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Sun Y, Sheng R, Cao Z, Liu C, Li J, Zhang P, Du Y, Mo Q, Yao Q, Chen J, Zhang W. Bioactive fiber-reinforced hydrogel to tailor cell microenvironment for structural and functional regeneration of myotendinous junction. SCIENCE ADVANCES 2024; 10:eadm7164. [PMID: 38657071 PMCID: PMC11042749 DOI: 10.1126/sciadv.adm7164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024]
Abstract
Myotendinous junction (MTJ) injuries are prevalent in clinical practice, yet the treatment approaches are limited to surgical suturing and conservative therapy, exhibiting a high recurrence rate. Current research on MTJ tissue engineering is scarce and lacks in vivo evaluation of repair efficacy. Here, we developed a three-dimensional-printed bioactive fiber-reinforced hydrogel containing mesenchymal stem cells (MSCs) and Klotho for structural and functional MTJ regeneration. In a rat MTJ defect model, the bioactive fiber-reinforced hydrogel promoted the structural restoration of muscle, tendon, and muscle-tendon interface and enhanced the functional recovery of injured MTJ. In vivo proteomics and in vitro cell cultures elucidated the regenerative mechanisms of the bioactive fiber-reinforced hydrogel by modulating oxidative stress and inflammation, thus engineering an optimized microenvironment to support the survival and differentiation of transplanted MSCs and maintain the functional phenotype of resident cells within MTJ tissues, including tendon/muscle cells and macrophages. This strategy provides a promising treatment for MTJ injuries.
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Affiliation(s)
- Yuzhi Sun
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, China
| | - Renwang Sheng
- School of Medicine, Southeast University, 210009 Nanjing, China
| | - Zhicheng Cao
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, China
| | - Chuanquan Liu
- School of Medicine, Southeast University, 210009 Nanjing, China
| | - Jiaxiang Li
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, China
| | - Po Zhang
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, China
| | - Yan Du
- School of Medicine, Southeast University, 210009 Nanjing, China
| | - Qingyun Mo
- School of Medicine, Southeast University, 210009 Nanjing, China
| | - Qingqiang Yao
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, 210006 Nanjing, China
- China Orthopedic Regenerative Medicine Group (CORMed), 310000 Hangzhou, China
| | - Jialin Chen
- School of Medicine, Southeast University, 210009 Nanjing, China
- China Orthopedic Regenerative Medicine Group (CORMed), 310000 Hangzhou, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, 210096 Nanjing, China
| | - Wei Zhang
- School of Medicine, Southeast University, 210009 Nanjing, China
- China Orthopedic Regenerative Medicine Group (CORMed), 310000 Hangzhou, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, 210096 Nanjing, China
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Tsurukami H, Itoigawa Y, Uehara H, Hatae F, Kubota A, Mizuno M, Maezawa K, Takazawa Y, Ishijima M. Stiffness Changes in Shoulder Muscles between Pitchers and Position Players after Throwing Overhead Using Shear Wave Elastography and Throwing Motion Analysis. J Clin Med 2024; 13:2056. [PMID: 38610821 PMCID: PMC11012453 DOI: 10.3390/jcm13072056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/16/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: The objective is to compare stiffness changes around the shoulder muscles between pitchers and position players after throwing overhead using shear wave elastography (SWE) in relation to throwing motion analysis and muscle strength. Methods: A total of 32 male college baseball players (12 pitchers and 20 position players) were observed throwing 20 times, and SWE was performed to evaluate 13 shoulder muscle items-tendons (supraspinatus, infraspinatus, subscapularis, and teres minor), muscles (supraspinatus, infraspinatus [transverse and oblique part], teres minor, lower trapezius, latissimus dorsi, and pectoralis minor), and capsules (posterior and posteroinferior). Motion analysis was used to assess elbow torque, forearm angle, forearm rotation speed, and maximum external rotation angle of the shoulder. Muscle strength was measured using a dynamometer for abduction, internal/external rotation of the shoulder at an abduction of 0°, internal/external rotation of the shoulder at an abduction of 90°, and internal/external rotation of shoulder at a flexion of 90°. Results: In the pitcher group, SWE values for the teres minor muscle and latissimus dorsi muscle increased significantly after throwing. In the position player group, SWE values for the teres minor muscle significantly increased, and SWE values of the pectoralis minor muscle decreased after throwing. In the pitcher group, positive correlations were found between the teres minor muscle and forearm rotation speed and between the latissimus dorsi muscle and forearm angle. No significant difference was found in muscle strength after throwing in any of the groups. Conclusions: Stiffness changes occurred after throwing and were related to the motion analysis, but the regions in which stiffness occurred varied between pitchers and position players.
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Affiliation(s)
- Hironori Tsurukami
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan; (H.T.); (F.H.); (K.M.)
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan; (H.T.); (F.H.); (K.M.)
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
| | - Hirohisa Uehara
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
| | - Fumitoshi Hatae
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan; (H.T.); (F.H.); (K.M.)
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
| | - Atsushi Kubota
- Graduate School of Health and Sports Science, Juntendo University, Inzai 270-1695, Japan; (A.K.); (M.M.); (Y.T.)
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan
| | - Motoki Mizuno
- Graduate School of Health and Sports Science, Juntendo University, Inzai 270-1695, Japan; (A.K.); (M.M.); (Y.T.)
| | - Katsuhiko Maezawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Urayasu 279-0021, Japan; (H.T.); (F.H.); (K.M.)
| | - Yuuji Takazawa
- Graduate School of Health and Sports Science, Juntendo University, Inzai 270-1695, Japan; (A.K.); (M.M.); (Y.T.)
- Department of Sports Medicine, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Faculty of Medicine, Juntendo University, Hongo, Tokyo 113-0034, Japan; (H.U.); (M.I.)
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Crawford SK, Wille CM, Joachim MR, Lee KS, Heiderscheit BC. Ultrasound shear wave seeds reduced following hamstring strain injury but not after returning to sport. Insights Imaging 2024; 15:7. [PMID: 38191955 PMCID: PMC10774410 DOI: 10.1186/s13244-023-01571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/17/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES The purpose of the study was to investigate differences in ultrasound shear wave speed (SWS) between uninjured and injured limbs following hamstring strain injury (HSI) at time of injury (TOI), return to sport (RTS), and 12 weeks after RTS (12wks). METHODS This observational, prospective, cross-sectional design included male and female collegiate athletes who sustained an HSI. SWS imaging was performed at TOI, RTS, and 12wks with magnetic resonance imaging. SWS maps were acquired by a musculoskeletal-trained sonographer at the injury location of the injured limb and location-matched on the contralateral limb. The average SWS from three 5 mm diameter Q-boxes on each limb were used for analysis. A linear mixed effects model was performed to determine differences in SWS between limbs across the study time points. RESULTS SWS was lower in the injured limb compared to the contralateral limb at TOI (uninjured - injured limb difference: 0.23 [0.05, 0.41] m/s, p = 0.006). No between-limb differences in SWS were observed at RTS (0.15 [-0.05, 0.36] m/s, p = 0.23) or 12wks (-0.11 [-0.41, 0.18] m/s, p = 0.84). CONCLUSIONS The SWS in the injured limb of collegiate athletes after HSI was lower compared to the uninjured limb at TOI but not at RTS or 12 weeks after RTS. CRITICAL RELEVANCE STATEMENT Hamstring strain injury with structural disruption can be detected by lower injured limb shear wave speed compared to the uninjured limb. Lack of between-limb differences at return to sport may demonstrate changes consistent with healing. Shear wave speed may complement traditional ultrasound or MRI for monitoring muscle injury. KEY POINTS • Ultrasound shear wave speed can non-invasively measure tissue elasticity in muscle injury locations. • Injured limb time of injury shear wave speeds were lower versus uninjured limb but not thereafter. • Null return to sport shear wave speed differences may correspond to structural changes associated with healing. • Shear wave speed may provide quantitative measures for monitoring muscle elasticity during recovery.
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Affiliation(s)
- Scott K Crawford
- Department of Kinesiology, University of Wisconsin-Madison, 1300 University Ave, Madison, WI, 53706, USA.
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA.
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Christa M Wille
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Mikel R Joachim
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
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Horvat U, Kozinc Ž. The Use of Shear-Wave Ultrasound Elastography in the Diagnosis and Monitoring of Musculoskeletal Injuries. Crit Rev Biomed Eng 2024; 52:15-26. [PMID: 38305275 DOI: 10.1615/critrevbiomedeng.2023049807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Ultrasound elastography is a valuable method employed to evaluate tissue stiffness, with shear-wave elastography (SWE) recently gaining significance in various settings. This literature review aims to explore the potential of SWE as a diagnostic and monitoring tool for musculoskeletal injuries. In total, 15 studies were found and included in the review. The outcomes of these studies demonstrate the effectiveness of SWE in detecting stiffness changes in individuals diagnosed with Achilles tendinopathy, Achilles tendon rupture, rotator cuff rupture, tendinosis of the long head of the biceps tendon, injury of the supraspinatus muscle, medial tibial stress syndrome, and patellar tendinopathy. Moreover, SWE proves its efficacy in distinguishing variations in tissue stiffness before the commencement and after the completion of rehabilitation in cases of Achilles tendon rupture and patellar tendinopathy. In summary, the findings from this review suggest that SWE holds promise as a viable tool for diagnosing and monitoring specific musculoskeletal injuries. However, while the field of ultrasound elastography for assessing musculoskeletal injuries has made considerable progress, further research is imperative to corroborate these findings in the future.
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Affiliation(s)
- Urša Horvat
- Univerza na Primorskem, Fakulteta za vede o zdravju, Polje 42, Izola, Slovenija
| | - Žiga Kozinc
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; University of Primorska, Andrej Marušič Institute, Muzejski trg 2, SI-6000 Koper, Slovenia
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Xu W, Zheng Y, Jiang Y, Zhang Z, Ma S, Cao Y. Shear wave imaging the active constitutive parameters of living muscles. Acta Biomater 2023; 166:400-408. [PMID: 37230437 DOI: 10.1016/j.actbio.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Shear wave elastography (SWE) of human skeletal muscles allows for measurement of muscle elastic properties in vivo and has important applications in sports medicine and for the diagnosis and treatment of muscle-related diseases. Existing methods of SWE for skeletal muscles rely on the passive constitutive theory and have so far been unable to provide constitutive parameters describing muscle active behavior. In the present paper, we overcome this limitation by proposing a SWE method for quantitative inference of active constitutive parameters of skeletal muscles in vivo. To this end, we investigate the wave motion in a skeletal muscle described by a constitutive model in which muscle active behavior has been defined by an active parameter. An analytical solution relating shear wave velocities to both passive and active material parameters of muscles is derived, based upon which an inverse approach has been developed to evaluate these parameters. To demonstrate the usefulness of the reported method, in vivo experiments were carried out on 10 volunteers to obtain constitutive parameters, particularly those describing active deformation behaviors of living muscles. The results reveal that the active material parameter of skeletal muscles varies with warm-up, fatigue and rest. STATEMENT OF SIGNIFICANCE: Existing shear wave elastography methods are limited to imaging the passive parameters of muscles. This limitation is addressed in the present paper by developing a method to image the active constitutive parameter of living muscles using shear waves. We derived an analytical solution demonstrating the relationship between constitutive parameters of living muscles and shear waves. Relying on the analytical solution, we proposed an inverse method to infer active parameter of skeletal muscles. We performed in vivo experiments to demonstrate the usefulness of the theory and method; the quantitative variation of the active parameter with muscle states such as warm-up, fatigue and rest has been reported for the first time.
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Affiliation(s)
- Weiqiang Xu
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Yang Zheng
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Yuxuan Jiang
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Zhaoyi Zhang
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Shiyu Ma
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China
| | - Yanping Cao
- Institute of Biomechanics and Medical Engineering, AML, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, PR China.
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Hayashi D, Roemer FW, Tol JL, Heiss R, Crema MD, Jarraya M, Rossi I, Luna A, Guermazi A. Emerging Quantitative Imaging Techniques in Sports Medicine. Radiology 2023; 308:e221531. [PMID: 37552087 DOI: 10.1148/radiol.221531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
This article describes recent advances in quantitative imaging of musculoskeletal extremity sports injuries, citing the existing literature evidence and what additional evidence is needed to make such techniques applicable to clinical practice. Compositional and functional MRI techniques including T2 mapping, diffusion tensor imaging, and sodium imaging as well as contrast-enhanced US have been applied to quantify pathophysiologic processes and biochemical compositions of muscles, tendons, ligaments, and cartilage. Dual-energy and/or spectral CT has shown potential, particularly for the evaluation of osseous and ligamentous injury (eg, creation of quantitative bone marrow edema maps), which is not possible with standard single-energy CT. Recent advances in US technology such as shear-wave elastography or US tissue characterization as well as MR elastography enable the quantification of mechanical, elastic, and physical properties of tissues in muscle and tendon injuries. The future role of novel imaging techniques such as photon-counting CT remains to be established. Eventual prediction of return to play (ie, the time needed for the injury to heal sufficiently so that the athlete can get back to playing their sport) and estimation of risk of repeat injury is desirable to help guide sports physicians in the treatment of their patients. Additional values of quantitative analyses, as opposed to routine qualitative analyses, still must be established using prospective longitudinal studies with larger sample sizes.
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Affiliation(s)
- Daichi Hayashi
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Frank W Roemer
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Johannes L Tol
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Rafael Heiss
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Michel D Crema
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Mohamed Jarraya
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Ignacio Rossi
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Antonio Luna
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
| | - Ali Guermazi
- From the Department of Radiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Mass (D.H.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, Mass (D.H., F.W.R., M.D.C., A.G.); Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany (F.W.R., R.H.); University of Amsterdam Academic Center for Evidence-based Sports Medicine, Amsterdam, the Netherlands (J.L.T.); Institute of Sports Imaging, French National Institute of Sports, Paris, France (M.D.C.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.J.); Centro Rossi, Buenos Aires, Argentina (I.R.); Department of Radiology, HT Medica, Jaén, Spain (A.L.); and Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132 (A.G.)
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7
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Varol U, Valera-Calero JA, Fernández-de-las-Peñas C, Buffet-García J, Plaza-Manzano G, Navarro-Santana MJ. Body Composition and Demographic Features Do Not Affect the Diagnostic Accuracy of Shear Wave Elastography. Bioengineering (Basel) 2023; 10:904. [PMID: 37627789 PMCID: PMC10451656 DOI: 10.3390/bioengineering10080904] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
Shear-wave elastography (SWE) is an imaging method that can be used to estimate shear wave speed and the Young's modulus based on the measured shear wave speed under certain conditions. Up to date, no research has analyzed whether body composition factors contribute to ultrasound attenuation, refraction, reflection, and, consequently, SWE measurement errors. Therefore, this study aimed to analyze the association between demographic and body composition features with SWE errors for assessing the anterior scalene stiffness (which is a key structure in patients with neck pain and nerve compressive syndromes). Demographic (sex, age, height, weight, and body mass index), body composition (water volume, fat mass, and lean mass), and anterior scalene muscle stiffness (Young's modulus and shear wave speed) data were collected from a sample of asymptomatic subjects. After calculating the absolute SWE differences between trials and the reliability estimates, a correlation matrix was generated to quantify the association among all the variables. A total of 34 asymptomatic subjects (24 males) were included in the analyses. Test-retest reliability was excellent for assessing the Young's modulus and shear wave velocity (ICC = 0.912 and 0.923, respectively). No significant associations were found between age, height, weight, body mass index, body fat, lean mass, or water volume with SWE errors (p > 0.05). However, the Young's modulus error was associated with the stiffness properties (p < 0.01), whereas shear wave speed was associated with none of them (all, p > 0.05). A detailed procedure can reliably assess the AS muscle stiffness. None of the sociodemographic or body composition features assessed were correlated with SWE errors. However, baseline stiffness seems to be associated with Young's modulus error.
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Affiliation(s)
- Umut Varol
- Escuela Internacional de Doctorado, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
| | - Juan Antonio Valera-Calero
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - César Fernández-de-las-Peñas
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Jorge Buffet-García
- Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain;
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Marcos José Navarro-Santana
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursery, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain; (G.P.-M.); (M.J.N.-S.)
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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8
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Yoshida K, Itoigawa Y, Morikawa D, Maruyama Y, Ishijima M. Chronologic Changes in the Elastic Modulus of a Healing Achilles Tendon Rupture Measured Using Shear Wave Elastography. Foot Ankle Int 2023; 44:243-250. [PMID: 36788728 DOI: 10.1177/10711007221151083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Shear wave elastography (SWE) has been used to examine the elasticity of a ruptured Achilles tendon; however, the healing process of a ruptured tendon has not been studied yet. This study aimed to detail the change in mechanical properties of a healing Achilles tendon rupture managed conservatively or surgically using SWE. METHODS Using a prospective cohort study design, we evaluated the patients treated conservatively (conservative group) and surgically (surgical group) with the "gift-box" technique for an isolated index acute Achilles tendon rupture during their healing process. SWE measurements were taken of both the injured and uninjured sides every 4 weeks up to 24, 36, and 48 weeks after treatment. Additionally, tendon thickness and power Doppler (PD) grade were measured at the same time points as SWE measurements. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot rating system score and Achilles tendon Total Rupture Score (ATRS) were compared at 24 and 48 weeks. RESULTS The ruptured Achilles tendon obtained an SWE value comparable with the unruptured side at 12 weeks in the conservative group and at 4 weeks with surgical group. The surgical group had significantly higher SWE values up to 24 weeks compared with the conservative group. Additionally, this group had a significantly larger increase in tendon thickness in nearly all periods. Both treatment groups were comparable regarding the PD grade, AOFAS score, and ATRS. CONCLUSION SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Our analysis using SWE has revealed the detailed chronologic changes in SWE values and related mechanical properties of a healing Achilles tendon rupture, which can be used for devising appropriate rehabilitation protocols. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Keiichi Yoshida
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan.,Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Daichi Morikawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan.,Department of Medicine for Orthopedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
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9
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Bordalo M, Arnaiz J, Yamashiro E, Al-Naimi MR. Imaging of Muscle Injuries. Magn Reson Imaging Clin N Am 2023; 31:163-179. [PMID: 37019544 DOI: 10.1016/j.mric.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Ultrasound (US) and MR imaging are the most common imaging modalities used to assess sports muscle injuries. The site of the muscle injury can be located at the peripheral aspect of the muscle (myofascial), within the muscle belly (musculotendinous), and with tendon involvement (intratendinous). Tears that affect the intramuscular tendon have a worse prognosis in terms of recovery time. US is an excellent method to evaluate muscle injuries, with high spatial and contrast resolution. MR imaging can be reserved for evaluation of professional athletes, surgical planning, differential diagnosis, and assessment of deep located and proximal muscle groups.
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10
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Pereira VL, Andreoli CV, Santos RFV, Belangero PS, Ejnisman B, Castro Pochini AD. Surgical repair of the medial head of the gastrocnemius: two case reports and review. J Surg Case Rep 2022; 2022:rjac335. [PMID: 35854818 PMCID: PMC9291348 DOI: 10.1093/jscr/rjac335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
The gastrocnemius medial head distal musculotendinous junction injury is relatively common. Musculature contraction in an already stretched structure leads to muscle breakdown. Patients affected are often physically active middle-aged men. The typical presentation includes sudden pain, audible popping, bruising and localized tenderness. Occasionally, there is a palpable defect if the rupture is complete. Although the initial diagnosis can be made on the basis of a careful history and clinical examination, ultrasound or magnetic resonance imaging can be used to better describe the lesion. In complete ruptures, even when conservative treatment shows good results, it is common that the patient presents decreased muscle strength, difficulty returning to sports and permanent and visible gap. Considering surgical treatment in patients with complete ruptures and extensive injuries with a more than 5 cm gap may lead to better healing process, rapid rehabilitation and more efficient return to sports.
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Affiliation(s)
- Vitor Luis Pereira
- Orthopedics and Traumatology Department , Traumatology Sports Center, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Vicente Andreoli
- Orthopedics and Traumatology Department , Traumatology Sports Center, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Paulo Santoro Belangero
- Orthopedics and Traumatology Department , Traumatology Sports Center, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Orthopedics and Traumatology Department , Traumatology Sports Center, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Alberto de Castro Pochini
- Orthopedics and Traumatology Department , Traumatology Sports Center, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP, Brazil
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11
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Zunarelli P, Lucenteforte G, Miceli M, Stride M, Nanni G, Della Villa F. The Use of Diagnostic Ultrasound in Sports Muscle Injuries in Football (Soccer) Players: State-of-the-art Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Return to Play After a Hamstring Strain Injury: It is Time to Consider Natural Healing. Sports Med 2021; 51:2067-2077. [PMID: 34143413 DOI: 10.1007/s40279-021-01494-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2021] [Indexed: 01/15/2023]
Abstract
Return to play (RTP) criteria after hamstring strain injuries (HSIs) help clinicians in deciding whether an athlete is ready to safely resume previous sport activities. Today, functional and sport-specific training tests are the gold standard in the decision-making process. These criteria lead to an average RTP time between 11 and 25 days after a grade 1 or 2 HSI. However, the high re-injury rates indicate a possible inadequacy of the current RTP criteria. A possible explanation for this could be the neglect of biological healing time. The present review shows that studies indicating time as a possible factor within the RTP-decision are very scarce. However, studies on biological muscle healing showed immature scar tissue and incomplete muscle healing at the average moment of RTP. Twenty-five percent of the re-injuries occur in the first week after RTP and at the exact same location as the index injury. This review supports the statement that functional recovery precedes the biological healing of the muscle. Based on basic science studies on biological muscle healing, we recommend a minimum period of 4 weeks before RTP after a grade 1 or 2 HSI. In conclusion, we advise a comprehensive RTP functional test battery with respect for the natural healing process. Before deciding RTP readiness, clinicians should reflect whether or not it is biologically possible for the injured tissue to have regained enough strength to withstand the sport-specific forces. In an attempt to reduce the detrimental injury-reinjury cycle, it is time to start considering (biological healing) time.
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