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Wearing SC, Hooper SL, Langton CM, Keiner M, Horstmann T, Crevier-Denoix N, Pourcelot P. The Biomechanics of Musculoskeletal Tissues during Activities of Daily Living: Dynamic Assessment Using Quantitative Transmission-Mode Ultrasound Techniques. Healthcare (Basel) 2024; 12:1254. [PMID: 38998789 PMCID: PMC11241410 DOI: 10.3390/healthcare12131254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
The measurement of musculoskeletal tissue properties and loading patterns during physical activity is important for understanding the adaptation mechanisms of tissues such as bone, tendon, and muscle tissues, particularly with injury and repair. Although the properties and loading of these connective tissues have been quantified using direct measurement techniques, these methods are highly invasive and often prevent or interfere with normal activity patterns. Indirect biomechanical methods, such as estimates based on electromyography, ultrasound, and inverse dynamics, are used more widely but are known to yield different parameter values than direct measurements. Through a series of literature searches of electronic databases, including Pubmed, Embase, Web of Science, and IEEE Explore, this paper reviews current methods used for the in vivo measurement of human musculoskeletal tissue and describes the operating principals, application, and emerging research findings gained from the use of quantitative transmission-mode ultrasound measurement techniques to non-invasively characterize human bone, tendon, and muscle properties at rest and during activities of daily living. In contrast to standard ultrasound imaging approaches, these techniques assess the interaction between ultrasound compression waves and connective tissues to provide quantifiable parameters associated with the structure, instantaneous elastic modulus, and density of tissues. By taking advantage of the physical relationship between the axial velocity of ultrasound compression waves and the instantaneous modulus of the propagation material, these techniques can also be used to estimate the in vivo loading environment of relatively superficial soft connective tissues during sports and activities of daily living. This paper highlights key findings from clinical studies in which quantitative transmission-mode ultrasound has been used to measure the properties and loading of bone, tendon, and muscle tissue during common physical activities in healthy and pathological populations.
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Affiliation(s)
- Scott C. Wearing
- School of Medicine and Health, Technical University of Munich, 80992 Munich, Bavaria, Germany
| | - Sue L. Hooper
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
| | - Christian M. Langton
- Griffith Centre of Rehabilitation Engineering, Griffith University, Southport, QLD 4222, Australia
| | - Michael Keiner
- Department of Exercise and Training Science, German University of Health and Sport, 85737 Ismaning, Bavaria, Germany
| | - Thomas Horstmann
- School of Medicine and Health, Technical University of Munich, 80992 Munich, Bavaria, Germany
| | | | - Philippe Pourcelot
- INRAE, BPLC Unit, Ecole Nationale Vétérinaire d’Alfort, 94700 Maisons-Alfort, France
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Wearing SC, Hooper SL, Smeathers JE, Pourcelot P, Crevier-Denoix N, Brauner T. Tendinopathy alters ultrasound transmission in the patellar tendon during squatting. Scand J Med Sci Sports 2015; 26:1415-1422. [PMID: 26660902 DOI: 10.1111/sms.12602] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/29/2022]
Abstract
Measurement of loading patterns of the patellar tendon during activity is important in understanding tendon injury. We used transmission-mode ultrasonography to investigate patellar tendon loading during squatting in adults with and without tendinopathy. It was hypothesized that axial ultrasonic velocity, a surrogate measure of the elastic modulus of tendon, would be lower in tendinopathy. Ultrasound velocity was measured in both patellar tendons of adults with unilateral patellar tendinopathy (n = 9) and in healthy controls (n = 16) during a bilateral squat maneuver. Sagittal knee movement was measured simultaneously with an electrogoniometer. Statistical comparisons between healthy and injured tendons were made using two-way mixed-design ANOVAs. Axial ultrasound velocity in both symptomatic and asymptomatic patellar tendons in tendinopathy was approximately 15% higher than in healthy tendons at the commencement (F1,23 = 5.2, P < 0.05) and completion (F1,23 = 4.5, P < 0.05) of the squat. While peak velocity was ≈5% higher during both flexion (F1,23 = 5.4, P < 0.05) and extension (F1,23 = 5.3, P < 0.05) phases, there was no significant between-group difference at the midpoint of the movement. There were no significant differences in the rate and magnitude of knee movement between groups. Although further research is required, these findings suggest enhanced baseline muscle activity in patellar tendinopathy and highlight fresh avenues for its clinical management.
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Affiliation(s)
- S C Wearing
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Division of Neurophysiology in the Center of Rare Diseases, Ulm University, Ulm, Baden-Württemberg, Germany
| | - S L Hooper
- Office of Health & Medical Research, Queensland Health, Brisbane, Queensland, Australia
| | - J E Smeathers
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - P Pourcelot
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.,INRA, Maisons-Alfort, France
| | - N Crevier-Denoix
- Ecole Nationale Vétérinaire d'Alfort, Université Paris Est, Maisons-Alfort, France.,INRA, Maisons-Alfort, France
| | - T Brauner
- Faculty of Sports & Health Sciences, Technische Universität München, Munich, Germany
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Lustgarten M, Redding WR, Labens R, Davis W, Daniel TM, Griffith E, Seiler GS. ELASTOGRAPHIC EVALUATION OF NATURALLY OCCURING TENDON AND LIGAMENT INJURIES OF THE EQUINE DISTAL LIMB. Vet Radiol Ultrasound 2015; 56:670-9. [PMID: 26304065 DOI: 10.1111/vru.12284] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 12/17/2022] Open
Abstract
Compression elastography is an ultrasonographic technique that estimates tissue strain and may have utility in diagnosing and monitoring soft tissue injuries in the equine athlete. Recently, elastography has been proven to be a feasible and repeatable imaging modality for evaluating normal tendons and ligaments of the equine distal forelimb. The purposes of this prospective study were to investigate the ability of elastography to detect spontaneously occurring lesions of equine tendons and ligaments diagnosed with magnetic resonance imaging (MRI) and gray-scale ultrasound (US) and to characterize the differences in the elastographic appearance of acute vs. chronic injuries. Fifty seven horses with a total of 65 lesions were evaluated. Images were assessed quantitatively and qualitatively. Acute lesions were found to be significantly softer (P < 0.0001) than chronic lesions (P < 0.0001) and the stiffness of lesions increased with progression of healing (P = 0.0138). A negative correlation between lesion hypoechogenicity and softness was appreciated with more hypoechoic lesions appearing softer (P = 0.0087) and more hyperechoic regions harder (P = 0.0002). A similar finding occurred with increased signal intensity on short tau inversion recovery (STIR) and proton density (PD) MRI sequences correlating with increased softness on elastography (P = 0.0164). Using US and MRI as references, commonly encountered soft tissue injuries of the equine distal limb could be detected with elastography. However, elastography was limited for detecting small, proximal injuries of the hindlimb proximal suspensory ligament. Elastographic evaluation of equine tendons and ligaments may allow better characterization of lesion chronicity and severity, and sequential examinations may optimize lesion management, rehabilitation, and return to training.
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Affiliation(s)
- Meghann Lustgarten
- Department of Molecular Biomedical Science, North Carolina State University, 1052 William Moore Drive, Raleight, NC, 27607
| | - W Rich Redding
- Department of Clinical Science, North Carolina State University, 1052 William Moore Drive, Raleight, NC, 27607
| | - Raphael Labens
- The Royal (Dick) School of Veterinary Studies, Edinburgh, Scotland
| | - Weston Davis
- Palm Beach Equine Medical Centers, Wellington, FL, 33414
| | | | - Emily Griffith
- Department of Clinical Science, North Carolina State University, 1052 William Moore Drive, Raleight, NC, 27607
| | - Gabriela S Seiler
- Department of Molecular Biomedical Science, North Carolina State University, 1052 William Moore Drive, Raleight, NC, 27607
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Akdemir O, Lineaweaver WC, Cavusoglu T, Binboga E, Uyanikgil Y, Zhang F, Pekedis M, Yagci T. Effect of taurine on rat Achilles tendon healing. Connect Tissue Res 2015; 56:300-6. [PMID: 25749029 DOI: 10.3109/03008207.2015.1026437] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Taurine has anti-inflammatory and antioxidant characteristics. We have introduced taurine into a tendon-healing model to evaluate its effects on tendon healing and adhesion formation. Two groups of 16 rats underwent diversion and repair of the Achilles tendon. One group received a taurine injection (200 mg/ml) at the repair site, while the other group received 1 ml of saline. Specimens were harvested at 6 weeks and underwent biomechanical and histological evaluation. No tendon ruptured. Average maximum load was significantly greater in the taurine-applied group compared with the control group (p < 0.05). Similarly, average energy uptake was significantly higher in the taurine-applied group compared with the control group (p < 0.05). We observed no significant differences in stiffness in both groups (p > 0.05). After histological assessment, we found that fibroblast proliferation, edema, and inflammation statistically decreased in the treatment group (p < 0.05). These findings could indicate greater tendon strength with less adhesion formation, and taurine may have an effect on adhesion formation.
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Affiliation(s)
- Ovunc Akdemir
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Kemerburgaz University , Istanbul , Turkey
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El-Shafaey E, Zaghloul A, Abou-Alsaud M, Karrouf G. Assessment of digital flexors tenorrhaphy in equine: a review. JOURNAL OF APPLIED ANIMAL RESEARCH 2015. [DOI: 10.1080/09712119.2015.1031769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ellison ME, Duenwald-Kuehl S, Forrest LJ, Vanderby R, Brounts SH. Reproducibility and feasibility of acoustoelastography in the superficial digital flexor tendons of clinically normal horses. Am J Vet Res 2014; 75:581-7. [PMID: 24866514 DOI: 10.2460/ajvr.75.6.581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the feasibility and repeatability of in vivo measurement of stiffness gradients by means of acoustoelastography in the superficial digital flexor tendons (SDFTs) of clinically normal horses. ANIMALS 15 clinically normal horses. PROCEDURES For each horse, stiffness gradient index and dispersion values for SDFTs in both forelimbs were evaluated in longitudinal orientation by use of acoustoelastography at 3 sites (5, 10, and 15 cm distal to the accessory carpal bone) by 2 observers; for each observer, data were acquired twice per site. The left forelimb was always scanned before the right forelimb. Lifting of the contralateral forelimb with the carpus flexed during image acquisition resulted in the required SDFT deformation in the evaluated limb. Interobserver repeatability, intraobserver repeatability, and right-to-left limb symmetry for stiffness gradient index and dispersion values were evaluated. RESULTS Stiffness gradient index and dispersion values for SDFTs at different locations as well as effects of age or sex did not differ significantly among the 15 horses. Interclass correlation coefficients for interobserver repeatability, intraobserver repeatability, and limb symmetry revealed good to excellent agreement (intraclass correlation coefficients, > 0.74). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that acoustoelastography is a feasible and repeatable technique for measuring stiffness gradients in SDFTs in clinically normal horses, and could potentially be used to compare healthy and diseased tendon states.
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Affiliation(s)
- Michelle E Ellison
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53705
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Smith R, McIlwraith W, Schweitzer R, Kadler K, Cook J, Caterson B, Dakin S, Heinegård D, Screen H, Stover S, Crevier-Denoix N, Clegg P, Collins M, Little C, Frisbie D, Kjaer M, van Weeren R, Werpy N, Denoix JM, Carr A, Goldberg A, Bramlage L, Smith M, Nixon A. Advances in the understanding of tendinopathies: A report on the Second Havemeyer Workshop on equine tendon disease. Equine Vet J 2013; 46:4-9. [DOI: 10.1111/evj.12128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- R. Smith
- Department of Veterinary Clinical Sciences and Services; The Royal Veterinary College; UK
| | - W. McIlwraith
- Clinical Sciences; Orthopaedic Research Center; Colorado State University; USA
| | - R. Schweitzer
- SOM-Cell and Developmental Biology Department; Oregon Health and Science University; USA
| | - K. Kadler
- Faculty of Life Sciences; University of Manchester; UK
| | - J. Cook
- Department of Physiotherapy; School of Primary Health Care; Monash University; Victoria Australia
| | | | - S. Dakin
- Department of Veterinary Clinical Sciences and Services; The Royal Veterinary College; UK
| | | | - H. Screen
- The School of Engineering and Materials Science; Queen Mary, University of London; UK
| | | | - N. Crevier-Denoix
- Ecole Vétérinaire d'Alfort; UMR INRA-ENVA BPLC (Biomécanique du Cheval); France
| | | | - M. Collins
- Department of Human Biology; UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM); South Africa
| | - C. Little
- Raymond Purves Bone and Joint Research Laboratories; Kolling Institute of Medical Research; E25 - Royal North Shore Hospital; University of Sydney; New South Wales Australia
| | - D. Frisbie
- Clinical Sciences; Colorado State University; USA
| | - M. Kjaer
- Department of Clinical Medicine; Section of Orthopaedics and Internal Medicine; Bispejerg Hospital; Denmark
| | - R. van Weeren
- Equine Sciences; Utrecht University; the Netherlands
| | - N. Werpy
- Veterinary Medicine and Surgery; University of Florida; USA
| | | | - A. Carr
- Nuffield Department of Orthopaedics; Rheumatology and Musculoskeletal Sciences; Nuffield Orthopaedic Centre; University of Oxford; UK
| | | | - L. Bramlage
- Rood and Riddle Equine Hospital; Kentucky USA
| | | | - A. Nixon
- Clinical Sciences; Cornell University; New York USA
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Ellison M, Kobayashi H, Delaney F, Danielson K, Vanderby R, Muir P, Forrest LJ. Feasibility and repeatability for in vivo measurements of stiffness gradients in the canine gastrocnemius tendon using an acoustoelastic strain gauge. Vet Radiol Ultrasound 2013; 54:548-54. [PMID: 23663072 DOI: 10.1111/vru.12052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 03/28/2013] [Indexed: 11/25/2022] Open
Abstract
B-mode ultrasound is an established imaging modality for evaluating canine tendon injury. However, full extent of tendon injury often remains difficult to estimate, as small changes in sonographic appearance are associated with large changes in biomechanical strength. The acoustoelastic strain gauge (ASG) is an ultrasound-based tissue evaluation technique that relates the change in echo intensity observed during relaxation or stretching of tendons to the tissue's mechanical properties. This technique deduces stiffness gradient (the rate of change of normalized stiffness as a function of tissue strain) by analyzing the ultrasound dynamic images captured from gradually deforming tissue. ASG has been proven to accurately model strain and stiffness within tendons in vitro. To determine the feasibility and repeatability for in vivo ASG measurements of canine tendon function, stiffness gradients for the gastrocnemius tendons of 10 clinically normal dogs were recorded by two nonindependent observers at three sites (musculotendinous junction, mid tendon, and insertion). Average stiffness gradient indices (0.0132, 0.0141, 0.0136) and dispersion values (0.0053, 0.0054, 0.0057) for each site, respectively, were consistent with published mechanical properties for normal canine tendon. Mean differences of the average stiffness gradient index and dispersion value between observers and between limbs for each site were less than 16%. Using interclass coefficients (ICC), intra-observer (ICC 0.79-0.98) and interobserver (ICC 0.77-0.95) reproducibility was good to excellent. Right and left limb values were symmetric (ICC 0.74-0.92). Findings from this study indicated that ASG is a feasible and repeatable technique for measuring stiffness gradients in canine tendons.
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Affiliation(s)
- Michelle Ellison
- Department of Surgical Sciences, University of Wisconsin-Madison School of Veterinary Medicine
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Vergari C, Ravary-Plumioën B, Evrard D, Laugier P, Mitton D, Pourcelot P, Crevier-Denoix N. Axial speed of sound is related to tendon's nonlinear elasticity. J Biomech 2012; 45:263-8. [DOI: 10.1016/j.jbiomech.2011.10.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/18/2011] [Accepted: 10/22/2011] [Indexed: 11/30/2022]
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