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Lee JH, Gong HS. Volumetric assessment of ulnar nerves in cubital tunnel syndrome with 3D modeling of the MRI and its relationship with electrodiagnostic findings. J Plast Reconstr Aesthet Surg 2024; 92:244-251. [PMID: 38574571 DOI: 10.1016/j.bjps.2024.03.014] [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: 01/08/2023] [Revised: 09/06/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Thickened nerve cross-sectional areas (CSA) have been investigated in compressive neuropathy, but the longitudinal extent of nerve swelling has yet to be evaluated. We did a volumetric assessment of the ulnar nerve in cubital tunnel syndrome (CuTS) with three-dimensional (3D) magnetic resonance imaging (MRI) modeling and investigated this relationship with clinical and electrodiagnostic parameters. METHODS We compared 40 CuTS patient elbow MRIs to 46 patient elbow MRIs with lateral elbow epicondylitis as controls. The ulnar nerve was modeled with Mimics software and was assessed qualitatively and quantitatively. The CSA and ulnar nerve volumes were recorded, and the area under the receiver operating characteristic (ROC) curve was calculated for diagnostic performance. We analyzed clinical and electrodiagnostic parameters to investigate their relationship with the 3D ulnar nerve parameters. RESULTS For the diagnosis of CuTS, the area under the curve value was 0.915 for the largest CSA and 0.910 for the volume in the ROC curve. The optimal cut-off was 14.53 mm2 and 529 mm3 respectively. When electrodiagnostic parameters were investigated, the 3D ulnar nerve volume was significantly inversely associated with motor conduction velocity, although there was no association between the largest CSA and any of the electrodiagnostic parameters. CONCLUSIONS The 3D ulnar nerve volume, which is an integration or multilevel measurement of CSAs, showed diagnostic usefulness similar to CSA, but it correlated better with conduction velocity, indicating demyelination or early-to-moderate nerve damage in CuTS.
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Affiliation(s)
- Jeong Hyun Lee
- Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Marshall SJ, Hicks KM, Howatson G, Cox L, Thomas K. B-Mode Ultrasonography Is a Reliable and Valid Alternative to Magnetic Resonance Imaging for Measuring Patellar Tendon Cross-Sectional Area. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:578-587. [PMID: 36376155 DOI: 10.1016/j.ultrasmedbio.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/27/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
This study investigated the validity and reliability of measuring patellar tendon (PT) cross-sectional area (CSA) using magnetic resonance imaging (MRI) and ultrasound (US) imaging. Nineteen healthy participants (10 women, 9 men) participated in three imaging sessions of the PT, once via MRI and twice via US, with image acquisition conducted by two raters, one experienced (rater 2) and one inexperienced (rater 1). All PT segmentations were analyzed by both raters. The validity of US-derived estimates of PT CSA against MRI estimates was analyzed using linear regression. Within-day reliability of US and MRI measurements and between-day reliability of US measurements were quantified using typical error (TE) and intra-class correlation coefficients (ICC3,1). There was good agreement between US- and MRI-derived estimations of PT CSA (standard errors of the estimate of 3.3 mm2 for rater 1 and 2.6 mm2 for rater 2; Pearson's r = 0.97 and 0.98 for raters 1 and 2, respectively). Within-session reliability for estimations of total PT CSA from US and MRI were excellent (ICC3,1 >0.95, coefficient of variation [CV] <4.1%, TE = 1.3-3.6 mm2. Between-day reliability for US was excellent (ICC3,1 >0.97, CV <2.7%, TE = 1.6-2.3 mm2), with little difference between raters. These findings suggest that MRI and US both provide reliable estimates of PT CSA and that US can provide a valid measure of PT CSA.
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Affiliation(s)
- Steven J Marshall
- Department of Service Sector Management, Sheffield Hallam University, Howard Street, Sheffield, South Yorkshire, UK; Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle City Campus, Newcastle upon Tyne, UK
| | - Kirsty M Hicks
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle City Campus, Newcastle upon Tyne, UK
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle City Campus, Newcastle upon Tyne, UK; Water Research Group, North West University, Potchefstroom, South Africa
| | - Lisa Cox
- Newcastle Clinic, Independent House, Team Valley, Gateshead, UK
| | - Kevin Thomas
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle City Campus, Newcastle upon Tyne, UK
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Lazarczuk SL, Maniar N, Opar DA, Duhig SJ, Shield A, Barrett RS, Bourne MN. Mechanical, Material and Morphological Adaptations of Healthy Lower Limb Tendons to Mechanical Loading: A Systematic Review and Meta-Analysis. Sports Med 2022; 52:2405-2429. [PMID: 35657492 PMCID: PMC9474511 DOI: 10.1007/s40279-022-01695-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exposure to increased mechanical loading during physical training can lead to increased tendon stiffness. However, the loading regimen that maximises tendon adaptation and the extent to which adaptation is driven by changes in tendon material properties or tendon geometry is not fully understood. OBJECTIVE To determine (1) the effect of mechanical loading on tendon stiffness, modulus and cross-sectional area (CSA); (2) whether adaptations in stiffness are driven primarily by changes in CSA or modulus; (3) the effect of training type and associated loading parameters (relative intensity; localised strain, load duration, load volume and contraction mode) on stiffness, modulus or CSA; and (4) whether the magnitude of adaptation in tendon properties differs between age groups. METHODS Five databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE) were searched for studies detailing load-induced adaptations in tendon morphological, material or mechanical properties. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated and data were pooled using a random effects model to estimate variance. Meta regression was used to examine the moderating effects of changes in tendon CSA and modulus on tendon stiffness. RESULTS Sixty-one articles met the inclusion criteria. The total number of participants in the included studies was 763. The Achilles tendon (33 studies) and the patella tendon (24 studies) were the most commonly studied regions. Resistance training was the main type of intervention (49 studies). Mechanical loading produced moderate increases in stiffness (standardised mean difference (SMD) 0.74; 95% confidence interval (CI) 0.62-0.86), large increases in modulus (SMD 0.82; 95% CI 0.58-1.07), and small increases in CSA (SMD 0.22; 95% CI 0.12-0.33). Meta-regression revealed that the main moderator of increased stiffness was modulus. Resistance training interventions induced greater increases in modulus than other training types (SMD 0.90; 95% CI 0.65-1.15) and higher strain resistance training protocols induced greater increases in modulus (SMD 0.82; 95% CI 0.44-1.20; p = 0.009) and stiffness (SMD 1.04; 95% CI 0.65-1.43; p = 0.007) than low-strain protocols. The magnitude of stiffness and modulus differences were greater in adult participants. CONCLUSIONS Mechanical loading leads to positive adaptation in lower limb tendon stiffness, modulus and CSA. Studies to date indicate that the main mechanism of increased tendon stiffness due to physical training is increased tendon modulus, and that resistance training performed at high compared to low localised tendon strains is associated with the greatest positive tendon adaptation. PROSPERO registration no.: CRD42019141299.
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Affiliation(s)
- Stephanie L Lazarczuk
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia.
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
| | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - David A Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Melbourne, VIC, Australia
| | - Steven J Duhig
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Anthony Shield
- School of Exercise and Nutrition Sciences and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Rod S Barrett
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Matthew N Bourne
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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Mauvieux B, Hingrand C, Drigny J, Hodzic A, Baron P, Hurdiel R, Jouffroy R, Vauthier JC, Pessiglione M, Wiehler A, Degache F, Pavailler S, Heyman E, Plard M, Noirez P, Dubois B, Esculier JF, Nguyen AP, Van Cant J, Roy Baillargeon O, Pairot de Fontenay B, Delaunay PL, Besnard S. Study of the kinetics of the determinants of performance during a mountain ultra marathon: Multidisciplinary protocol of the first Trail Scientifique de Clécy 2021 (Preprint). JMIR Res Protoc 2022; 11:e38027. [PMID: 35704381 PMCID: PMC9244647 DOI: 10.2196/38027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/20/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background The growing interest of the scientific community in trail running has highlighted the acute effects of practice at the time of these races on isolated aspects of physiological and structural systems; biological, physiological, cognitive, and muscular functions; and the psychological state of athletes. However, no integrative study has been conducted under these conditions with so many participants and monitoring of pre-, per-, and postrace variables for up to 10 days over a distance close to 100 miles. Objective The aim of this study was to evaluate the kinetics of the performance parameters during a 156 km trail run and 6000 m of elevation gain in pre-, per-, and postrace conditions. The general hypothesis is based on significant alterations in the psychological, physiological, mechanical, biological, and cognitive parameters. Methods The Trail Scientifique de Clécy took place on November 11, 2021. This prospective experimental study provides a comprehensive exploration of the constraints and adaptations of psychophysiological and sociological variables assessed in real race conditions during a trail running of 156 km on hilly ground and 6000 m of elevation gain (D+). The study protocol allowed for repeatability of study measurements under the same experimental conditions during the race, with the race being divided into 6 identical loops of 26 km and 1000 m D+. Measurements were conducted the day before and the morning of the race, at the end of each lap, after a pit stop, and up to 10 days after the race. A total of 55 participants were included, 43 (78%) men and 12 (22%) women, who were experienced in ultra–trail-running events and with no contraindications to the practice of this sport. Results The launch of the study was authorized on October 26, 2021, under the trial number 21-0166 after a favorable opinion from the Comité de Protection des Personnes Ouest III (21.09.61/SIRIPH 2G 21.01586.000009). Of the 55 runners enrolled, 41 (75%) completed the race and 14 (25%) dropped out for various reasons, including gastric problems, hypothermia, fatigue, and musculoskeletal injuries. All the measurements for each team were completed in full. The race times (ie, excluding the measurements) ranged from 17.8206 hours for the first runner to 35.9225 hours for the last runner. The average time to complete all measurements for each lap was 64 (SD 3) minutes. Conclusions The Trail Scientifique de Clécy, by its protocol, allowed for a multidisciplinary approach to the discipline. This approach will allow for the explanation of the studied parameters in relation to each other and observation of the systems of dependence and independence. The initial results are expected in June 2022. International Registered Report Identifier (IRRID) RR1-10.2196/38027
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Affiliation(s)
| | | | - Joffrey Drigny
- U1075 Comete/INSERM, Université de Caen, Caen, France
- Unité de Médecine du Sport, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Amir Hodzic
- U1075 Comete/INSERM, Université de Caen, Caen, France
- Unité de Médecine du Sport, Centre Hospitalier Universitaire de Caen Normandie, Caen, France
| | - Pauline Baron
- ULR 7369 - Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Université du Littoral Côte d'Opale, Dunkerque, France
| | - Rémy Hurdiel
- ULR 7369 - Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Université du Littoral Côte d'Opale, Dunkerque, France
| | - Romain Jouffroy
- Intensive Care Unit, Anaethesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- IRMES - Institute for Research in Medicine and Epidemiology of Sport, Institut National du Sport, de l'Expertise et de la Performance, Paris, France
- INSERM U-1018, Centre de recherche en Epidémiologie et Santé des Populations, Paris Saclay University, Paris, France
| | - Jean-Charles Vauthier
- Departement de Medecine Générale, Faculté de Médecine - Département du Grand Est de recherche en soins primaires, Université de Lorraine, Nancy, France
| | - Mathias Pessiglione
- Motivation, Brain and Behavior lab, Institut du cerveau et de la moelle épinière Inserm U1127, CNRS U9225, Université Pierre et Marie Curie (UPMC-Paris 6), Paris, France
| | - Antonius Wiehler
- Motivation, Brain and Behavior lab, Institut du cerveau et de la moelle épinière Inserm U1127, CNRS U9225, Université Pierre et Marie Curie (UPMC-Paris 6), Paris, France
| | | | | | - Elsa Heyman
- ULR 7369 - Unité de Recherche Pluridisciplinaire Sport, Santé, Société, Université de Lille, LILLE, France
- Institut Universitaire de France, Paris, France
| | - Mathilde Plard
- Espace et Sociétés UMR 6590 CNRS, Université d'Angers, Angers, France
| | - Philippe Noirez
- Performance Santé Métrologie Société (EA7507), Université Reims Champagne Ardenne, Reims, France
| | | | | | - Anh Phong Nguyen
- La Clinique du Coureur, Lac Beauport, QC, Canada
- Neuromusculoskeletal Laboratory, Institut de Recherche Expérimentale et Clinique, Catholic University of Louvain, Louvain La Neuve, Belgium
| | - Joachim Van Cant
- La Clinique du Coureur, Lac Beauport, QC, Canada
- Department of Physical Therapy, Institut Parnasse-ISEI, Brussels, Belgium
| | | | | | | | - Stéphane Besnard
- Explorations Fonctionnelles Neurologiques, Centre Hospitalier Universitaire de Caen, Caen, France
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Hernández-Belmonte A, Martínez-Cava A, Pallarés JG. Pectoralis Cross-Sectional Area can be Accurately Measured using Panoramic Ultrasound: A Validity and Repeatability Study. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:460-468. [PMID: 34857426 DOI: 10.1016/j.ultrasmedbio.2021.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/13/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
The objective of the current study was to examine the validity and repeatability of panoramic ultrasound in evaluating the anatomical cross-sectional area (ACSA) of the pectoralis major. Specifically, we aimed to quantify the measurement errors generated during the image acquisition and analysis (repeatability), as well as when comparing with magnetic resonance imaging (MRI) (validity). Moreover, we aimed to analyze the influence of the operator's experience on these measurement errors. Both sides of the chest of 16 participants (n = 32) were included. Errors made by two operators (trained and novice) when measuring pectoralis major ACSA (50% of sternum-areola mammae distance) were examined. Acquisition errors included the comparison of two images acquired 5 min apart. Acquisition 1 was analyzed twice to quantify analysis errors. Thereafter, acquisition 1 was compared with MRI. Statistics include the standard error of measurement (SEM), expressed in absolute (cm2) and relative (%) terms as a coefficient of variation (CV), and the calculation of systematic bias. Errors made by the trained operator were lower than those made by the novice, especially during the image acquisition (SEM = 0.25 vs. 0.66 cm2, CV = 1.06 vs. 2.98%) and when compared with MRI (SEM = 0.27 vs. 1.90 cm2, CV = 1.13 vs. 8.16%). Furthermore, although both operators underestimated the ACSA, magnitude and variability [SD] of these errors were lower for the trained operator (bias = -0.19 [0.34] cm2) than for the novice (bias = -1.97 [2.59] cm2). Panoramic ultrasound is a valid and repeatable technique for measuring pectoralis major ACSA, especially when implemented by a trained operator.
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Affiliation(s)
| | - Alejandro Martínez-Cava
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | - Jesús G Pallarés
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain.
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Hernández-Belmonte A, Martínez-Cava A, Pallarés JG. Panoramic ultrasound requires a trained operator and specific evaluation sites to maximize its sensitivity: A comprehensive analysis of the measurement errors. Physiol Behav 2022; 248:113737. [PMID: 35150708 DOI: 10.1016/j.physbeh.2022.113737] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/08/2022] [Indexed: 01/07/2023]
Abstract
This study aimed to examine the validity and repeatability of panoramic ultrasound to evaluate the anatomical cross-sectional area (ACSA) of quadriceps femoris muscles. Specifically, we aimed to quantify the errors generated during the image acquisition and analysis (repeatability), as well as when comparing with magnetic resonance imaging (MRI) (validity). Moreover, we analyzed the influence of the operator's experience, and the region of the thigh, on these errors. Both thighs of 16 subjects were included. The validity and repeatability study quantified the errors made by two operators (trained and novice) when measuring ACSA of vastus lateralis (VL), vastus medialis-intermedius (VMVI), and rectus femoris (RF), in six thigh regions (from 20% to 70%). Two ACSA images were acquired 5 min apart to examine acquisition errors, whereas acquisition #1 was analyzed twice to quantify analysis errors. Thereafter, ACSA of acquisition #1 was compared with that measured by MRI. Statistics included the standard error of measurement (SEM) expressed in absolute (cm2) and relative terms (%) as a coefficient of variation (CV). Measurement errors were lower for the trained operator than for the novice: Acquisition (SEM = 0.05-0.78 vs. 0.25-1.42 cm2), analysis (SEM = 0.13-1.93 vs. 0.30-3.05 cm2) and compared-with-MRI (SEM = 0.13-1.93 vs. 0.30-3.05 cm2). Regions with the lowest errors were those located at the middle of the thigh (40-50%), although slight between-muscle differences were found: VMVI (30-40%), VL (40-50%), RF (50-60%). The accurate implementation of panoramic ultrasound to measure ACSA of quadriceps femoris muscles requires a trained operator and specific evaluation sites.
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Affiliation(s)
| | - Alejandro Martínez-Cava
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | - Jesús G Pallarés
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, Murcia, Spain.
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Fung HJ, Cheung AM, Mathur S, Szabo E, Wong AK. Validation of High-Resolution peripheral Quantitative Computed Tomography-Derived Achilles Tendon Properties Against Diagnostic Ultrasound. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2022; 22:203-211. [PMID: 35642700 PMCID: PMC9186460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES 1) To assess the precision of high resolution peripheral quantitative computed tomography (HR-pQCT)-derived Achilles tendon (AT) cross-sectional area (HR AT-CSA) and density, and 2) to validate HR AT-CSA against ultrasound-derived AT-CSA (US AT-CSA). METHODS Women and men (≥50 years) had HR-pQCT (0.082mm isotropic) and US scans (B-mode) performed on the non-dominant ankle. Linear regression and Bland-Altman analyses assessed systematic differences between HR-pQCT and US-derived AT-CSA. Precision measured by % root mean square coefficients of variation (%RMSCV) and agreement by type 2,1 intraclass correlation coefficients (ICC2,1), were determined for test-retest US AT-CSA scans, and analysis-reanalysis of 30 HR-pQCT and US images. RESULTS Among 44 participants, HR and US AT-CSA were strongly correlated (R2=0.84, p<0.01, B=1.05[0.90-1.19]), with no differences between modalities (p=0.37). Bland-Altman analysis revealed minimal systematic bias (-0.7mm2[-10.7-9.3]; 1.3%) between HR-pQCT and US-derived AT-CSA with smaller AT-CSA values showing larger inter-modality differences (R2=0.098, B=-0.137 [-0.268--0.008], p=0.039). US AT-CSA demonstrated excellent test-retest precision (ICC2,1=0.998, %RMSCV=1.04%). Analysis-reanalysis of HR-pQCT AT-density and both HR-pQCT and US AT-CSA displayed ICC2,1 above 0.95 and %RMSCV within 3%. CONCLUSION HR-pQCT can examine AT-morphometry with acceptable analytical precision. Future studies should explore these metrics' association with functional outcomes and ankle-bone structural and mechanical properties.
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Affiliation(s)
- Hugo J.W. Fung
- Department of Exercise Science, Faculty of Kinesiology and Physical Education, University of Toronto, Canada,Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada
| | - Angela M. Cheung
- Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada,Department of Medicine, University Health Network, Canada,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada,Osteoporosis Program, Schroeder’s Arthritis Institute, University Health Network
| | - Sunita Mathur
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada
| | - Eva Szabo
- Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada,Osteoporosis Program, Schroeder’s Arthritis Institute, University Health Network
| | - Andy K.O. Wong
- Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, ON, Canada,Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Canada,Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada,Osteoporosis Program, Schroeder’s Arthritis Institute, University Health Network,Corresponding author: Andy Kin On Wong, 200 Elizabeth St. Toronto General Hospital Research Institute , 7EN-238, Toronto, ON M5G 2C4, Canada E-mail:
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Validity and reliability of a novel 3D ultrasound approach to assess static lengths and the lengthening behavior of the gastrocnemius medialis muscle and the Achilles tendon in vivo. Knee Surg Sports Traumatol Arthrosc 2022; 30:4203-4213. [PMID: 35906410 PMCID: PMC9668947 DOI: 10.1007/s00167-022-07076-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Human muscle-tendon units (MTUs) are highly plastic and undergo changes in response to specific diseases and disorders. To investigate the pathological changes and the effects of therapeutic treatments, the use of valid and reliable examination methods is of crucial importance. Therefore, in this study, a simple 3D ultrasound approach was developed and evaluated with regard to: (1) its validity in comparison to magnetic resonance imaging (MRI) for the assessment of the gastrocnemius medialis (GM) MTU, muscle belly, and Achilles tendon lengths; and (2) its reliability for static and dynamic length measurements. METHODS Sixteen participants were included in the study. To evaluate the validity and reliability of the novel 3D ultrasound approach, two ultrasound measurement sessions and one MRI assessment were performed. By combining 2D ultrasound and 3D motion capture, the tissue lengths were assessed at a fixed ankle joint position and compared to the MRI measurements using Bland-Altman plots. The intra-rater and inter-rater reliability for the static and dynamic length assessments was determined using the coefficient of variation, standard error of measurement (SEM), minimal detectable change (MDC95), and intraclass correlation coefficient (ICC). RESULTS The 3D ultrasound approach slightly underestimated the length when compared with MRI by 0.7%, 1.5%, and 1.1% for the GM muscle belly, Achilles tendon, and MTU, respectively. The approach showed excellent intra-rater as well as inter-rater reliability, with high ICC (≥ 0.94), small SEM (≤ 1.3 mm), and good MDC95 (≤ 3.6 mm) values, with even better reliability found for the static length measurements. CONCLUSION The proposed 3D ultrasound approach was found to be valid and reliable for the assessment of the GM MTU, muscle belly, and Achilles tendon lengths, as well as the tissue lengthening behavior, confirming its potential as a useful tool for investigating the effects of training interventions or therapeutic treatments (e.g., surgery or conservative treatments such as stretching and orthotics). LEVEL OF EVIDENCE Level II.
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Rodriguez Sanz D, LOSA IGLESIAS MARTA, BECERRO DE BENGOA VALLEJO RICARDO, SORIANO MEDRANO ALFREDO, MORALES PONCE ANGEL, CALVO LOBO CESAR, San Antolin M, Ramirez Navarro PC, Garcia Garcia D. Actualización científica en ecografía y tendinopatía aquilea. Implicaciones anatómicas relacionadas, abordaje terapéutico y nuevas perspectivas basadas en la evidencia. REVISTA ESPAÑOLA DE PODOLOGÍA 2022. [DOI: 10.20986/revesppod.2022.1632/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Pentidis N, Mersmann F, Bohm S, Schroll A, Giannakou E, Aggelousis N, Arampatzis A. Development of Muscle-Tendon Adaptation in Preadolescent Gymnasts and Untrained Peers: A 12-Month Longitudinal Study. Med Sci Sports Exerc 2021; 53:2565-2576. [PMID: 34649260 DOI: 10.1249/mss.0000000000002742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The current study investigated the effects of long-term athletic training on the development of the triceps surae muscle-tendon unit in preadolescence. METHODS Eleven preadolescent untrained children and a group of 21 artistic gymnastics athletes of similar age (9 ± 1.7 yr) and maturity (Tanner stages I and II) participated in the study. The measurements were conducted every 3 months for 1 yr, and training volume and duration of the athletes were documented. Plantar flexor muscle strength, Achilles tendon stiffness, maximum tendon strain, and gastrocnemius medialis morphometrics were measured by integrating kinematics, ultrasonography, and dynamometry. A linear mixed-effects model was used to analyze the investigated parameters. RESULTS We found greater muscle strength (P < 0.001) in athletes compared with nonathletes but no differences in Achilles tendon stiffness (P = 0.252), indicating a training-induced imbalanced adaptation of muscle strength and tendon stiffness in preadolescent athletes. Although pennation angle (P = 0.490), thickness (P = 0.917), and fascicle length (P = 0.667) did not differ between groups, we found higher fluctuations in pennation angle and muscle strength over 1 yr in athletes. The imbalanced adaptation of muscle strength and tendon stiffness together with greater fluctuations of muscle strength resulted in greater tendon strain fluctuations over 1 yr (P = 0.017) and a higher frequency of athletes with high-level tendon strain (≥9%) compared with nonathletes. CONCLUSIONS The findings indicate an increased mechanical demand for the tendon in preadolescent athletes that could have implications for the risk of tendon overuse injury. Therefore, we recommend the implementation of individual training approaches to preserve a balanced adaptation within the triceps surae muscle-tendon unit in preadolescent athletes.
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Affiliation(s)
| | | | | | | | - Erasmia Giannakou
- Department of Physical Education and Sports Science, Democritus University of Thrace, Komotini, GREECE
| | - Nickos Aggelousis
- Department of Physical Education and Sports Science, Democritus University of Thrace, Komotini, GREECE
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11
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Ying J, Fekete G. Comparison Between Ultrasonography and Magnetic Resonance Imaging in Achilles Tendon. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: This study aims was to compared the effectiveness of Magnetic Resonance Imaging (MRI) and Ultrasonography (US) imaging techniques in the diagnosis of tendon pathology. Method: The databases search of PubMed, Scopus, and Embase extracted 567 articles for a title
and abstract review. After removing and evaluating, a total of 6 articles were collected. Results and conclusion: There are three views on the diagnosis of Achilles tendon (AT) by US and MRI: US has higher sensitivity and reliability than MRI; MRI is more effective than the US, and
there is a similar diagnosis result between US and MRI. It may not be necessary to distinguish between the diagnostic role of US and MRI, since US and MRI tools can be used as effective means to provide valuable information for the diagnosis and treatment of AT.
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Affiliation(s)
- Jianhua Ying
- College of Science & Technology, Ningbo University, Ningbo, 315300, China
| | - Gusztáv Fekete
- Savaria Institute of Technology, Eötvös Loránd University, Szombathely H-9700, Hungary
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12
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Cao S, Teng Z, Wang C, Zhou Q, Wang X, Ma X. Influence of Achilles tendon rupture site on surgical repair outcomes. J Orthop Surg (Hong Kong) 2021; 29:23094990211007616. [PMID: 33845659 DOI: 10.1177/23094990211007616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study aims to measure the distance between the common site of Achilles tendon rupture and calcaneal insertion through ultrasound and to compare the outcomes between proximal and distal rupture groups. METHODS We investigated the electronic medical records of 117 patients and preoperative ultrasound describing the rupture site. Among 88 patients, we compared the patient-reported outcome and re-rupture rate of proximal and distal rupture groups. RESULTS The mean rupture site of the 117 included subjects was 4.5 ± 1.3 cm. The rupture site had a weak negative correlation with body mass index (ρ = -0.230, P = 0.013). Furthermore, 77% of the patients with distal rupture reported good outcome (Achilles Tendon Rupture Score > 80) compared to 56% of the patients with proximal rupture (P = 0.041). CONCLUSION Patients with proximal rupture had less satisfactory postoperative outcomes than those with distal rupture.
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Affiliation(s)
- Shengxuan Cao
- Department of Orthopedics, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhaolin Teng
- Department of Orthopedics, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chen Wang
- Department of Orthopedics, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qian Zhou
- Department of Sonography, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xu Wang
- Department of Orthopedics, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xin Ma
- Department of Orthopedics, 159397Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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13
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Szaro P, Ghali Gataa K. The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging. Sci Rep 2021; 11:6131. [PMID: 33731785 PMCID: PMC7969943 DOI: 10.1038/s41598-021-85604-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
This comparative study aimed to investigate how tendinopathy-related lesions change correlations in the dimensions of the Achilles tendon. Our experimental group included 74 patients. The mean age was 52.9 ± 10.4 years. The control group included 81 patients with a mean age was 35.2 ± 13.6 years, p < .001. The most significant difference in correlation was the thickness of the tendon and the midportion's width, which was more significant in the tendinopathy (r = .49 vs. r = .01, p < .001). The correlation was positive between width and length of the insertion but negative in normal tendons (r = .21 vs. r = − .23, p < .001). The correlation was between the midportions width in tendinopathy and the tendon's length but negative in the normal tendon (r = .16 vs. r = − .23, p < .001). The average thickness of the midportion in tendinopathy was 11.2 ± 3.3 mm, and 4.9 ± 0.5 mm in the control group, p < .001. The average width of the midportion and insertion was more extensive in the experimental group, 17.2 ± 3.1 mm vs. 14.7 ± 1.8 mm for the midportion and 31.0 ± 3.9 mm vs. 25.7 ± 3.0 mm for insertion, respectively, p < .001. The tendon's average length was longer in tendinopathy (83.5 ± 19.3 mm vs. 61.5 ± 14.4 mm, p < .001). The dimensions correlations in normal Achilles tendon and tendinopathic tendon differ significantly.
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Affiliation(s)
- Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.
| | - Khaldun Ghali Gataa
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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14
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Merza E, Pearson S, Lichtwark G, Ollason M, Malliaras P. Immediate and long-term effects of mechanical loading on Achilles tendon volume: A systematic review and meta-analysis. J Biomech 2021; 118:110289. [PMID: 33556887 DOI: 10.1016/j.jbiomech.2021.110289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 01/07/2023]
Abstract
The Achilles tendon (AT) may experience changes in dimensions related to fluid flow under load. The extent to which fluid flow involves redistribution within or flow out of the tendon is not known and could be determined by investigating volume changes. This study aimed to synthesize data on immediate and long-term effects of loading on tendon volume among people with a healthy AT and midportion Achilles tendinopathy (MAT). A secondary aim was to synthesise data from the included studies investigating parallel change in cross-sectional area and length. Systematic electronic search was performed in MEDLINE, EMBASE, CINAHL, AMED, and Scopus from inception until May 2020. Standardized mean differences (SMDs) were calculated for intervention-induced changes from baseline for all outcomes. Methodological quality was assessed using modified version of Newcastle Ottawa Scale (NOS). Twelve studies were included in meta-analysis. For healthy AT, there were negligible to small changes in volume following cross-country running (-0.33 [95% CI = -1.11 to 0.45] (P = 0.41)) and isometric exercise (0.01 [95% CI = -0.54 to 0.55] (P = 0.98)) and a large increase at the short-term with 12-week isometric protocol (0.88 [95% CI = -0.10 to1.86] (P = 0.08)). For MAT, there was an immediate large reduction in volume with isometric exercise (-1.24 [95% CI = -1.93 to -0.55] (P = 0.0004)), small increase with eccentric exercise (0.41 [95% CI = -0.18 to 1.01](P = 0.18)) and small reduction at the short-term with long-term interventions (-0.46 [95% CI = -0.87 to -0.05] (P = 0.03)). This meta-analysis suggests that healthy AT remain isovolumetric with acute interventions while MAT exhibit immediate and short-term volume reductions in response to different interventions.
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Affiliation(s)
- Eman Merza
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Vic 3199, Melbourne, Australia.
| | - Stephen Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Greater Manchester M5 4WT, United Kingdom.
| | - Glen Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD 4072, Brisbane, Australia.
| | - Meg Ollason
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Vic 3800, Melbourne, Australia.
| | - Peter Malliaras
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Vic 3199, Melbourne, Australia.
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15
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Ge X, Zhang L, Xiang G, Hu Y, Lun D. Cross-Sectional Area Measurement Techniques of Soft Tissue: A Literature Review. Orthop Surg 2020; 12:1547-1566. [PMID: 32930465 PMCID: PMC7767688 DOI: 10.1111/os.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023] Open
Abstract
Evaluation of the biomechanical properties of soft tissues by measuring the stress-strain relationships has been the focus of numerous investigations. The accuracy of stress depends, in part, upon the determination of the cross-sectional area (CSA). However, the complex geometry and pliability of soft tissues, especially ligaments and tendons, make it difficult to obtain accurate CSA, and the development of CSA measurement methods of soft tissues continues. Early attempts to determine the CSA of soft tissues include gravimetric method, geometric approximation technique, area micrometer method, and microtomy technique. Since 1990, a series of new methods have emerged, including medical imaging techniques (e.g. magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging (USI)), laser techniques (e.g. the laser micrometer method, the linear laser scanner (LLS) technique, and the laser reflection system (LRS) method), molding techniques, and three-dimensional (3D) scanning techniques.
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Affiliation(s)
- Xiao‐jing Ge
- Beijing Wonderful Biomaterials Co., Ltd.BeijingChina
| | - Lei Zhang
- Beijing Wonderful Biomaterials Co., Ltd.BeijingChina
| | - Gang Xiang
- Beijing Wonderful Biomaterials Co., Ltd.BeijingChina
| | | | - Deng‐xing Lun
- Beijing Ceramic BiotechnologyBeijingChina
- Weifang People's HospitalWeifangChina
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16
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Achilles Tendon Length Is Not Related to 100-m Sprint Time in Sprinters. J Appl Biomech 2020; 37:30-35. [PMID: 33176276 DOI: 10.1123/jab.2020-0125] [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: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/19/2020] [Indexed: 11/18/2022]
Abstract
This study examined the relationship between Achilles tendon (AT) length and 100-m sprint time in sprinters. The AT lengths at 3 different portions of the triceps surae muscle in 48 well-trained sprinters were measured using magnetic resonance imaging. The 3 AT lengths were calculated as the distance from the calcaneal tuberosity to the muscle-tendon junction of the soleus, gastrocnemius medialis, and gastrocnemius lateralis, respectively. The absolute 3 AT lengths did not correlate significantly with personal best 100-m sprint time (r = -.023 to .064, all Ps > .05). Furthermore, to minimize the differences in the leg length among participants, the 3 AT lengths were normalized to the shank length, and the relative 3 AT lengths did not correlate significantly with personal best 100-m sprint time (r = .023 to .102, all Ps > .05). Additionally, no significant correlations were observed between the absolute and relative (normalized to body mass) cross-sectional areas of the AT and personal best 100-m sprint time (r = .012 and .084, respectively, both Ps > .05). These findings suggest that the AT morphological variables, including the length, may not be related to superior 100-m sprint time in sprinters.
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17
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Aufwerber S, Edman G, Grävare Silbernagel K, Ackermann PW. Changes in Tendon Elongation and Muscle Atrophy Over Time After Achilles Tendon Rupture Repair: A Prospective Cohort Study on the Effects of Early Functional Mobilization. Am J Sports Med 2020; 48:3296-3305. [PMID: 32986466 DOI: 10.1177/0363546520956677] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Early functional mobilization (EFM) may improve patient outcome after Achilles tendon rupture (ATR). However, whether EFM affects patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy is unknown. PURPOSE To analyze differences in tendon and muscle morphology recovery over time between groups treated with EFM or standard treatment after ATR repair. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS This prospective cohort study included 86 patients (20 women) with ATR repair who had a mean (SD) age of 39.3 (8.2) years and were part of a larger prospective randomized controlled trial. Patients were postoperatively randomized to immediate postoperative weightbearing and ankle motion (EFM group) or to immobilization in a below-knee plaster cast for 2 weeks (control group). Patient-reported and functional outcomes were assessed at 6 and 12 months with the Achilles Tendon Total Rupture Score and the heel-rise test for endurance. At 2 and 6 weeks and 6 and 12 months postoperatively, B-mode ultrasound imaging was performed to assess the length and cross-sectional area (CSA) of the Achilles tendon, the gastrocnemius CSA, as well as the thickness of soleus. RESULTS The Achilles Tendon Total Rupture Score for the EFM and control groups were 65.8 (18.7) and 56.8 (20.1; P = .045), respectively, at 6 months and 79.6 (15.8) and 78.9 (17.2; P = .87), respectively, at 12 months. At 2 weeks, tendon elongation was significantly more pronounced in the EFM group as compared with the control group (mean side-to-side difference, 1.88 cm vs 0.71 cm; P = .005). Subsequently, tendon elongation increased in the control group while it decreased in the EFM group so that at 6 and 12 months no significant differences between groups were found. Mean Achilles tendon elongation at 1 year was 1.73 (1.07) cm for the EFM group (n = 55) and 1.67 (0.92) cm for the control group (n = 27), with a mean difference of 0.06 cm (95% CI, 0.54 to -0.42; P = .80). Achilles tendon CSA and calf muscle atrophy displayed no significant differences between the groups; however, significant changes were demonstrated over time (P ≤ .001) in both groups. CONCLUSION EFM results in more Achilles tendon elongation at early healing, but this difference subsides over time. EFM does not seem to affect patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy. REGISTRATION NCT02318472 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Susanna Aufwerber
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Occupational Therapy and Physiotherapy, Function Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Edman
- R&D, Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden
- Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden
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18
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Mersmann F, Laube G, Bohm S, Arampatzis A. Muscle and Tendon Morphology in Early-Adolescent Athletes and Untrained Peers. Front Physiol 2020; 11:1029. [PMID: 32973557 PMCID: PMC7472460 DOI: 10.3389/fphys.2020.01029] [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: 05/15/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Adolescent athletes can feature significantly greater muscle strength and tendon stiffness compared to untrained peers. However, to date, it is widely unclear if radial muscle and tendon hypertrophy may contribute to loading-induced adaptation at this stage of maturation. The present study compares the morphology of the vastus lateralis (VL) and the patellar tendon between early-adolescent athletes and untrained peers. In 14 male elite athletes (A) and 10 untrained controls (UC; 12–14 years of age), the VL was reconstructed from full muscle segmentations of magnetic resonance imaging (MRI) sequences and ultrasound imaging was used to measure VL fascicle length and pennation angle. The physiological cross-sectional area (PCSA) of the VL was calculated by dividing muscle volume by fascicle length. The cross-sectional area (CSA) of the patellar tendon was measured over its length based on MRI segmentations as well. Considering body mass as covariate in the analysis, there were no significant differences between groups considering the VL anatomical cross-sectional area (ACSA) over its length or maximum ACSA (UC: 24.0 ± 8.3 cm2, A: 28.1 ± 5.3 cm2, p > 0.05), yet athletes had significantly greater VL volume (UC: 440 ± 147 cm3, A: 589 ± 121 cm3), PCSA (UC: 31 ± 9 cm2, A: 46 ± 9 cm2), pennation angle (UC: 8.2 ± 1.4°, A: 10.1 ± 1.3°), and average patellar tendon CSA (UC: 1.01 ± 0.18 cm2, A: 1.21 ± 0.18 cm2) compared to the untrained peers (p < 0.05). However, the ratio of average tendon CSA to VL PCSA was significantly lower in athletes (UC: 3.4 ± 0.1%, A: 2.7 ± 0.5%; p < 0.05). When inferring effects of athletic training based on the observed differences between groups, these results suggest that both muscle and tendon of the knee extensors respond to athletic training with radial growth. However, the effect seems to be stronger in the muscle compared to the tendon, with an increase of pennation angle contributing to the marked increase of muscle PCSA. A disproportionate response to athletic training might be associated with imbalances of muscle strength and tendon stiffness and could have implications for the disposition towards tendon overuse injury.
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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, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gunnar Laube
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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19
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Mogi Y. The effects of growth on structural properties of the Achilles and Patellar tendons: A cross-sectional study. Physiol Rep 2020; 8:e14544. [PMID: 32812369 PMCID: PMC7435028 DOI: 10.14814/phy2.14544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study was to investigate the structural properties (length and cross-sectional area) of both the Patellar and Achilles tendons at around adolescent growth spurt. One hundred-twenty children and adolescents participated in this study. Based on estimated age at peak height velocity, the participants were separated into three groups (before takeoff of adolescent growth spurt group, from takeoff of adolescent growth spurt until peak height velocity group and after peak height velocity group). An ultrasonography technique was used to determine structural properties of the Patellar and Achilles tendons. Significant group difference was observed in tendon length for the Patellar and Achilles tendons among groups. However, there were no significant differences in the ratio of the Patellar tendon to upper leg length and the ratio of the Achilles tendon to lower leg length among groups. The cross-sectional area of all regions for the Patellar and Achilles tendons in adolescents with after takeoff adolescent growth spurt group was greater than those of before takeoff adolescent growth spurt group. These results indicate that the cross-sectional area of both the Patellar and Achilles tendons increase with takeoff of adolescent growth spurt and tendons lengthen without the changes in the ratio of tendon length to bone length. In addition, the increases in the cross-sectional area of both the Patellar and Achilles tendons occur in whole regions but not specific regions.
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Affiliation(s)
- Yasuyoshi Mogi
- Faculty of Policy ManagementDepartment of Human Life ManagementShobi UniversityKawagoeJapan
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20
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Romero-Morales C, Bravo-Aguilar M, Ruiz-Ruiz B, Almazán-Polo J, López-López D, Blanco-Morales M, Téllez-González P, Calvo-Lobo C. Current advances and research in ultrasound imaging to the assessment and management of musculoskeletal disorders. Dis Mon 2020; 67:101050. [PMID: 32711897 DOI: 10.1016/j.disamonth.2020.101050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Currently evidence-based practice has given scientific weight to the physical therapist profession; it is essential that all medical professional and physical therapists know the usefulness of new tools that optimize the effectiveness of their interventions and allow the growing of the scientific knowledge base. The use of ultrasound imaging (USI) by physiotherapists has evolved in recent years, consolidating as an increasingly standardized technique, low cost compared to other imaging techniques, quickly of execution, feasible and reliable tool. USI offers a wide range of opportunities in clinical practice as well as in different research areas. Therefore, ultrasound has been currently used as a diagnostic tool by physicians and in recent years there has been an expansion of the use of ultrasound equipment by non-physicians professionals such as physical therapist or physical trainers, who incorporates USI as a means of assessing musculoskeletal system architecture and composition, musculoskeletal changes in dysfunction, pain or injury conditions, as an interventional technique assisting echo-guided procedures or using the visual real-time information as a biofeedback in control motor approaches, as guiding tool in clinical decisions as well as to improve the understanding of tissue adaptations to exercise or movement. The purpose of this article is to review and provide an overview about the currently research of the USI applications and their benefits for the diagnosis and management in individuals with musculoskeletal conditions.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - María Bravo-Aguilar
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Beatriz Ruiz-Ruiz
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403, Ferrol, Spain
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403, Ferrol, Spain.
| | - María Blanco-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - Patricia Téllez-González
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670, Madrid, Spain
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040, Madrid, Spain
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21
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Kositsky A, Gonçalves BAM, Stenroth L, Barrett RS, Diamond LE, Saxby DJ. Reliability and Validity of Ultrasonography for Measurement of Hamstring Muscle and Tendon Cross-Sectional Area. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:55-63. [PMID: 31668942 DOI: 10.1016/j.ultrasmedbio.2019.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/15/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to determine the reliability and validity of ultrasonography for measurement of hamstring muscle and semitendinosus (ST) tendon cross-sectional area (CSA). On two consecutive days, muscle anatomical CSA (ACSA) and ST tendon CSA were measured at standardized positions (30%-80% of thigh length; half the distance from the distal muscle-tendon junction to the popliteal crease) on 12 legs using ultrasonography and compared with corresponding magnetic resonance imaging measures. Inter-day intraclass correlation coefficients were good-to-excellent (0.882-0.996) for all assessed muscle and tendon sites. The limits of agreement widths were narrowest (range: 17%-52%) when muscle ACSA was large but were wide at sites with relatively small ACSA (≤184%) and for ST tendon CSA (range: 72%). Results suggest ultrasound-based measures of individual hamstring muscle maximal ACSA are reliable and valid and ST tendon CSA measures are reliable but require comparison with cadaveric or intra-operative measurements to verify validity.
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Affiliation(s)
- Adam Kositsky
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Basílio A M Gonçalves
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Rod S Barrett
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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22
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Stenroth L, Sefa S, Arokoski J, Töyräs J. Does Magnetic Resonance Imaging Provide Superior Reliability for Achilles and Patellar Tendon Cross-Sectional Area Measurements Compared with Ultrasound Imaging? ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3186-3198. [PMID: 31493954 DOI: 10.1016/j.ultrasmedbio.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
This study investigated the reliability of Achilles and patellar tendon cross-sectional area (CSA) measurement using ultrasound imaging (USI) and magnetic resonance imaging (MRI). Fifteen healthy adults were imaged twice on two occasions, interrupted by a tendon loading protocol. Tendon CSA segmentations were conducted by an experienced and an inexperienced rater blinded to information regarding subject, session and loading status. USI provided good test-retest reliability (intra-class correlation coefficient [ICC] 2,1 > 0.85, standard error of measurement [SEM] 5%-6%), while with MRI it was excellent (ICC 2,1 > 0.92, SEM 4%) for the experienced rater. This study suggests that MRI provides superior reliability for tendon CSA measurements compared with USI. However, the difference in reliability between the methods was small, and the results were inconclusive regarding objectivity and sensitivity to change when assessed based on the effect of loading. We concluded that both methods can be used for reliable CSA measurements of the Achilles and patellar tendons when using a highly standardized measurement protocol and when conducted by an experienced rater.
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Affiliation(s)
- Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Sandra Sefa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Jari Arokoski
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
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A clinically applicable tool for rapidly estimating muscle volume using ultrasound images. Eur J Appl Physiol 2019; 119:2685-2699. [PMID: 31654124 PMCID: PMC6858406 DOI: 10.1007/s00421-019-04242-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/10/2019] [Indexed: 11/03/2022]
Abstract
Purpose This study aimed to identify a safe, rapid, and accessible method of estimating muscle volume of key lower limb muscle groups to reduce the time-demand of acquiring this measurement and potentially facilitate its application as a clinical monitoring tool. Methods Unilateral MRI images were acquired from the 12th thoracic vertebrae to the base of the foot in 18 recreationally active males. Panoramic B-mode ultrasound images were acquired from the same leg at the mid-hip, 25%, 50%, and 75% of thigh length, and 25% of shank length. Body mass, height, limb lengths, and circumferences at the sites corresponding to the ultrasound images were acquired. A single investigator manually analysed all images. Regression analyses were conducted to identify models for estimating volume of the hip extensor, knee extensor and flexor, and ankle plantarflexor muscle groups. Results Models were developed for estimating hip extensor (SEE = 8.92%, R2 = 0.690), knee extensor (SEE = 5.24%, R2 = 0.707) and flexor (SEE = 7.89%, R2 = 0.357), and ankle plantarflexor (SEE = 10.78%, R2 = 0.387) muscle group volumes. The hip and knee extensor models showed good potential for generalisation. Systematic error was observed for the knee flexor and ankle plantarflexor models. Conclusions Hip extensor, knee extensor and flexor, and ankle plantarflexor muscle group volumes can be estimated using B-mode ultrasound images and anthropometric measurements. The error shown for each of the models was sufficient to identify previously reported differences in muscle volume due to training or injury, supporting their clinical application.
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The Effect of Functional Home-Based Strength Training Programs on the Mechano-Morphological Properties of the Plantar Flexor Muscle-Tendon Unit in Children With Spastic Cerebral Palsy. Pediatr Exerc Sci 2019; 31:67-76. [PMID: 30424684 DOI: 10.1123/pes.2018-0106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effects of functional progressive resistance training (PRT) and high-intensity circuit training (HICT) on the mechano-morphological properties of the plantar flexor muscle-tendon unit in children with spastic cerebral palsy. METHODS Twenty-two children (12.8 [2.6] y old, Gross Motor Function Classification System levels I/II = 19/3) were randomly assigned to either a PRT group or an HICT group. The interventions consisted of functional lower limb exercises, which were performed at home 3 times per week for 8 weeks. Measurements at baseline, preintervention, postintervention, and follow-up were taken to assess ankle joint range of motion and the properties of the gastrocnemius medialis, vastus lateralis, rectus femoris, and Achilles tendon (eg, thickness, strength, stiffness). RESULTS Despite a nonsignificant increase in active torque in the HICT group, neither gastrocnemius medialis morphology nor Achilles tendon properties were significantly altered after the interventions. Vastus lateralis thickness increased following PRT only. CONCLUSIONS Functional home-based strength training did not lead to significant changes at the muscular level in children with cerebral palsy. We therefore assume that a more specific stimulus of higher intensity combined with a longer training duration might be necessary to evoke changes in muscles and tendons in individuals with cerebral palsy.
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Hayes A, Easton K, Devanaboyina PT, Wu JP, Kirk TB, Lloyd D. A review of methods to measure tendon dimensions. J Orthop Surg Res 2019; 14:18. [PMID: 30636623 PMCID: PMC6330756 DOI: 10.1186/s13018-018-1056-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Tendons are soft tissues of the musculoskeletal system that are designed to facilitate joint movement. Tendons exhibit a wide range of mechanical properties matched to their functions and, as a result, have been of interest to researchers for many decades. Dimensions are an important aspect of tendon properties. Change in the dimensions of tissues is often seen as a sign of injury and degeneration, as it may suggest inflammation or general disorder of the tissue. Dimensions are also important for determining the mechanical properties and behaviours of materials, particularly the stress, strain, and elastic modulus. This makes the dimensions significant in the context of a mechanical study of degenerated tendons. Additionally, tendon dimensions are useful in planning harvesting for tendon transfer and joint reconstruction purposes. Historically, many methods have been used in an attempt to accurately measure the dimensions of soft tissue, since improper measurement can lead to large errors in the calculated properties. These methods can be categorised as destructive (by approximation), contact, and non-contact and can be considered in terms of in vivo and ex vivo.
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Affiliation(s)
- Alex Hayes
- Department of Mechanical Engineering, Curtin University of Technology, Perth, Western Australia, Australia. .,Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, Australia.
| | | | - Pavan Teja Devanaboyina
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jian-Ping Wu
- Academy of Advanced Interdisciplinary Studies and the Department of Biomedical Engineering of Southern University of Science and Technology, No 1088, Xueyaun Rd, Xili, Nanshan District, Shenzhen City, 518055, Guangdong Province, China
| | - Thomas Brett Kirk
- Department of Mechanical Engineering, Curtin University of Technology, Perth, Western Australia, Australia.,Faculty of Science and Engineering, Curtin University of Technology, Perth, Western Australia, Australia
| | - David Lloyd
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Ernat JJ, Johnson JD, Anderson CD, Ryan PM, Yim DG. Does Clinical Exam and Ultrasound Compare With MRI Findings When Assessing Tendon Approximation in Acute Achilles Tendon Tears? A Clinical Study. J Foot Ankle Surg 2019; 58:161-164. [PMID: 30314935 DOI: 10.1053/j.jfas.2018.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine if clinical palpation and ultrasound determination of apposition compares with magnetic resonance imaging (MRI) findings in patients with an acute Achilles tendon rupture. A review of 18 consecutive patients presenting with an acute Achilles tendon tear was performed. All tears were diagnosed by clinical exam and confirmed by ultrasound. Ankles were then plantarflexed to a point where tendon apposition was achieved as determined by palpation and ultrasound. Dorsally based equinus splints were applied, and approximation was reconfirmed by palpation and ultrasound. MRI was performed on all patients for comparison to the exam/ultrasound for any residual gapping after splinting. Demographic and clinical comparisons were made between those with <0.5 cm and ≥0.5 cm of residual gapping found on MRI. Eighteen patients with acute Achilles tears were splinted at a mean of 41° ± 11°, with presumed, complete tendon approximation confirmed with palpation and ultrasound. Post-splinting MRI demonstrated that 9/18 (50%) of these patients had residual gapping at a mean of 2.2 ± 1 cm. Mean time to MRI from splinting was not different between those with gapping (1.3 ± 2 days) and those without (1.2 ± 1 days). No other clinical or demographic differences were observed between these groups. In conclusion, clinical exam and ultrasound did not routinely relate to MRI in assessing tendon approximation after splinting of an acute Achilles tendon tear. For surgeons who use approximation as a determination of nonoperative treatment, varying results can be obtained depending on the clinical utility used.
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Affiliation(s)
- Justin J Ernat
- Orthopedic Surgeon, Blanchfield Army Community Hospital, Fort Campbell, KY.
| | - John D Johnson
- Orthopedic Surgery Resident, Tripler Army Medical Center, Honolulu, HI
| | | | - Paul M Ryan
- Orthopedic Surgeon, Tripler Army Medical Center, Honolulu, HI
| | - Duke G Yim
- Orthopedic Surgeon, Tripler Army Medical Center, Honolulu, HI
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Thoirs KA, Childs J. Are Ultrasound Measurements of Achilles Tendon Size Reliable? A Systematic Review of Rater Reliability. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2476-2491. [PMID: 30154035 DOI: 10.1016/j.ultrasmedbio.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/04/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound measurements of Achilles tendon size are used to assess the tendon's response to exercise, aging, rehabilitation, tendon loading and healing. It is important to understand and minimise the measurement error that occurs with these measurements. This review identified and synthesised studies reporting on intra- and inter-rater reliability of ultrasound measurements of Achilles tendon size. Analysis of 21 studies revealed that good to excellent intra- and inter-rater reliability can be achieved for ultrasound measurements of Achilles tendon size. Reliability can be optimised by using one experienced operator, standardising transducer pressure and orientation and averaging two or three measurements. There was a high risk of methodological bias across the included studies. Reporting of reliability studies needs to be improved by the use of existing reporting guidelines and expansion of these guidelines to include important elements of ultrasound imaging.
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Affiliation(s)
- Kerry A Thoirs
- International Centre of Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia 5001, Australia.
| | - Jessie Childs
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001, Australia
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28
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Patel NN, Labib SA. The Achilles Tendon in Healthy Subjects: An Anthropometric and Ultrasound Mapping Study. J Foot Ankle Surg 2018; 57:285-288. [PMID: 29275904 DOI: 10.1053/j.jfas.2017.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 02/03/2023]
Abstract
Ultrasonography is an inexpensive, fast, and reliable imaging technique widely used to assess the Achilles tendon. Although significant data exists regarding pathologic tendon changes, ultrasound data from healthy individuals are more limited. We aimed to better characterize ultrasound Achilles tendon measurements in healthy individuals and identify important correlating factors. The information collected included patient demographics, body habitus, activity level, foot dominance, and resting ankle angle. Ultrasound analysis was performed bilaterally on the Achilles tendons of 50 subjects using a high-frequency transducer to measure tendon width, thickness, cross-sectional area, and length. Males had a significantly larger mean tendon length, width, thickness, and cross-sectional area. No statistically significant difference was found in any tendon dimension between the white and black participants. Similarly, no difference was found in any tendon parameter when comparing right versus left leg dominance. Healthy subjects had a mean ankle resting angle of 45.1° ± 24° with no statistically significant difference between right and left ankles. Considering all individuals, each tendon parameter (tendon length, width, thickness, and cross-sectional area) correlated positively with subject height, weight, tibia length, and foot size. Only the Achilles cross-sectional area correlated significantly with the activity level. The resting angle of the ankle correlated positively with both tendon length and thickness. In conclusion, we found significant variations in Achilles tendon anatomy in the healthy adult population. We have thoroughly characterized significant correlations between healthy tendon dimensions and various body habitus, activity levels, and ankle parameters. Greater knowledge of the normal Achilles tendon anatomy and characterization of its variations in the healthy population will potentially allow for better pathologic diagnosis and surgical repair.
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Affiliation(s)
- Nick N Patel
- Resident Physician, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Sameh A Labib
- Associate Professor, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA
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Kruse A, Schranz C, Tilp M, Svehlik M. Muscle and tendon morphology alterations in children and adolescents with mild forms of spastic cerebral palsy. BMC Pediatr 2018; 18:156. [PMID: 29743109 PMCID: PMC5941654 DOI: 10.1186/s12887-018-1129-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/30/2018] [Indexed: 11/18/2022] Open
Abstract
Background Early detection of changes at the muscular level before a contracture develops is important to gain knowledge about the development of deformities in individuals with spasticity. However, little information is available about muscle morphology in children with spastic diplegic cerebral palsy (CP) without contracture or equinus gait. Therefore, the aim of this study was to compare the gastrocnemius medialis (GM) and Achilles tendon architecture of children and adolescents with spastic CP without contracture or equinus gait to that of typically developing (TD) children. Methods Two-dimensional ultrasonography was used to assess the morphological properties of the GM muscle and Achilles tendon in 10 children with spastic diplegic CP (Gross Motor Function Classification System level I–II) and 12 TD children (mean age 12.0 (2.8) and 11.3 (2.5) years, respectively). The children with CP were not restricted in the performance of daily tasks, and therefore had a high functional capacity. Mean muscle and tendon parameters were statistically compared (independent t-tests or Mann-Whitney U-tests). Results When normalized to lower leg length, muscle-tendon unit length and GM muscle belly length were found to be significantly shorter (p < 0.05, effect size (ES) = 1.00 and 0.98, respectively) in the children with spastic CP. Furthermore, there was a tendency for increased Achilles tendon length when expressed as a percentage of muscle-tendon unit length (p = 0.08, ES = − 0.80) in the individuals with CP. This group also showed shorter muscle fascicles (3.4 cm vs. 4.4 cm, p < 0.01, ES = 1.12) and increased fascicle pennation angle (21.9° vs. 18.1°, p < 0.01, ES = − 1.36, respectively). However, muscle thickness and Achilles tendon cross-sectional area did not differ between groups. Resting ankle joint angle was significantly more plantar flexed (− 26.2° vs. − 20.8°, p < 0.05, ES = 1.06) in the children with CP. Conclusions Morphological alterations of the plantar flexor muscle-tendon unit are also present in children and adolescents with mild forms of spastic CP. These alterations may contribute to functional deficits such as muscle weakness, and therefore have to be considered in the clinical decision-making process, as well as in the selection of therapeutic interventions.
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Affiliation(s)
- Annika Kruse
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Christian Schranz
- Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
| | - Markus Tilp
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria.
| | - Martin Svehlik
- Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria
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30
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Jensen JK, Nygaard RH, Svensson RB, Hove HD, Magnusson SP, Kjær M, Couppé C. Biomechanical properties of the patellar tendon in children with heritable connective tissue disorders. Eur J Appl Physiol 2018; 118:1301-1307. [PMID: 29623400 DOI: 10.1007/s00421-018-3862-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/26/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Hereditary connective tissue disorders (HCTDs), such as classic Ehlers-Danlos syndrome (cEDS) and Marfan syndrome (MS) share overlapping features like hypermobility and tissue fragility. In clinical practice it remains a challenge to distinguish children and adolescents with HCTD from healthy children. The purpose of this study was to investigate the biomechanical properties of the patellar tendon and joint laxity (Beighton score) in children with HCTDs (n = 7) compared to healthy controls (n = 14). METHODS The mechanical properties of the patellar tendon were assessed using simultaneous force and ultrasonographic measurements during isometric ramp contractions. Ultrasonography was also used to measure tendon dimensions. The HCTD children were matched with 2 healthy controls with regard to age, body mass index (BMI), sex and physical activity level. RESULTS The HCTD children had a greater degree of joint laxity (P < 0.01). Although, the patellar tendon dimensions did not differ significantly between the two groups, the HCTD children showed a tendency toward a larger patellar tendon cross-sectional area (CSA) (35%, P = 0.19). Moreover, stiffness did not differ between the two groups, but secant modulus was 27% lower in children with a HCTD (P = 0.05) at common force and 34% lower at maximum force (P = 0.02). CONCLUSIONS The present study demonstrates for the first time that children with HCTDs have lower material properties (modulus) of their patellar tendon, which may be indicative of general impairment of connective tissue mechanics related to their increased joint laxity.
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Affiliation(s)
- Jacob K Jensen
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
| | - Rie H Nygaard
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Hanne D Hove
- Section of Rare Diseases, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Raredis Database, Department of Clinical Genetics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
- Department of Occupational and Physical Therapy, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjær
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Christian Couppé
- Institute of Sports Medicine, Department of Orthopaedic Surgery M, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
- Department of Occupational and Physical Therapy, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Massey GJ, Balshaw TG, Maden-Wilkinson TM, Folland JP. Tendinous tissue properties after short- and long-term functional overload: Differences between controls, 12 weeks and 4 years of resistance training. Acta Physiol (Oxf) 2018; 222:e13019. [PMID: 29253326 DOI: 10.1111/apha.13019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/27/2017] [Accepted: 12/08/2017] [Indexed: 01/20/2023]
Abstract
AIM The potential for tendinous tissues to adapt to functional overload, especially after several years of exposure to heavy-resistance training, is largely unexplored. This study compared the morphological and mechanical characteristics of the patellar tendon and knee extensor tendon-aponeurosis complex between young men exposed to long-term (4 years; n = 16), short-term (12 weeks; n = 15) and no (untrained controls; n = 39) functional overload in the form of heavy-resistance training. METHODS Patellar tendon cross-sectional area, vastus lateralis aponeurosis area and quadriceps femoris volume, plus patellar tendon stiffness and Young's modulus, and tendon-aponeurosis complex stiffness, were quantified with MRI, dynamometry and ultrasonography. RESULTS As expected, long-term trained had greater muscle strength and volume (+58% and +56% vs untrained, both P < .001), as well as a greater aponeurosis area (+17% vs untrained, P < .01), but tendon cross-sectional area (mean and regional) was not different between groups. Only long-term trained had reduced patellar tendon elongation/strain over the whole force/stress range, whilst both short-term and long-term overload groups had similarly greater stiffness/Young's modulus at high force/stress (short-term +25/22%, and long-term +17/23% vs untrained; all P < .05). Tendon-aponeurosis complex stiffness was not different between groups (ANOVA, P = .149). CONCLUSION Despite large differences in muscle strength and size, years of resistance training did not induce tendon hypertrophy. Both short-term and long-term overload demonstrated similar increases in high-force mechanical and material stiffness, but reduced elongation/strain over the whole force/stress range occurred only after years of overload, indicating a force/strain specific time-course to these adaptations.
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Affiliation(s)
- G. J. Massey
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis; Loughborough University; Leicestershire UK
- School of Sport, Exercise, and Health Sciences; Loughborough University; Leicestershire UK
| | - T. G. Balshaw
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis; Loughborough University; Leicestershire UK
- School of Sport, Exercise, and Health Sciences; Loughborough University; Leicestershire UK
| | - T. M. Maden-Wilkinson
- School of Sport, Exercise, and Health Sciences; Loughborough University; Leicestershire UK
- Faculty of Health and Wellbeing; Sheffield Hallam University; Sheffield UK
| | - J. P. Folland
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis; Loughborough University; Leicestershire UK
- School of Sport, Exercise, and Health Sciences; Loughborough University; Leicestershire UK
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Eriksen CS, Henkel C, Svensson RB, Agergaard AS, Couppé C, Kjaer M, Magnusson SP. Lower tendon stiffness in very old compared with old individuals is unaffected by short-term resistance training of skeletal muscle. J Appl Physiol (1985) 2018; 125:205-214. [PMID: 29596014 DOI: 10.1152/japplphysiol.00028.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aging negatively affects collagen-rich tissue, like tendons, but in vivo tendon mechanical properties and the influence of physical activity after the 8th decade of life remain to be determined. This study aimed to compare in vivo patellar tendon mechanical properties in moderately old (old) and very old adults and the effect of short-term resistance training. Twenty old (9 women, 11 men, >65 yr) and 30 very old (11 women, 19 men, >83 yr) adults were randomly allocated to heavy resistance training (HRT) or no training (CON) and underwent testing of in vivo patellar tendon (PT) mechanical properties and PT dimensions before and after a 3-mo intervention. Previous measurements of muscle properties, blood parameters, and physical activity level were included in the analysis. Data from 9 old HRT, 10 old CON, 14 very old CON, and 12 old HRT adults were analyzed. In addition to lower quadriceps muscle strength and cross-sectional area (CSA), we found lower PT stiffness and Young's modulus ( P < 0.001) and a trend toward the lower mid-portion PT-CSA ( P = 0.09) in very old compared with old subjects. Daily step count was also lower in very old subjects ( P < 0.001). Resistance training improved muscle strength and cross-sectional area equally in old and very old subjects ( P < 0.05) but did not affect PT mechanical properties or dimension. We conclude that PT material properties are reduced in very old age, and this may likely be explained by reduced physical activity. Three months of resistance training however, could not alter PT mechanical properties in very old individuals. NEW & NOTEWORTHY This research is the first to quantify in vivo tendon mechanical properties in a group of very old adults in their eighties. Patellar tendon stiffness was lower in very old (87 yr on average) compared with moderately old (68 yr on average) individuals. Reduced physical activity with aging may explain some of the loss in tendon stiffness, but regular heavy resistance training for 3 mo was not sufficient to change tendon mechanical properties.
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Affiliation(s)
- Christian Skou Eriksen
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Cecilie Henkel
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Anne-Sofie Agergaard
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital , Copenhagen , Denmark
| | - Christian Couppé
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital , Copenhagen , Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital , Copenhagen , Denmark
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Mechanical muscle and tendon properties of the plantar flexors are altered even in highly functional children with spastic cerebral palsy. Clin Biomech (Bristol, Avon) 2017; 50:139-144. [PMID: 29100187 DOI: 10.1016/j.clinbiomech.2017.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/03/2017] [Accepted: 10/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent ultrasound studies found increased passive muscle stiffness and no difference in tendon stiffness in highly impaired children and young adults with cerebral palsy. However, it is not known if muscle and tendon mechanical properties are already altered in highly functional children with cerebral palsy. Therefore, the purpose of this study was to compare the mechanical and material properties of the plantar flexors in highly functional children with cerebral palsy and typically developing children. METHODS Besides strength measurements, ultrasonography was used to assess gastrocnemius medialis and Achilles tendon elongation and stiffness, Achilles tendon stress, strain, and Young's modulus in twelve children with cerebral palsy (GMFCS levels I and II) and twelve typically developing peers during passive dorsiflexion rotations as well as maximum voluntary contractions. FINDINGS Despite no difference in ankle joint stiffness (P>0.05) between groups, passive but not active Achilles tendon stiffness was significantly decreased (-39%) and a tendency of increased passive muscle stiffness was observed even in highly functional children with cerebral palsy. However, material properties of the tendon were not altered. Maximum voluntary contraction showed reduced plantar flexor strength (-48%) in the cerebral palsy group. INTERPRETATION Even in children with mild spastic cerebral palsy, muscle and tendon mechanical properties are altered. However, it appears that the Achilles tendon stiffness is different only when low forces act on the tendon during passive movements. Although maximum voluntary force is already decreased, forces acting on the Achilles tendon during activity appear to be sufficient to maintain typical material properties.
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A cross-sectional study on the mechanical properties of the Achilles tendon with growth. Eur J Appl Physiol 2017; 118:185-194. [PMID: 29177722 DOI: 10.1007/s00421-017-3760-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to elucidate growth pattern of mechanical properties of the Achilles tendon and to examine if imbalance between growth of bone and muscle-tendon unit occurs during adolescence. METHODS Fourteen elementary school boys, 30 junior high school boys, 20 high school boys and 15 male adults participated in this study. Based on estimated age at peak height velocity (PHV), junior high school boys were separated into two groups (before or after PHV). An ultrasonography technique was used to determine the length, cross-sectional area, stiffness and Young's modulus of Achilles tendon. In addition, the maximum strain in "toe region" (strainTP) was determined to describe the balance between growth of bone and muscle-tendon unit. RESULTS No group difference was observed in length, cross-sectional area and strainTP among the groups. However, stiffness and Young's modulus in after PHV groups were significantly higher than those of elementary school boys and before PHV groups (p ≤ 0.05). CONCLUSIONS These results indicate that mechanical properties of Achilles tendon change dramatically at and/or around PHV to increased stiffness. The widely believed assumption that muscle-tendon unit is passively stretched due to rapid bone growth in adolescence is not supported.
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