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Bontemps B, Gruet M, Louis J, Owens DJ, Miríc S, Vercruyssen F, Erskine RM. Patellar Tendon Adaptations to Downhill Running Training and Their Relationships With Changes in Mechanical Stress and Loading History. J Strength Cond Res 2024; 38:21-29. [PMID: 38085619 DOI: 10.1519/jsc.0000000000004617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ABSTRACT Bontemps, B, Gruet, M, Louis, J, Owens, DJ, Miríc, S, Vercruyssen, F, and Erskine, RM. Patellar tendon adaptations to downhill running training and their relationships with changes in mechanical stress and loading history. J Strength Cond Res 38(1): 21-29, 2024-It is unclear whether human tendon adapts to moderate-intensity, high-volume long-term eccentric exercise, e.g., downhill running (DR) training. This study aimed to investigate the time course of patellar tendon (PT) adaptation to short-term DR training and to determine whether changes in PT properties were related to changes in mechanical stress or loading history. Twelve untrained, young, healthy adults (5 women and 7 men) took part in 4 weeks' DR training, comprising 10 sessions. Running speed was equivalent to 60-65% V̇O2max, and session duration increased gradually (15-30 minutes) throughout training. Isometric knee extensor maximal voluntary torque (MVT), vastus lateralis (VL) muscle physiological cross-sectional area (PCSA) and volume, and PT CSA, stiffness, and Young's modulus were assessed at weeks 0, 2, and 4 using ultrasound and isokinetic dynamometry. Patellar tendon stiffness (+6.4 ± 7.4%), Young's modulus (+6.9 ± 8.8%), isometric MVT (+7.5 ± 12.3%), VL volume (+6.6 ± 3.2%), and PCSA (+3.8 ± 3.3%) increased after 4 weeks' DR (p < 0.05), with no change in PT CSA. Changes in VL PCSA correlated with changes in PT stiffness (r = 0.70; p = 0.02) and Young's modulus (r = 0.63; p = 0.04) from 0 to 4 weeks, whereas changes in MVT did not correlate with changes in PT stiffness and Young's modulus at any time point (p > 0.05). To conclude, 4 weeks' DR training promoted substantial changes in PT stiffness and Young's modulus that are typically observed after high-intensity, low-volume resistance training. These tendon adaptations seemed to be driven primarily by loading history (represented by VL muscle hypertrophy), whereas increased mechanical stress throughout the training period did not seem to contribute to changes in PT stiffness or Young's modulus.
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Affiliation(s)
- Bastien Bontemps
- Université de Toulon, Laboratoire IAPS (n°201723207F), Toulon, France
- Université Côte d'Azur, LAMHESS, Nice, France
| | - Mathieu Gruet
- Université de Toulon, Laboratoire IAPS (n°201723207F), Toulon, France
| | - Julien Louis
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; and
| | - Daniel J Owens
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; and
| | - Stella Miríc
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; and
| | | | - Robert M Erskine
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom; and
- Institute of Sport, Exercise and Health, University College London, London, United Kingdom
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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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Lunardi M, Furtado FE, Sakugawa RL, Sonda FC, Sampaio LT, Diefenthaeler F. Reliability of a special device for measuring the cross-sectional area of the patellar tendon by ultrasonography. J Ultrasound 2023; 26:897-903. [PMID: 37743436 PMCID: PMC10632332 DOI: 10.1007/s40477-023-00829-w] [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: 07/29/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
The objective of this study was to evaluate the intra- and inter-rater reliability and agreement between conditions with and without a special device (SD) in the evaluation of the patellar tendon (PT) cross-sectional area (CSA). Forty trained adult volunteers participated in the study. With the knee positioned at 90°, the ultrasound probe was placed in the transverse plane at 25, 50, and 75% of the PT length. Two raters and one analyzer obtained the images. We use a two-way ANOVA with a significance level of α = 0.05. No significant differences were found between raters or conditions. Intra-rater reliability ranged from moderate to good. Inter-rater reliability without the SD ranged from low to good, improving from moderate to good when the SD was used. Evaluation of the PT ends showed a lower coefficient of variation with the SD. We observed a moderate correlation at the ends and a strong correlation in the middle between conditions. The mean difference in the three positions is small (~ 0.013 cm2/ ~ 1.7%) with an upper limit of 43.2% and a lower limit of 32.5%. Therefore, we conclude that the use of the SD can be employed for evaluating the PT ends, while for the central region, it becomes optional.
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Affiliation(s)
- Morgana Lunardi
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Franklin Everaldo Furtado
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Raphael Luiz Sakugawa
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Francesca Chaida Sonda
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lucas Tavares Sampaio
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Fernando Diefenthaeler
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil.
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Balshaw TG, Funnell MP, McDermott EJ, Maden-Wilkinson TM, Massey GJ, Abela S, Quteishat B, Edsey M, James LJ, Folland JP. The Effect of Specific Bioactive Collagen Peptides on Tendon Remodeling during 15 wk of Lower Body Resistance Training. Med Sci Sports Exerc 2023; 55:2083-2095. [PMID: 37436929 DOI: 10.1249/mss.0000000000003242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
PURPOSE Collagen peptide supplementation has been reported to enhance synthesis rates or growth in a range of musculoskeletal tissues and could enhance tendinous tissue adaptations to resistance training (RT). This double-blind placebo-controlled study aimed to determine if tendinous tissue adaptations, size (patellar tendon cross-sectional area (CSA) and vastus lateralis (VL) aponeurosis area), and mechanical properties (patellar tendon), after 15 wk of RT, could be augmented with collagen peptide (CP) versus placebo (PLA) supplementation. METHODS Young healthy recreationally active men were randomized to consume either 15 g of CP ( n = 19) or PLA ( n = 20) once every day during a standardized program of lower-body RT (3 times a week). Measurements pre- and post-RT included patellar tendon CSA and VL aponeurosis area (via magnetic resonance imaging), and patellar tendon mechanical properties during isometric knee extension ramp contractions. RESULTS No between-group differences were detected for any of the tendinous tissue adaptations to RT (ANOVA group-time, 0.365 ≤ P ≤ 0.877). There were within-group increases in VL aponeurosis area (CP, +10.0%; PLA, +9.4%), patellar tendon stiffness (CP, +17.3%; PLA, +20.9%) and Young's modulus (CP, +17.8%; PLA, +20.6%) in both groups (paired t -tests (all), P ≤ 0.007). There were also within-group decreases in patellar tendon elongation (CP, -10.8%; PLA, -9.6%) and strain (CP, -10.6%; PLA, -8.9%) in both groups (paired t -tests (all), P ≤ 0.006). Although no within-group changes in patellar tendon CSA (mean or regional) occurred for CP or PLA, a modest overall time effect ( n = 39) was observed for mean (+1.4%) and proximal region (+2.4%) patellar tendon CSA (ANOVA, 0.017 ≤ P ≤ 0.048). CONCLUSIONS In conclusion, CP supplementation did not enhance RT-induced tendinous tissue remodeling (either size or mechanical properties) compared with PLA within a population of healthy young men.
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Affiliation(s)
- Thomas G Balshaw
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UNITED KINGDOM
| | - Mark P Funnell
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UNITED KINGDOM
| | - Emmet J McDermott
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UNITED KINGDOM
| | - Thomas M Maden-Wilkinson
- Academy of Sport and Physical Activity, Faculty of Health and Wellbeing, Collegiate Campus, Sheffield Hallam University, Sheffield, UNITED KINGDOM
| | - Garry J Massey
- School of Sport and Health Sciences, University of Exeter, UNITED KINGDOM
| | - Sean Abela
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UNITED KINGDOM
| | - Btool Quteishat
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UNITED KINGDOM
| | - Max Edsey
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UNITED KINGDOM
| | - Lewis J James
- School of Sport, Exercise, and Health Sciences, Loughborough University, Leicestershire, UNITED KINGDOM
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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: 0] [Impact Index Per Article: 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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Mansur H, Durigan JLQ, de Noronha M, Kjaer M, Magnusson SP, de Araújo BAS, de Cássia Marqueti R. Differences in the cross-sectional area along the ankle tendons with both age and sex. J Anat 2023; 242:213-223. [PMID: 36250976 PMCID: PMC9877482 DOI: 10.1111/joa.13774] [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: 01/02/2022] [Revised: 06/14/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023] Open
Abstract
Increasing age appears to influence several morphologic changes in major tendons. However, the effects of aging on the cross-sectional area (CSA) of different ankle tendons are much less understood. Furthermore, potential differences in specific tendon regions along the length of the tendons have not been investigated in detail. Sixty healthy adult participants categorized by age as young (n = 20; mean ± SD age = 22.5 ± 4.5 years), middle-age (n = 20; age = 40.6 ± 8. 0 years), or old (n = 20; age = 69.9 ± 9.1 years), from both sexes, were included. The tendon CSA of tibialis anterior (TA), tibialis posterior (TP), fibularis (FT), and Achilles (AT) was measured from T1-weighted 1.5 T MR images in incremental intervals of 10% along its length (from proximal insertion) and compared between different age groups and sexes. The mean CSA of the AT was greater in the middle-age group than both young and old participants (p < 0.01) and large effect sizes were observed for these differences (Cohen's d > 1). Furthermore, there was a significant difference in CSA in all three groups along the length of the different tendons. Region-specific differences between groups were observed in the distal portion (90% and 100% of the length), in which the FT presented greater CSA comparing middle-age to young and old (p < 0.05). In conclusion, (1) great magnitude of morpho-structural differences was discovered in the AT; (2) there are region-specific differences in the CSA of ankle tendons within the three groups and between them; and (3) there were no differences in tendon CSA between sexes.
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Affiliation(s)
- Henrique Mansur
- Department of Physical Education, University of Brasília (UnB), Brasilia, Brazil
| | | | - Marcos de Noronha
- La Trobe University - Rural Health School, Bendigo, Victoria, Australia
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
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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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Klich S, Kosendiak A, Krymski I, Kawczyński A, Madeleine P, Fernández-de-las-Peñas C. Ultrasound imaging of patellar tendon thickness in elite sprint track cyclists and elite soccer players: An intra-rater and inter-rater reliability study. PLoS One 2022; 17:e0270871. [PMID: 35789336 PMCID: PMC9255822 DOI: 10.1371/journal.pone.0270871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/19/2022] [Indexed: 12/02/2022] Open
Abstract
The goal of our study was to investigate the relative and absolute intra-rater and inter-rater reliability of ultrasound assessment of patellar tendon (PT) thickness assessed over four locations, in track cyclists and soccer players. Fifteen male elite track cyclists and 15 male elite soccer players participated. Tendon thickness was measured over 4 locations placed at 5-10-15-20 mm inferior to the apex of the patella by two experienced examiners. Each examiner took two US images for the test measurements with a 10-min rest period. After a 30-min period, the subjects underwent a retest measurements that were also repeated 1-week after. A two-way analysis of variance revealed a significant group x location interaction on PT thickness for Examiner 1 (p = .001, η2 = .81) and Examiner 2 (p = 0.001, η2 = 0.78). Intra-rater reliability ranged from good to excellent (ICC2,k ≥ 0.75), whereas inter-rater reliability was good (ICC2,k ≥ 0.75) in both groups. Ultrasonographic assessment of PT was found to be a reliable method to assess tendon thickness. The middle location of the PT (corresponding to 15 and 20 mm) can be considered the most reliable spot to measure PT thickness. The PT thickness was larger among track cyclists than soccer players, with larger differences over the distal location (15 mm). Ultrasonographic assessment of PT was found to be a reliable method to assess tendon thickness. The middle location of the PT corresponding to 15 mm and 20 mm can be considered the most reliable area to measure PT thickness.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wrocław University of Health and Sport Science, Wrocław, Poland
- * E-mail:
| | - Aureliusz Kosendiak
- Study of Physical Education and Sport, Wrocław Medical University, Wrocław, Poland
| | | | - Adam Kawczyński
- Department of Paralympic Sport, Wrocław University of Health and Sport Science, Wrocław, Poland
| | - Pascal Madeleine
- Department of Health Science and Technology, Sport Sciences–Performance and Technology, Aalborg University, Aalborg, Denmark
| | - Cesar Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Madrid, Spain
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Merza E, Pearson S, Lichtwark G, Garofolini A, Malliaras P. Reliability of Human Achilles Tendon Stiffness Measures Using Freehand 3-D Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:973-981. [PMID: 33487471 DOI: 10.1016/j.ultrasmedbio.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Achilles tendon (AT) stiffness is an important property of both human locomotor performance and injury mechanics. Freehand 3-D ultrasound (3-DUS) is a promising method for measuring stiffness of the Achilles tendon, particularly the free AT (2-6 cm proximal to calcaneus), which is commonly injured. The aim of this study was to investigate the test-retest reliability of freehand 3-DUS in measuring free AT stiffness in humans. The free Achilles tendon length of healthy participants (n = 10) was scanned on the same day on two consecutive occasions (1 h apart) during rest and isometric plantar flexion contractions at 20%, 40% and 60% of maximum force. The slope of the force-elongation curve over these force levels represented individual stiffness (N/mm). Relative reliability was assessed using the intra-class correlation coefficient (ICC), and absolute reliability was estimated with the standard error of measurement (SEM) and smallest detectable change. Systematic bias in stiffness measures was explored by comparing test and retest distributions and Bland-Altman plots. The test-retest reliability of free AT stiffness measured using freehand 3-DUS was excellent [ICC = 0.994, 95% confidence interval [CI]: 0.978-0.999)]. The mean stiffness values at test (361.83 N/mm [170.77]) and retest (364.98 N/mm [168.57]) did not significantly differ (p = 0.72), and the smallest detectable change was 52.14 N/mm. The Bland-Altman plot indicated the absence of systematic bias (95% CI: -22.18 to 15.88). Freehand 3-DUS provides reliable and precise measures of tendon stiffness and can be used to detect small changes in free AT stiffness in response to load or tendon pathology.
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Affiliation(s)
- Eman Merza
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Stephen Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Greater Manchester, United Kingdom
| | - Glen Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, University of Queensland, St. Lucia, Brisbane, Australia
| | | | - Peter Malliaras
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia.
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10
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Klich S, Ficek K, Krymski I, Klimek A, Kawczyński A, Madeleine P, Fernández-de-Las-Peñas C. Quadriceps and Patellar Tendon Thickness and Stiffness in Elite Track Cyclists: An Ultrasonographic and Myotonometric Evaluation. Front Physiol 2020; 11:607208. [PMID: 33381054 PMCID: PMC7767861 DOI: 10.3389/fphys.2020.607208] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Track cyclists are required to perform short- and long-term efforts during sprint and endurance race events, respectively. The 200 m flying sprint races require maximal power output and anaerobic capacity, while the 4,000 m pursuit cyclists demand a high level of aerobic capacity. Our goal was to investigate spatial changes in morphological and mechanical properties displayed using 3D topographical maps of the quadriceps muscle and tendons after 200 m flying start and 4,000 m individual pursuit race in elite track cyclists. We hypothesized a non-uniform distribution of the changes in the quadriceps muscle stiffness (QMstiff), and acute alterations in quadriceps tendon (QTthick) and patellar tendon (PTthick) thickness. Fifteen men elite sprint and 15 elite men endurance track cyclists participated. Sprint track cyclists participated in a 200 m flying start, while endurance track cyclists in 4,000 m individual pursuit. Outcomes including QTthick (5–10–15 mm proximal to the upper edge of the patella), PTthick (5–10–15–20 mm inferior to the apex of the patella)—using ultrasonography evaluation, QMstiff, and quadriceps tendon stiffness (QTstiff) were measured according to anatomically defined locations (point 1–8) and patellar tendon stiffness (PTstiff)—using myotonometry, measured in a midway point between the patella distal and the tuberosity of tibial. All parameters were assessed before and after (up to 5 min) the 200 m or 4,000 m events. Sprint track cyclists had significantly larger QTthick and PTthick than endurance track cyclists. Post-hoc analysis showed significant spatial differences in QMstiff between rectus femoris, vastus lateralis, and vastus medialis in sprint track cyclists. At before race, sprint track cyclists presented significantly higher mean QTthick and PTthick, and higher QMstiff and the QTstiff, as compared with the endurance track cyclists. The observed changes in PTThick and QTThick were mostly related to adaptation-based vascularity and hypertrophy processes. The current study suggests that assessments using both ultrasonography and myotonometry provides crucial information about tendons and muscles properties and their acute adaptation to exercise. Higher stiffness in sprint compared with endurance track cyclists at baseline seems to highlight alterations in mechanical properties of the tendon and muscle that could lead to overuse injuries.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Krzysztof Ficek
- Department of Physiotherapy, Academy of Physical Education in Katowice, Katowice, Poland.,Galen Orthopedic Center, Bieruń, Poland
| | | | - Andrzej Klimek
- Biomedical Science Institute, University School of Physical Education in Kraków, Kraków, Poland
| | - Adam Kawczyński
- Department of Paralympic Sport, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Pascal Madeleine
- Department of Health Science and Technology, Sport Sciences-Performance and Technology, Aalborg University, Aalborg, Denmark
| | - 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
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11
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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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12
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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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13
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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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14
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Centner C, Lauber B, Seynnes OR, Jerger S, Sohnius T, Gollhofer A, König D. Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training. J Appl Physiol (1985) 2019; 127:1660-1667. [PMID: 31725362 DOI: 10.1152/japplphysiol.00602.2019] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Low-load blood flow restriction (LL-BFR) training has gained increasing interest in the scientific community by demonstrating that increases in muscle mass and strength are comparable to conventional high-load (HL) resistance training. Although adaptations on the muscular level are well documented, there is little evidence on how LL-BFR training affects human myotendinous properties. Therefore, the aim of the present study was to investigate morphological and mechanical Achilles tendon adaptations after 14 wk of strength training. Fifty-five male volunteers (27.9 ± 5.1 yr) were randomly allocated into the following three groups: LL-BFR [20-35% of one-repetition maximum (1RM)], HL (70-85% 1RM), or a nonexercising control (CON) group. The LL-BFR and HL groups completed a resistance training program for 14 wk, and tendon morphology, mechanical as well as material properties, and muscle cross-sectional area (CSA) and isometric strength were assessed before and after the intervention. Both HL (+40.7%) and LL-BFR (+36.1%) training induced significant increases in tendon stiffness (P < 0.05) as well as tendon CSA (HL: +4.6%, LL-BFR: +7.8%, P < 0.001). These changes were comparable between groups without significant changes in Young's modulus. Furthermore, gastrocnemius medialis muscle CSA and plantar flexor strength significantly increased in both training groups (P < 0.05), whereas the CON group did not show significant changes in any of the evaluated parameters. In conclusion, the adaptive change in Achilles tendon properties following low-load resistance training with partial vascular occlusion appears comparable to that evoked by high-load resistance training.NEW & NOTEWORTHY Low-load blood flow restriction (LL-BFR) training has been shown to induce beneficial adaptations at the muscular level. However, studies examining the effects on human tendon properties are rare. The findings provide first evidence that LL-BFR can increase Achilles tendon mechanical and morphological properties to a similar extent as conventional high-load resistance training. This is of particular importance for individuals who may not tolerate heavy training loads but still aim for improvements in myotendinous function.
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Affiliation(s)
- Christoph Centner
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Benedikt Lauber
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany.,Department of Neurosciences and Movement Sciences, Université de Fribourg, Fribourg, Switzerland
| | - Olivier R Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Simon Jerger
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Tim Sohnius
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Daniel König
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
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15
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Castro J, Livino de Carvalho K, Silva PE, Fachin-Martins E, Babault N, Marqueti RDC, Durigan JLQ. Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients. PLoS One 2019; 14:e0219057. [PMID: 31247020 PMCID: PMC6597100 DOI: 10.1371/journal.pone.0219057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/15/2019] [Indexed: 02/06/2023] Open
Abstract
Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571–1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience.
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Affiliation(s)
- Joana Castro
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Institute of Strategic Health Management of the Federal District (IGESDF), Brasília, Brazil
- * E-mail:
| | - Karina Livino de Carvalho
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Paulo Eugênio Silva
- Institute of Strategic Health Management of the Federal District (IGESDF), Brasília, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Emerson Fachin-Martins
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Nicolas Babault
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Rita de Cássia Marqueti
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - João Luiz Quagliotti Durigan
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
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16
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Ultrasonographic assessment of patellar tendon thickness at 16 clinically relevant measurement sites - A study of intra- and interrater reliability. J Bodyw Mov Ther 2019; 23:344-351. [PMID: 31103118 DOI: 10.1016/j.jbmt.2019.02.004] [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: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine intra- and interrater reliability of ultrasonographic imaging (USI) measurements of patellar tendon (PT) thickness using 16 measurement sites covering the entire tendon. DESIGN Reliability study. SETTING Physiotherapy outpatient clinic. PARTICIPANTS Twenty healthy and physically active volunteers (9 women). Mean age: 24 years (SD ± 2.73). Mean body mass: 75.8 kg (SD ± 11.8). MAIN OUTCOME MEASURES Intraclass correlation coefficient (ICC) and 95% limits of agreement (LOA) in cm and in percentage relative to the mean PT thickness. RESULTS Intrarater reliability ranged from 0.59 to 0.87 and 0.59 to 0.93 for examiners I and II, respectively. Interrater reliability ranged from 0.37 to 0.89. Measurement precision for examiner I ranged from 0.05 to 0.09 cm (17.5%-26.7%) while ranging from 0.04 to 0.13 cm (13.3%-38.7%) for examiner II. Interrater measurement precision ranged from 0.07 to 0.15 cm (19.1%-42.5%). CONCLUSION In an attempt to replicate daily clinical USI practice, this was the first study extensively assessing reliability throughout the full range of the patellar tendon - revealing a considerable variation in intra- and interrater reliability as well as measurement precision throughout the 16 individual PT sites. In a clinical context, the low interrater reliability and precision found at the proximal tendon insertion site may have implications for USI of the symptomatic PT, as this is the site mainly associated with underlying pathologic changes. Further reliability studies are needed to clarify the region-specific reliability of the full length PT.
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17
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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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18
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Kubo K. Effects of static stretching on mechanical properties and collagen fiber orientation of the Achilles tendon in vivo. Clin Biomech (Bristol, Avon) 2018; 60:115-120. [PMID: 30342379 DOI: 10.1016/j.clinbiomech.2018.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/21/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The study was designed to examine changes in tendon properties measured during ramp and ballistic contractions after static stretching and to elucidate the relationship between stretching-induced changes in tendon properties (particularly hysteresis) and collagen fiber orientation. METHODS Thirteen males performed static stretching, in which the ankle was passively flexed to 36° dorsiflexion and remained stationary for 10 min. Before and after stretching, the stiffness and hysteresis of tendon structures in the medial gastrocnemius muscle were measured using ultrasonography during ramp and ballistic contractions. Tendon collagen fiber orientation was also estimated from the coefficient of variation (CV) of echogenicity on transverse ultrasonic images of the Achilles tendon. FINDINGS The hysteresis of tendon structures significantly decreased by 15.5% (p = 0.005) during ramp contractions and by 15.3% (p = 0.003) during ballistic contractions after stretching, whereas stiffness did not. The mean echogenicity of the Achilles tendon significantly increased by 6.0% (p = 0.002) after stretching, whereas the CV of echogenicity did not (p = 0.148). Furthermore, the relative change in mean echogenicity, which reflected interstitial fluid movement within tendons, tended to be correlated to that in hysteresis measured during ballistic contractions (r = 0.439, p = 0.133). INTERPRETATION These results suggest that the hysteresis, but not stiffness, of tendon structures measured during ramp and ballistic contractions significantly decreased after stretching. Furthermore, a decline in the hysteresis of tendon structures after static stretching was associated with interstitial fluid movement within tendons, but not to changes in collagen fiber orientation.
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Affiliation(s)
- Keitaro Kubo
- Department of Life Science (Sports Sciences), The University of Tokyo, Meguro, Tokyo, Japan.
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19
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Sims DT, Onambélé-Pearson GL, Burden A, Payton C, Morse CI. Morphological and Mechanical Properties of the Human Patella Tendon in Adult Males With Achondroplasia. Front Physiol 2018; 9:867. [PMID: 30079026 PMCID: PMC6063341 DOI: 10.3389/fphys.2018.00867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/18/2018] [Indexed: 11/13/2022] Open
Abstract
Achondroplasia is a genetic mutation of fibroblast growth factor receptor resulting in impaired growth plate development in long bones due to lower collagen turnover. Despite the characteristic shorter stature and lower strength in Achondroplasic groups, little is known of the tendon mechanical properties under loading. The aim of this study was therefore to conduct a between measure design of patella tendon (PT) mechanical properties (stress, strain, stiffness and Young's Modulus) in 10 men with Achondroplasia (22 ± 3 years) and 17 male controls (22 ± 2 years). PT mechanical properties were measured during isometric maximal voluntary contraction (iMVC) of the knee extensors using ultrasonography. The Achondroplasic group produced 54% less stress at iMVC than controls (29.4 ± 8.0 v 64.5 ± 14.0 MPa, P < 0.001, d = 3.12). Maximal excursion of the Achondroplasic PT was 22% less than controls at iMVC (7.4 ± 2.1 v 5.5 ± 1.7 mm, P < 0.001, d = 0.99), but there was no difference in strain between groups (13 ± 4 v 13 ± 3%, P > 0.05). Achondroplasic PT were 47% less stiff (748 ± 93 v 1418 ± 101 N·mm−1, P < 0.001, d = 6.89) and had a 51% lower Young's modulus (0.39 ± 0.09 v 0.77 ± 0.14 GPa, P < 0.001, d = 3.46) than controls at iMVC. Achondroplasic PT are indeed more compliant than controls which may contribute to lower relative force production. The causes of higher Achondroplasic PT compliance are unclear but are likely due to the collagen related genetic mutation which causes Achondroplasia.
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Affiliation(s)
- David T Sims
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, United Kingdom
| | - Gladys L Onambélé-Pearson
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, United Kingdom
| | - Adrian Burden
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, United Kingdom
| | - Carl Payton
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, United Kingdom
| | - Christopher I Morse
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, United Kingdom
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20
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Hartley DR, McMahon JJ. The Role of Strength Training for Lower Extremity Tendinopathy. Strength Cond J 2018. [DOI: 10.1519/ssc.0000000000000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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McCrum C, Leow P, Epro G, König M, Meijer K, Karamanidis K. Alterations in Leg Extensor Muscle-Tendon Unit Biomechanical Properties With Ageing and Mechanical Loading. Front Physiol 2018. [PMID: 29541035 PMCID: PMC5835978 DOI: 10.3389/fphys.2018.00150] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Tendons transfer forces produced by muscle to the skeletal system and can therefore have a large influence on movement effectiveness and safety. Tendons are mechanosensitive, meaning that they adapt their material, morphological and hence their mechanical properties in response to mechanical loading. Therefore, unloading due to immobilization or inactivity could lead to changes in tendon mechanical properties. Additionally, ageing may influence tendon biomechanical properties directly, as a result of biological changes in the tendon, and indirectly, due to reduced muscle strength and physical activity. This review aimed to examine age-related differences in human leg extensor (triceps surae and quadriceps femoris) muscle-tendon unit biomechanical properties. Additionally, this review aimed to assess if, and to what extent mechanical loading interventions could counteract these changes in older adults. There appear to be consistent reductions in human triceps surae and quadriceps femoris muscle strength, accompanied by similar reductions in tendon stiffness and elastic modulus with ageing, whereas the effect on tendon cross sectional area is unclear. Therefore, the observed age-related changes in tendon stiffness are predominantly due to changes in tendon material rather than size with age. However, human tendons appear to retain their mechanosensitivity with age, as intervention studies report alterations in tendon biomechanical properties in older adults of similar magnitudes to younger adults over 12–14 weeks of training. Interventions should implement tendon strains corresponding to high mechanical loads (i.e., 80–90% MVC) with repetitive loading for up to 3–4 months to successfully counteract age-related changes in leg extensor muscle-tendon unit biomechanical properties.
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Affiliation(s)
- Christopher McCrum
- Department of Human Movement Science, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands.,Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - Pamela Leow
- Department of Human Movement Science, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Matthias König
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Kenneth Meijer
- Department of Human Movement Science, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
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22
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Giacchino M, Caresio C, Gorji NE, Molinari F, Massazza G, Minetto MA. Quantitative analysis of patellar tendon size and structure in asymptomatic professional players: sonographic study. Muscles Ligaments Tendons J 2018; 7:449-458. [PMID: 29387638 DOI: 10.11138/mltj/2017.7.3.449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Ultrasonographic abnormalities of the patellar tendon frequently occur in asymptomatic athletes and it is not always clear whether they precede (and may predict) the development of tendinopathy. Objective This study aimed to investigate by ultrasonography the prevalence of patellar tendon abnormalities in players of "pallapugno" and to establish whether structural tendon abnormalities predict tendinopathy development. Methods Ultrasound B-mode images of the patellar tendon of both sides were acquired in fourteen throwers. Qualitative assessments of tendon structure and neovascularization and quantitative assessments of tendon thickness, cross sectional area (CSA), and echo-intensity were performed. Results Qualitative assessments showed a subclinical tendinopathy of the non-dominant tendon in 5 out of 14 throwers (35% of cases), while quantitative assessments showed abnormalities of the non-dominant tendon in 8 out of 14 players (57% of cases). Echo-intensity and CSA were the quantitative variables most discriminant between asymptomatic players without structural tendon abnormalities and those with tendon abnormalities. Two players (2 out of 8 cases: 25%) developed a clinical tendinopathy after a follow-up of six months. Conclusion The prevalence of subclinical tendinopathy in the non-dominant patellar tendon of throwers was high. Patellar tendon abnormalities at baseline seem to increase the risk of development of subsequent patellar tendinopathy. Level of evidence II b (individual cohort study).
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Affiliation(s)
| | - Cristina Caresio
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Negar E Gorji
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Filippo Molinari
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Alessandro Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
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23
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Increased Reliability of Quantitative Ultrasound Measures of the Supraspinatus Tendon Using Multiple Image Analysts and Analysis Runs. Am J Phys Med Rehabil 2018; 97:62-67. [DOI: 10.1097/phm.0000000000000820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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24
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Mc Auliffe S, Mc Creesh K, Purtill H, O'Sullivan K. A systematic review of the reliability of diagnostic ultrasound imaging in measuring tendon size: Is the error clinically acceptable? Phys Ther Sport 2016; 26:52-63. [PMID: 28162938 DOI: 10.1016/j.ptsp.2016.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 11/21/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnostic ultrasound (US) is a commonly used imaging modality for visualising tendon pathology and morphology. In comparison to magnetic resonance imaging (MRI), diagnostic US is perceived to have a higher risk of error when evaluating tendon size. AIM To systematically assess the evidence regarding the Intra rater and Inter rater reliability of diagnostic US measurements of tendon size. DATA SOURCES Eight electronic databases were searched using an agreed set of keywords. Studies which investigated the reliability of tendon size (thickness or cross sectional area) using diagnostic US were eligible. RESULTS Combined Inter rater and Intra rater ICC values for tendon thickness ranged from 0.45 to 0.99. Combined Inter rater and Intra rater ICC values for tendon cross-sectional area (CSA) ranged from 0.58 to 0.92. Overall, Intra rater ICC values (0.59-0.99) were marginally higher than Inter rater values (0.45-0.99) across all tendon sites. Percentage co-efficient of variation (CV%) for tendon thickness and CSA ranged from 0 to 35% across all tendons. Percentage standard error of the mean SEM% values for tendon thickness ranged from 3.33% to 7.39%. CONCLUSIONS The findings of this review suggest diagnostic US measures of tendon size are reliable, both in terms of relative and absolute reliability. However, the findings must be considered in light of the presence of tendon abnormalities in a large percentage of asymptomatic populations.
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Affiliation(s)
- Sean Mc Auliffe
- Department of Clinical Therapies, University of Limerick, Ireland.
| | - Karen Mc Creesh
- Department of Clinical Therapies, University of Limerick, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Ireland
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25
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Mersmann F, Bohm S, Schroll A, Marzilger R, Arampatzis A. Athletic training affects the uniformity of muscle and tendon adaptation during adolescence. J Appl Physiol (1985) 2016; 121:893-899. [DOI: 10.1152/japplphysiol.00493.2016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/29/2016] [Indexed: 12/26/2022] Open
Abstract
With the double stimulus of mechanical loading and maturation acting on the muscle-tendon unit, adolescent athletes might be at increased risk of developing imbalances of muscle strength and tendon mechanical properties. This longitudinal study aims to provide detailed information on how athletic training affects the time course of muscle-tendon adaptation during adolescence. In 12 adolescent elite athletes (A) and 8 similar-aged controls (C), knee extensor muscle strength and patellar tendon mechanical properties were measured over 1 yr in 3-mo intervals. A linear mixed-effects model was used to analyze time-dependent changes and the residuals of the model to quantify fluctuations over time. The cosine similarity (CS) served as a measure of uniformity of the relative changes of tendon force and stiffness. Muscle strength and tendon stiffness increased significantly in both groups ( P < 0.01). However, the fluctuations of muscle strength were greater [A, 17 ± 7 (SD) N·m; C, 6 ± 2 N·m; P < 0.05] and the uniformity of changes of tendon force and stiffness was lower in athletes (CS A, −0.02 ± 0.5; C, 0.5 ± 0.4; P < 0.05). Further, athletes demonstrated greater maximum tendon strain (A, 7.6 ± 1.7%; C, 5.5 ± 0.9%; P < 0.05) and strain fluctuations (A, 0.9 ± 0.4; C, 0.3 ± 0.1; P < 0.05). We conclude that athletic training in adolescence affects the uniformity of muscle and tendon adaptation, which increases the demand on the tendon with potential implications for tendon injury.
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Affiliation(s)
- Falk Mersmann
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
| | - Sebastian Bohm
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
| | - Arno Schroll
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
| | - Robert Marzilger
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
| | - Adamantios Arampatzis
- Humboldt-Universität zu Berlin, Department of Training- and Movement Sciences, Berlin, Germany; and
- Berlin School of Movement Sciences, Berlin, Germany
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26
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Bohm S, Mersmann F, Schroll A, Mäkitalo N, Arampatzis A. Insufficient accuracy of the ultrasound-based determination of Achilles tendon cross-sectional area. J Biomech 2016; 49:2932-2937. [DOI: 10.1016/j.jbiomech.2016.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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27
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Alegre LM, Hasler M, Wenger S, Nachbauer W, Csapo R. Does knee joint cooling change in vivo patellar tendon mechanical properties? Eur J Appl Physiol 2016; 116:1921-9. [PMID: 27473447 PMCID: PMC5020126 DOI: 10.1007/s00421-016-3444-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/24/2016] [Indexed: 12/26/2022]
Abstract
Purpose This study aimed to assess the influence of knee joint cooling on the in vivo mechanical properties of the patellar tendon. Methods Twenty young, healthy women volunteered for the study. B-mode ultrasonography was used to record patellar tendon elongation during isometric ramp contraction of the knee extensors (5–7 s, 90° knee angle) and calculate tendon stiffness. Skin temperature was measured by infrared thermometry. Data were acquired before and after 30 min of local icing of the knee joint and compared by paired samples t-tests. Results After cold exposure, skin temperature as measured over the patellar tendon dropped by 16.8 ± 2.0 °C. Tendon stiffness increased from 2189 ± 551 to 2705 ± 902 N mm−1 (+25 %, p = 0.007). Tendon strain decreased by 9 % (p = 0.004). A small, albeit significant reduction in maximum tendon force was observed (−3.3 %, p = 0.03). Conclusions Knee cooling is associated with a significant increase in patellar tendon stiffness. The observed tendon stiffening may influence the operating range of sarcomeres, possibly limiting the maximal force generation capacity of knee extensor muscles. In addition, a stiffer tendon might benefit rate of force development, thus countering the loss in explosiveness typically described for cold muscles.
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Affiliation(s)
- Luis M Alegre
- GENUD Toledo Research Group, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071, Toledo, Spain
| | - Michael Hasler
- Centre of Technology of Ski and Alpine Sport, Fürstenweg 187, Innsbruck, Austria
| | - Sebastian Wenger
- Centre of Technology of Ski and Alpine Sport, Fürstenweg 187, Innsbruck, Austria
| | - Werner Nachbauer
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, Innsbruck, Austria
| | - Robert Csapo
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, Innsbruck, Austria.
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28
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The influence of ultrasound measurement techniques on the age-related differences in Achilles tendon size. Exp Gerontol 2016; 76:68-71. [DOI: 10.1016/j.exger.2016.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/07/2015] [Accepted: 01/27/2016] [Indexed: 11/20/2022]
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29
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Incidence of elbow injuries in adolescent baseball players: screening by a low field magnetic resonance imaging system specialized for small joints. Jpn J Radiol 2016; 34:300-6. [DOI: 10.1007/s11604-016-0526-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
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30
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Correlation between semitendinosus and gracilis tendon cross-sectional area determined using ultrasound, magnetic resonance imaging and intraoperative tendon measurements. J Electromyogr Kinesiol 2016; 26:44-51. [DOI: 10.1016/j.jelekin.2015.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/13/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022] Open
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31
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Methods of Assessing Human Tendon Metabolism and Tissue Properties in Response to Changes in Mechanical Loading. METABOLIC INFLUENCES ON RISK FOR TENDON DISORDERS 2016; 920:97-106. [DOI: 10.1007/978-3-319-33943-6_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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32
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Immediate effects of whole body vibration on patellar tendon properties and knee extension torque. Eur J Appl Physiol 2015; 116:553-61. [PMID: 26708361 DOI: 10.1007/s00421-015-3316-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Reports about the immediate effects of whole body vibration (WBV) exposure upon torque production capacity are inconsistent. However, the changes in the torque-angle relationship observed by some authors after WBV may hinder the measurement of torque changes at a given angle. Acute changes in tendon mechanical properties do occur after certain types of exercise but this hypothesis has never been tested after a bout of WBV. The purpose of the present study was to investigate whether tendon compliance is altered immediately after WBV, effectively shifting the optimal angle of peak torque towards longer muscle length. METHODS Twenty-eight subjects were randomly assigned to either a WBV (n = 14) or a squatting control group (n = 14). Patellar tendon CSA, stiffness and Young's modulus and knee extension torque-angle relationship were measured using ultrasonography and dynamometry 1 day before and directly after the intervention. Tendon CSA was additionally measured 24 h after the intervention to check for possible delayed onset of swelling. RESULTS The vibration intervention had no effects on patellar tendon CSA, stiffness and Young's modulus or the torque-angle relationship. Peak torque was produced at ~70° knee angle in both groups at pre- and post-test. Additionally, the knee extension torque globally remained unaffected with the exception of a small (-6%) reduction in isometric torque at a joint angle of 60°. CONCLUSION The present results indicate that a single bout of vibration exposure does not substantially alter patellar tendon properties or the torque-angle relationship of knee extensors.
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33
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Tanaka Y, Gotani H, Yano K, Sasaki K, Miyashita M, Hamada Y. Sonographic evaluation of effects of the volar plate on trigger finger. J Orthop Sci 2015. [PMID: 26197960 DOI: 10.1007/s00776-015-0752-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated trigger fingers ultrasonographically and clarified differences between fingers with and without continuous locking or snapping symptoms according to the thicknesses of the A1 pulley, flexor tendon and volar plate. METHODS We evaluated 26 trigger fingers, divided into two groups: Group 1, 14 fingers with locking or snapping; and Group 2, 12 fingers without such symptoms. We also evaluated 26 contralateral fingers as controls (Control 1 and 2 groups). We compared each group to the respective control group according to thickness of the A1 pulley and volar plate, and cross-sectional area of the flexor tendon. In addition, nine fingers with locking or snapping and treated using corticosteroid injection were evaluated according to symptoms and sonographic findings 3-4 weeks after treatment. RESULTS Thickness of the A1 pulley and cross-sectional area of the flexor tendon were greater in both Groups 1 and 2 than in controls. Thickness of the volar plate was greater in Group 1 than in Control 1, although no significant difference was seen between Group 2 and Control 2. In Group 1, eight of the nine fingers showed an alleviation of locking or snapping symptoms with corticosteroid injection, and sonographic findings showed that thickness of the volar plate was significantly decreased with corticosteroid injection, in addition to reduced thickness of the A1 pulley. CONCLUSION In addition to thickening of the A1 pulley, thickening of the volar plate may represent an important contributor to continuous snapping or locking symptoms.
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Affiliation(s)
- Yoshitaka Tanaka
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan.
| | - Hiroyuki Gotani
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan
| | - Koichi Yano
- Department of Orthopaedic Hand and Microsurgery Center, Seikeikai Hospital, 4-2-10 Kouryounaka-machi, Sakai-ku, Sakai, Osaka, 590-0024, Japan
| | - Kosuke Sasaki
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan
| | - Masahiro Miyashita
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan
| | - Yoshitaka Hamada
- Department of Orthopaedic Hand and Microsurgery Center, Osaka Ekisaikai Hospital, 2-1-10, Honden, Nishi-ku, Osaka, Osaka, 550-0022, Japan
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Rieder F, Wiesinger HP, Kösters A, Müller E, Seynnes OR. Whole-body vibration training induces hypertrophy of the human patellar tendon. Scand J Med Sci Sports 2015; 26:902-10. [PMID: 26173589 DOI: 10.1111/sms.12522] [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] [Accepted: 06/14/2015] [Indexed: 01/26/2023]
Abstract
Animal studies suggest that regular exposure to whole-body vibration (WBV) induces an anabolic response in bone and tendon. However, the effects of this type of intervention on human tendon properties and its influence on the muscle-tendon unit function have never been investigated. The aim of this study was to investigate the effect of WBV training on the patellar tendon mechanical, material and morphological properties, the quadriceps muscle architecture and the knee extension torque-angle relationship. Fifty-five subjects were randomized into either a vibration, an active control, or an inactive control group. The active control subjects performed isometric squats on a vibration platform without vibration. Muscle and tendon properties were measured using ultrasonography and dynamometry. Vibration training induced an increase in proximal (6.3%) and mean (3.8%) tendon cross-sectional area, without any appreciable change in tendon stiffness and modulus or in muscle architectural parameters. Isometric torque at a knee angle of 90° increased in active controls (6.7%) only and the torque-angle relation remained globally unchanged in all groups. The present protocol did not appreciably alter knee extension torque production or the musculo-tendinous parameters underpinning this function. Nonetheless, this study shows for the first time that WBV elicits tendon hypertrophy in humans.
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Affiliation(s)
- F Rieder
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - H-P Wiesinger
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - A Kösters
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - E Müller
- Department of Sport Science and Kinesiology, University of Salzburg, Salzburg, Austria
| | - O R Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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35
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Papatzika F, Papandreou M, Ekizos A, Panteli C, Arampatzis A. Reliability and Limits of Agreement of the Supraspinatus Muscle Anatomical Cross-Sectional Area Assessment by Ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1821-1826. [PMID: 25842257 DOI: 10.1016/j.ultrasmedbio.2015.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/20/2015] [Accepted: 02/24/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to evaluate the reliability and limits of agreement for assessment of the anatomical cross-sectional area (ACSA) of the supraspinatus muscle using B-mode ultrasonography. Sixteen participants were examined with two different protocols, on two different days. There were no statistically significant differences (p > 0.05) in ACSA values between days 1 and 2 or between protocols 1 and 2; the average intra-class correlation coefficient ranged from 0.93 to 0.96. The limits of agreement for supraspinatus ACSA were, in both protocols, about ± 1 cm(2). Our findings revealed that both protocols had high reliability in distinguishing differences of about 1 cm(2) between groups or after interventions and that ultrasonography can be used for experimental designs in which the expected changes in ACSA would be higher than 14%.
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Affiliation(s)
- Fyllis Papatzika
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany
| | - Maria Papandreou
- Department of Physiotherapy, Technological Education Institute of Athens, Greece
| | - Antonis Ekizos
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany
| | - Chrystalla Panteli
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany.
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36
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Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. SPORTS MEDICINE-OPEN 2015; 1:7. [PMID: 27747846 PMCID: PMC4532714 DOI: 10.1186/s40798-015-0009-9] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/29/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present article systematically reviews recent literature on the in vivo adaptation of asymptomatic human tendons following increased chronic mechanical loading, and meta-analyzes the loading conditions, intervention outcomes, as well as methodological aspects. METHODS The search was performed in the databases PubMed, Web of Knowledge, and Scopus as well as in the reference lists of the eligible articles. A study was included if it conducted (a) a longitudinal exercise intervention (≥8 weeks) on (b) healthy humans (18 to 50 years), (c) investigating the effects on mechanical (i.e., stiffness), material (i.e., Young's modulus) and/or morphological properties (i.e., cross-sectional area (CSA)) of tendons in vivo, and was reported (d) in English language. Weighted average effect sizes (SMD, random-effects) and heterogeneity (Q and I 2 statistics) of the intervention-induced changes of tendon stiffness, Young's modulus, and CSA were calculated. A subgroup analysis was conducted regarding the applied loading intensity, muscle contraction type, and intervention duration. Further, the methodological study quality and the risk of bias were assessed. RESULTS The review process yielded 27 studies with 37 separate interventions on either the Achilles or patellar tendon (264 participants). SMD was 0.70 (confidence interval: 0.51, 0.88) for tendon stiffness (N=37), 0.69 (0.36, 1.03) for Young's modulus (N=17), and 0.24 (0.07, 0.42) for CSA (N=33), with significant overall intervention effects (p<0.05). The heterogeneity analysis (stiffness: I 2 =30%; Young's modulus: I 2 =57%; CSA: I 2 =21%) indicated that differences in the loading conditions may affect the adaptive responses. The subgroup analysis confirmed that stiffness adaptation significantly (p<0.05) depends on loading intensity (I 2 =0%), but not on muscle contraction type. Although not significantly different, SMD was higher for interventions with longer duration (≥12 weeks). The average score of 71±9% in methodological quality assessment indicated an appropriate quality of most studies. CONCLUSIONS The present meta-analysis provides elaborate statistical evidence that tendons are highly responsive to diverse loading regimens. However, the data strongly suggests that loading magnitude in particular plays a key role for tendon adaptation in contrast to muscle contraction type. Furthermore, intervention-induced changes in tendon stiffness seem to be more attributed to adaptations of the material rather than morphological properties.
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Affiliation(s)
- Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, Berlin, Germany.
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