetic resonance techniques for the musculoskeletal system. Quant Imaging Med Surg 2016; 6:731-743. [PMID: 28090449 DOI: 10.21037/qims.2016.12.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic resonance (MR) imaging has been widely implemented as a non-invasive modality to investigate musculoskeletal (MSK) tissue disease, injury, and pathology. Advancements in MR sequences provide not only enhanced morphologic contrast for soft tissues, but also quantitative biochemical evaluation. Ultrashort time to echo (UTE) sequence, in particular, enables novel morphologic and quantitative evaluation of previously unseen MSK tissues. By using short minimum echo times (TE) below 1 msec, the UTE sequence can unveil short T2 properties of tissues including the deepest layers of the articular cartilage, cartilaginous endplate at the discovertebral junction, the meniscus, and the cortical bone. This article will discuss the application of UTE to evaluate these MSK tissues, starting with tissue structure, MR imaging appearance on standard versus short and ultrashort TE sequences, and provide the range of quantitative MR values found in literature.
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Affiliation(s)
- Palanan Siriwanarangsun
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sheronda Statum
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Reni Biswas
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Won C Bae
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California, San Diego, La Jolla, CA, USA;; Department of Radiology, VA San Diego Healthcare System, San Diego, CA, USA
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