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Klich S, Michalik K, Rajca J, Ficek K, Fernández-de-Las-Peñas C, Kawczynski A, Madeleine P. Fatigue-induced Alterations of the Patellar Tendon in Elite Sprint Track Cyclists. Int J Sports Med 2023; 44:995-1002. [PMID: 36690028 DOI: 10.1055/a-2018-2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aims to investigate morphological and mechanical properties and echogenicity of the patellar tendon (PT) after acute fatigue-induced alterations in sprint track cyclists. Fourteen elite track cyclists participated in this study. The exercise protocol consisted of three maximal start accelerations (over a distance of 62.5 m), one maximal start acceleration (at both 125 m and 250 m), and sprints from the standing start. Immediately after testing all measurements, PT stiffness and thickness were set at 5-10-15-20 mm distal from the apex of the patella and 5-10 mm proximal to the tibial tuberosity. CSA was set at proximal, middle, and distal, while echogenicity was at proximal and distal points. The results showed significant increases in PT stiffness at all reference points after start acceleration (p<0.001). PT thickness showed similar results for stiffness, except for location placed at TT-5 (p<0.001). CSA increased significantly in proximal, middle, and distal regions (p<0.001), while echogenicity of the tendon increased in proximal and distal regions (p<0.001) after start acceleration. Regional-dependent alterations of PT thickness and stiffness may be related to anatomical and physiological mechanisms due to acute isometric contraction in the initial phase of standing start. Tendon echogenicity might be also useful in monitoring tendon mechanical properties and defining acute fatigue-induced changes.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
| | - Kamil Michalik
- Department of Human Motor Skills, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
| | - Jolanta Rajca
- Department of Science, Innovation and Development, Galen-Orthopaedics, Bieruń, Poland
| | - Krzysztof Ficek
- Department of Physiotherapy, Jerzy Kukuczka Academy of Physical Education In Katowice, Katowice, Poland
- Department of Science, Innovation and Development, Galen-Orthopaedics, Bieruń, Poland
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional En Docencia, Clínica E Investigación En Fisioterapia: Terapia Manual, Punción Seca Y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Adam Kawczynski
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Pascal Madeleine
- Health Science and Technology, Aalborg University, Aalborg, Denmark
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Sato Y, Kösters A, Rieder F, Sasho T, Müller E, Wiesinger HP. Quantitative Analysis of Patellar Tendon After Total Knee Arthroplasty Using Echo Intensity: A Nonrandomized Controlled Trial of Alpine Skiing. J Arthroplasty 2020; 35:2858-2864. [PMID: 32561260 DOI: 10.1016/j.arth.2020.05.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/10/2020] [Accepted: 05/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the knee extensor weakness, less attention has been paid to the evaluation of patellar tendon after total knee arthroplasty (TKA). We previously observed patellar tendon hypertrophy after TKA. The purpose of this study is to reanalyze these ultrasound data to detect whether brightness mode ultrasound imaging reflects pathological changes of the patellar tendon after TKA. METHODS Twenty-eight participants with post unilateral TKA were assigned to an intervention group or control group. The intervention group underwent a 12-week skiing program. Patellar tendon mechanical properties were obtained by combining isometric dynamometry, ultrasound imaging, and electromyography in operated knee and nonoperated knee. Luminosity ratio (LR) was measured using echo intensity in a relaxed and maximally loaded phase. RESULTS Baseline comparisons revealed significant effects of the surgical side (P < .001) and loading phase (P = .017), but no interaction between leg and phase (P < .149). LR of the operated knee was significantly lower than LR of the nonoperated knee in relaxed (P < .001) and maximally loaded phases (P = .003). In addition, there was a significant correlation between LR of maximum phase and isometric knee extension torque (r2 = 0.156, P = .038). However, LR was not related to patellar tendon stiffness, Young's modulus, or strain. There was a significant time effect in knee extension torque, but no time effects on LR and tendon force. CONCLUSION Patellar tendon LR is decreased along with degenerative change after TKA. Ultrasound imaging provides a promising metric to acquire in vivo patellar tendon pathological assessment after TKA.
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Affiliation(s)
- Yusuke Sato
- Department of Sport and Exercise Science, Paris Lodron University of Salzburg, Salzburg, Austria; Department of Orthopedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Alexander Kösters
- Department of Sport and Exercise Science, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Florian Rieder
- Department of Sport and Exercise Science, Paris Lodron University of Salzburg, Salzburg, Austria; Department of Physical Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Takahisa Sasho
- Department of Orthopedic Surgery, Chiba University Hospital, Chiba, Japan
| | - Erich Müller
- Department of Sport and Exercise Science, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Hans-Peter Wiesinger
- Department of Sport and Exercise Science, Paris Lodron University of Salzburg, Salzburg, Austria
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Ackerman JE, Studentsova V, Myers M, Buckley MR, Richards MS, Loiselle AE. Non-Invasive Ultrasound Quantification of Scar Tissue Volume Identifies Early Functional Changes During Tendon Healing. J Orthop Res 2019; 37:2476-2485. [PMID: 31231903 PMCID: PMC6816309 DOI: 10.1002/jor.24397] [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] [Received: 11/28/2018] [Accepted: 06/18/2019] [Indexed: 02/04/2023]
Abstract
Tendon injuries are very common and disrupt the transmission of forces from muscle to bone, leading to impaired function and quality of life. Successful restoration of tendon function after injury is a challenging clinical problem due to the pathological, scar-mediated manner in which the tendons heal. Currently, there are no standard treatments to modulate scar tissue formation and improve tendon healing. A major limitation to the identification of therapeutic candidates has been the reliance on terminal endpoint metrics of healing in pre-clinical studies, which require a large number of animals and result in destruction of the tissue. To address this limitation, we have identified quantification of scar tissue volume (STV) from ultrasound (US) imaging as a longitudinal, non-invasive metric of tendon healing. STV was strongly correlated with established endpoint metrics of gliding function including gliding resistance and metatarsophalangeal (MTP) flexion angle. However, no associations were observed between STV and structural or material properties. To define the sensitivity of STV to identify differences between functionally discrete tendon healing phenotypes, we utilized S100a4 haploinsufficient mice (S100a4GFP/+ ), which heal with improved gliding function relative to wild-type (WT) littermates. A significant decrease in STV was observed in S100a4GFP/+ repairs, relative to WT at day 14. Taken together, these data suggest US quantification of STV as a means to facilitate the rapid screening of biological and pharmacological interventions to improve tendon healing, and identify promising therapeutic targets, in an efficient, cost-effective manner. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2476-2485, 2019.
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Affiliation(s)
- Jessica E. Ackerman
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester, Rochester, New York, United States of America
| | - Valentina Studentsova
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester, Rochester, New York, United States of America
| | - Marlin Myers
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester, Rochester, New York, United States of America
| | - Mark R. Buckley
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester, Rochester, New York, United States of America,Department of Biomedical Engineering, University of Rochester, Rochester, New York, United States of America
| | - Michael S. Richards
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, New York, United States of America
| | - Alayna E. Loiselle
- Center for Musculoskeletal Research, Department of Orthopaedics & Rehabilitation, University of Rochester, Rochester, New York, United States of America,Corresponding Author Alayna E. Loiselle, PhD, Center for Musculoskeletal Research, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, Phone: 585-275-7239, Fax: 585-276-2177,
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Nunes GS, Tessarin BM, Scattone Silva R, Serrão FV. Relationship between the architecture and function of ankle plantar flexors with Achilles tendon morphology in ballet dancers. Hum Mov Sci 2019; 67:102494. [PMID: 31326740 DOI: 10.1016/j.humov.2019.102494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022]
Abstract
Achilles tendinopathy is the most frequent foot overuse injury in ballet dancers and knowledge of clinically modifiable factors related to tendon structure in a population at risk, such as ballet dancers, would be important for the development of preventive programs. Therefore, the present study aimed to assess relationships of gastrocnemius muscle architecture and ankle plantar flexors function with Achilles tendon morphology in ballet dancers. Fifty-four measures from 27 ballet dancers were collected. Tendon morphology (thickness, echogenicity, hypoechoic areas and neovascularisation) and muscle architecture (thickness, pennation angle and fascicle length) were evaluated using ultrasonography; ankle plantar flexors torque was evaluated using hand-held dynamometry, flexibility was evaluated in maximal weight-bearing ankle dorsiflexion position using inclinometer, and endurance was evaluated using the heel rise test. Ankle plantar flexors torque and medial gastrocnemius muscle architecture (thickness, pennation angle and fascicle length) are associated with Achilles tendon thickness in ballet dancers (r2 = 0.24, p = 0.008). Ankle plantar flexors torque and medial gastrocnemius muscle fascicle length are also associated with the echogenicity of the Achilles tendon (r2 = 0.13, p = 0.03). These findings call attention to the potential importance of ankle plantar flexors muscle force in healthy ballet dancers for the prevention of alterations in Achilles tendon structure.
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Affiliation(s)
- Guilherme S Nunes
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Rodrigo Scattone Silva
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
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Hillin CD, Fryhofer GW, Freedman BR, Choi DS, Weiss SN, Huegel J, Soslowsky LJ. Effects of immobilization angle on tendon healing after achilles rupture in a rat model. J Orthop Res 2019; 37:562-573. [PMID: 30720208 PMCID: PMC6534419 DOI: 10.1002/jor.24241] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/29/2019] [Indexed: 02/04/2023]
Abstract
Conservative (non-operative) treatment of Achilles tendon ruptures is a common alternative to operative treatment. Following rupture, ankle immobilization in plantarflexion is thought to aid healing by restoring tendon end-to-end apposition. However, early activity may improve limb function, challenging the role of immobilization position on tendon healing, as it may affect loading across the injury site. This study investigated the effects of ankle immobilization angle in a rat model of Achilles tendon rupture. We hypothesized that manipulating the ankle from full plantarflexion into a more dorsiflexed position during the immobilization period would result in superior hindlimb function and tendon properties, but that prolonged casting in dorsiflexion would result in inferior outcomes. After Achilles tendon transection, animals were randomized into eight immobilization groups ranging from full plantarflexion (160°) to mid-point (90°) to full dorsiflexion (20°), with or without angle manipulation. Tendon properties and ankle function were influenced by ankle immobilization position and time. Tendon lengthening occurred after 1 week at 20° compared to more plantarflexed angles, and was associated with loss of propulsion force. Dorsiflexing the ankle during immobilization from 160° to 90° produced a stiffer, more aligned tendon, but did not lead to functional changes compared to immobilization at 160°. Although more dorsiflexed immobilization can enhance tissue properties and function of healing Achilles tendon following rupture, full dorsiflexion creates significant tendon elongation regardless of application time. This study suggests that the use of moderate plantarflexion and earlier return to activity can provide improved clinical outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Cody D. Hillin
- McKay Orthopaedic LaboratoryUniversity of Pennsylvania110 Stemmler Hall, 3450 Hamilton WalkPhiladelphiaPennsylvania19104‐6081
| | - George W. Fryhofer
- McKay Orthopaedic LaboratoryUniversity of Pennsylvania110 Stemmler Hall, 3450 Hamilton WalkPhiladelphiaPennsylvania19104‐6081
| | - Benjamin R. Freedman
- McKay Orthopaedic LaboratoryUniversity of Pennsylvania110 Stemmler Hall, 3450 Hamilton WalkPhiladelphiaPennsylvania19104‐6081
| | - Daniel S. Choi
- McKay Orthopaedic LaboratoryUniversity of Pennsylvania110 Stemmler Hall, 3450 Hamilton WalkPhiladelphiaPennsylvania19104‐6081
| | - Stephanie N. Weiss
- McKay Orthopaedic LaboratoryUniversity of Pennsylvania110 Stemmler Hall, 3450 Hamilton WalkPhiladelphiaPennsylvania19104‐6081
| | - Julianne Huegel
- McKay Orthopaedic LaboratoryUniversity of Pennsylvania110 Stemmler Hall, 3450 Hamilton WalkPhiladelphiaPennsylvania19104‐6081
| | - Louis J. Soslowsky
- McKay Orthopaedic LaboratoryUniversity of Pennsylvania110 Stemmler Hall, 3450 Hamilton WalkPhiladelphiaPennsylvania19104‐6081
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Slane LC, Slane JA, D'hooge J, Scheys L. The challenges of measuring in vivo knee collateral ligament strains using ultrasound. J Biomech 2017; 61:258-262. [PMID: 28802742 PMCID: PMC5581255 DOI: 10.1016/j.jbiomech.2017.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/10/2017] [Accepted: 07/17/2017] [Indexed: 12/13/2022]
Abstract
Ultrasound-based methods have shown promise in their ability to characterize non-uniform deformations in large energy-storing tendons such as the Achilles and patellar tendons, yet applications to other areas of the body have been largely unexplored. The noninvasive quantification of collateral ligament strain could provide an important clinical metric of knee frontal plane stability, which is relevant in ligament injury and for measuring outcomes following total knee arthroplasty. In this pilot cadaveric experiment, we investigated the possibility of measuring collateral ligament strain with our previously validated speckle-tracking approach, but encountered a number of challenges during both data acquisition and processing. Given the clinical interest in this type of tool, and the fact that this is a developing area of research, the goal of this article is to transparently describe this pilot study, both in terms of methods and results, while also identifying specific challenges to this work and areas for future study. Some challenges faced relate generally to speckle-tracking of soft tissues (e.g. the limitations of using a 2D imaging modality to characterize 3D motion), while others are specific to this application (e.g. the small size and complex anatomy of the collateral ligaments). This work illustrates a clear need for additional studies, particularly relating to the collection of ground-truth data and more thorough validation work. These steps will be critical prior to the translation of ultrasound-based measures of collateral ligament strains into the clinic.
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Affiliation(s)
- Laura C Slane
- KU Leuven, Institute for Orthopaedic Research and Training, Leuven, Belgium.
| | - Josh A Slane
- KU Leuven, Institute for Orthopaedic Research and Training, Leuven, Belgium
| | - Jan D'hooge
- KU Leuven, Lab on Cardiovascular Imaging and Dynamics, Dept. of Cardiovascular Sciences, Leuven, Belgium
| | - Lennart Scheys
- KU Leuven, Institute for Orthopaedic Research and Training, Leuven, Belgium; University Hospitals Leuven, Dept. of Orthopaedics, Campus Pellenberg, Pellenberg, Belgium
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POPCHAK ADAMJ, HOGABOOM NATHANS, VYAS DHARMESH, ABT JOHNP, DELITTO ANTHONY, IRRGANG JAMESJ, BONINGER MICHAELL. Acute Response of the Infraspinatus and Biceps Tendons to Pitching in Youth Baseball. Med Sci Sports Exerc 2017; 49:1168-1175. [DOI: 10.1249/mss.0000000000001205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ishigaki T, Kouno M, Ikebukuro T, Kubo K. Quantification of collagen fiber orientation in human tendons with the coefficient of variation of echogenicity. J Biomech 2016; 49:3923-3927. [DOI: 10.1016/j.jbiomech.2016.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/28/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022]
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Pochini ADC, Ferretti M, Kawakami EFKI, Fernandes ADRC, Yamada AF, Oliveira GCD, Cohen M, Andreoli CV, Ejnisman B. Analisys of pectoralis major tendon in weightlifting athletes using ultrasonography and elastography. EINSTEIN-SAO PAULO 2016; 13:541-6. [PMID: 26761551 PMCID: PMC4878628 DOI: 10.1590/s1679-45082015ao3335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 10/28/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate tendinopathy of the pectoralis major muscle in weightlifting athletes using ultrasound and elastography. METHODS This study included 20 patients, 10 with rupture of the pectoralis major muscle and 10 control patients. We evaluated pectoralis major muscle contralateral tendon with ultrasonographic and elastography examinations. The ultrasonographic examinations were performed using a high-resolution B mode ultrasound device. The elastography evaluation was classified into three patterns: (A), if stiff (more than 50% area with blue staining); (B), if intermediate (more than 50% green); and (C), if softened (more than 50% red). RESULTS Patients' mean age was 33±5.3 years. The presence of tendinous injury measured by ultrasound had a significant different (p=0.0055), because 80% of cases had tendinous injury versus 10% in the Control Group. No significant differences were seen between groups related with change in elastography (p=0.1409). CONCLUSION Long-term bodybuilders had ultrasound image with more tendinous injury than those in Control Group. There was no statistical significance regarding change in tendon elasticity compared with Control Group.
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Affiliation(s)
| | - Mario Ferretti
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | | | | | | | - Moisés Cohen
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Benno Ejnisman
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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