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Cushman DM, Catalano E, Hoffman J, Casey E. Achilles tendon rupture preceded by normal asymptomatic imaging in a collegiate gymnast: A case report. Radiol Case Rep 2024; 19:3470-3472. [PMID: 38872751 PMCID: PMC11169073 DOI: 10.1016/j.radcr.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 06/15/2024] Open
Abstract
Female gymnasts are the athletes that are most likely to experience Achilles tendon rupture, due to the high energy and eccentric load place on their Achilles tendon related to their sport. It is postulated that degenerative changes, watershed vascular supply, calcifications, and high amounts of inflammatory cells may play a role. This case report highlights an athlete with an asymptomatic Achilles tendon that was visualized to be normal utilizing ultrasound. She was found to have no evidence of underlying tendon pathology. The athlete then ruptured her Achilles tendon 8 months later during a gymnastic meet with no proceeding symptoms. This case report challenges the accepted theory that preexisting tendinosis or pathology proceeds Achilles tendon rupture. In this case, it is postulated that tendon rupture may be secondary to significant mechanical force even without underlying pathology. Level of evidence: Level 4.
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Affiliation(s)
- Daniel M. Cushman
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, UT 84108, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA
| | - Emily Catalano
- Department of Emergency Medicine, East Carolina University, Greenville, NC 27858, USA
| | | | - Ellen Casey
- Hospital for Special Surgery New York, NY 10021, USA
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2
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Kruse RC, Rudolph L, Negaard M. Asymptomatic sonographic abnormalities of the hindfoot region in Division I collegiate gymnasts. PM R 2024; 16:563-569. [PMID: 37799012 DOI: 10.1002/pmrj.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/09/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The hindfoot region is commonly injured in gymnasts, and musculoskeletal ultrasound can be used to identify structural abnormalities in this region. Although prior studies have shown that sonographic abnormalities may not correlate with symptomatic pathology, the presence of asymptomatic sonographic abnormalities of the hindfoot in Division I collegiate gymnasts has not been evaluated. OBJECTIVE To identify and describe commonly seen asymptomatic sonographic abnormalities of the hindfoot region in Division I collegiate gymnasts. DESIGN Cross-sectional study. SETTING Tertiary care academic medical center. PARTICIPANTS 39 Division I NCAA men's and women's collegiate gymnasts without current hindfoot pain or history of hindfoot injury. INTERVENTIONS Diagnostic musculoskeletal ultrasound of the hindfoot region. MAIN OUTCOME MEASURES Sonographic appearance of the hindfoot region, specifically the plantar fascia, plantar fad pad, and Achilles tendon. RESULTS A total of 37 of 39 gymnasts included in the study were found to have at least one asymptomatic sonographic abnormality of the hindfoot region. A total of 28.2% of athletes were found to have sonographic abnormalities within the Achilles tendon, with Doppler flow being the most common finding, and 35.8% of athletes were found to have a Haglund's deformity. However, only 7% of athletes with a Haglund's deformity demonstrated abnormal sonographic findings within the tendon. Sonographic abnormalities of the plantar fascia and plantar fat pad were seen in 30.7% and 69.2% of athletes, respectively. CONCLUSIONS Asymptomatic sonographic abnormalities of the hindfoot region are common in collegiate gymnasts. Clinicians should use clinical judgment when interpreting these findings as they may not represent symptomatic pathology.
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Affiliation(s)
- Ryan C Kruse
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | | | - Matthew Negaard
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
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Tortosa-Cabañas M, Tejero-Carmona ME, García-Montes N, Guillén-Astete CA. Ultrasound Changes in the Enthesis and Peri-enthesis Area of the Patellar and Achilles Tendons in Response to Physical Exercise: Comparison Between Healthy Subjects and Patients with Spondyloarthritis in Clinical Remission. Acad Radiol 2024:S1076-6332(24)00230-7. [PMID: 38796403 DOI: 10.1016/j.acra.2024.04.021] [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: 12/14/2023] [Revised: 04/09/2024] [Accepted: 04/13/2024] [Indexed: 05/28/2024]
Abstract
RATIONALE AND OBJECTIVES The goal of achieving clinical remission in patients with spondyloarthritis does not necessarily include the resolution of entheseal inflammation from a histological perspective. However, enthesis not clinically inflamed, under mechanical stress, may behave differently from healthy subjects considering the physiopathology of SpA. Our goal was to determine whether ultrasound changes in entheses differ between SpA patients in clinical remission and healthy subjects. METHODS SpA patients in clinical remission and matched healthy controls were recruited. At baseline, the following variables were measured on the dominant side by ultrasound: thickness of the distal patellar enthesis (hDP), the deep infrapatellar bursa (hDIB), the Achilles enthesis (hA), the preachilleal bursa (hPAB), effusion in the preachileal bursa (hePAB), and the presence of power Doppler signal in both enthesis. All measurements except hDP and hA were collected again after exercise (post-stress ultrasound). RESULTS 30 patients and 30 controls were enrolled. In all subjects, hDIB, hPAB, and the preachileal bursa occupancy index increased significantly after the exercise. The increase was significantly greater in patients for all variables. At baseline, in patients, hyperemia was detected in one patellar tendon (3.3%) and in two Achilles tendons (6.7%). After exercise, the number of tendons with hyperemia increased to 11/30 (36.7%) and 12/30 (40%), respectively. Among controls, there was no detectable basal hyperemia, but after exercise, it was detected in 1/30 patellar tendons (3.3%) and 2/30 Achilles tendons (6.7%). CONCLUSION Exercise triggers a greater effusive and hyperemic synovial response in patients in remission than in healthy controls. These findings suggest that the definition of remission should also include an assessment of the synovial response to mechanical stress. HIGHLIGHTS
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Affiliation(s)
| | | | - Nuria García-Montes
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Alcorcón, Madrid, Spain
| | - Carlos Antonio Guillén-Astete
- Hospital Universitario Ramón y Cajal, Madrid, Spain; Facultad de Medicina, Universidad CEU San Pablo, Alcorcón, Madrid, Spain; Universidad Europea de Madrid, Dept. of Medicine, Fac. of Biomedical and Health Sciences, Spain.
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Cushman DM, Carefoot A, Corcoran B, Vu L, Fredericson M, Fausett C, Teramoto M, Eby SF. Prevalence of Sonographic Achilles Tendon, Patellar Tendon, and Plantar Fascia Abnormalities in Division I Collegiate Athletes From a Variety of Sports. Clin J Sport Med 2024; 34:297-303. [PMID: 37540559 PMCID: PMC10838354 DOI: 10.1097/jsm.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE This study aimed to determine the prevalence of ultrasound abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among a large cohort of collegiate student-athletes. DESIGN Observational cross-sectional study. SETTING Three Division I institutions. PARTICIPANTS 243 student-athletes participated in this study. Exclusion criteria included those younger than 18 years or who underwent prior surgery/amputation of structures, including anterior cruciate ligament (ACL) surgeries with patellar tendon grafts. INTERVENTIONS Ultrasound examination of the Achilles tendon, patellar tendon, and plantar fascia of each leg was performed. An experienced sonographer reviewed each tendon video in a blinded manner, with a separate experienced sonographer separately reviewing to establish inter-rater reliability. MAIN OUTCOME MEASURES The primary outcome measured was the presence of any sonographic abnormality including hypoechogenicity, thickening, or neovascularity. RESULTS Ultrasound abnormalities were identified in 10.1%, 37.2%, and 3.9% of all Achilles tendons, patellar tendons, and plantar fasciae, respectively. Abnormalities were significantly associated with the presence of concurrent pain for all structures ( P < 0.01). Specifically, athletes with sonographic abnormalities were approximately 4 times [relative risk (RR) = 4.25; 95% confidence interval (CI), 2.05-8.84], 6 times (RR = 5.69; 95% CI, 2.31-14.00), and 5 times (RR = 5.17; 95% CI, 1.76-15.25) more likely to self-report pain in the Achilles tendon, patellar tendon, and plantar fascia, respectively. CONCLUSIONS This multi-institutional study completed at 3 Division I institutions is the largest study of its kind to identify the prevalence of sonographic abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among collegiate student-athletes of various sports.
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Affiliation(s)
- Daniel M Cushman
- Departments of Physical Medicine & Rehabilitation; and
- Orthopaedics, University of Utah, Salt Lake City, Utah
| | | | - Blake Corcoran
- Washington State University, Cougar Health Services, Pullman, Washington
| | - Leyen Vu
- Washington State University, Cougar Health Services, Pullman, Washington
| | - Michael Fredericson
- Division of Physical Medicine & Rehabilitation, Department of Orthopedic Surgery, Stanford University, Palo Alto, California; and
| | - Cameron Fausett
- Division of Physical Medicine & Rehabilitation, Department of Orthopedic Surgery, Stanford University, Palo Alto, California; and
| | | | - Sarah F Eby
- Department of Physical Medicine & Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
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Kobayashi JK, Kobayashi EF, Tomasevich KM, Lorens KL, Aoki SK. Characterization of Achilles Tendon Ruptures in Collegiate Women's Gymnastics. Orthopedics 2023; 46:205-210. [PMID: 36853933 DOI: 10.3928/01477447-20230224-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Collegiate female gymnasts are at high risk of Achilles tendon injuries. Achilles tendon ruptures can negatively impact an athlete's ability to return to competitive sport. Understanding the natural history of Achilles tendon tears in collegiate female gymnasts is important in the development of preventive treatment. To expand our knowledge of the natural history of Achilles tendon ruptures among collegiate female gymnasts, a REDCap retrospective survey was emailed to athletic trainers on all 80 National Collegiate Athletic Association (NCAA) women's gymnastics teams. The survey gathered information regarding number of Achilles tendon injuries, pain prior to injuries, events and skills on which injuries occurred, and functional outcome after injuries among athletes competing in the 2013 to 2018 NCAA seasons. Forty-two of 80 (52.5%) programs responded to the survey. Seventy-one Achilles tendon ruptures were reported between 2013 and 2018. Among these, 46% had antecedent pain. Gymnasts sustained 95% of Achilles tendon ruptures while performing on floor exercise, with 98% of ruptures occurring during the take-off portion of a tumbling skill. Of the 61% of gymnasts who were able to return to competition, 59% were able to achieve the same level of function after injury. Achilles tendon ruptures in collegiate female gymnasts primarily occur during the take-off motion while tumbling on the floor exercise. Future studies should evaluate degenerative Achilles tendon changes in collegiate female gymnasts. A collaborative effort among gymnasts, coaches, judges, and medical experts is required to identify at-risk athletes and develop and implement injury prevention programs. [Orthopedics. 2023;46(4):205-210.].
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Fryar C, Tilley D, Casey E, Vincent H. A Research and Clinical Framework for Understanding Achilles Injury in Female Collegiate Gymnasts. Curr Sports Med Rep 2023; 22:260-267. [PMID: 37417663 DOI: 10.1249/jsr.0000000000001082] [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: 07/08/2023]
Abstract
ABSTRACT Gymnastics is a popular sport with a high injury rate, particularly at the collegiate level. Achilles tendon rupture is a catastrophic injury with career-changing impact. Over the last decade, there has been a growing incidence of Achilles tendon ruptures, especially in female gymnasts. Currently, neither the effects of contributing risk factors on Achilles tendon rupture nor the research frameworks to guide future intervention strategies have been well described. This article reviews the functional anatomy and mechanical properties of the Achilles tendon, provides precollegiate and collegiate intrinsic and extrinsic risk factors for Achilles tendon rupture, and proposes a research framework to address this injury from a systemic perspective. Potential clinical interventions to mitigate Achilles tendon injury are proposed based on currently available peer-reviewed evidence.
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Affiliation(s)
- Caroline Fryar
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Dave Tilley
- Champion Physical Therapy & Performance, Watham, MA
| | - Ellen Casey
- Department of Physiatry, Hospital for Special Surgery, New York, NY
| | - Heather Vincent
- University of Florida College of Medicine, UF Physical Medicine & Rehabilitation
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Götschi T, Franchi MV, Schulz N, Fröhlich S, Frey WO, Snedeker JG, Spörri J. Altered regional 3D shear wave velocity patterns in youth competitive alpine skiers suffering from patellar tendon complaints - A prospective case-control study. Eur J Sport Sci 2022; 23:1068-1076. [PMID: 35699187 DOI: 10.1080/17461391.2022.2088404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractPatellar tendon (PT) complaints are frequent throughout the population, with increased occurrence in athletes and, particularly, in youth competitive alpine skiers. Timely detection and treatment might improve prospects of recovery. Diagnostic modalities in clinical use to date rely on pain symptoms, manual palpation, and potentially, magnetic resonance imaging (MRI); however, MRI-based imaging yields limited sensitivity. Quantitatively measuring the morphological and mechanical properties of PTs by means of B-mode ultrasound and shear wave elastography (SWE), instead, may allow improved diagnosis or even early detection. We performed B-mode scans and three-dimensional ultrasound shear wave velocity (SWV) mapping and MRI of the PT in 106 youth skiers. A prospective one-year survey on health problems combined with clinical assessments served to categorize symptomatic and asymptomatic youth skiers. Skiers suffering from distal or proximal tendon complaints showed lower SWV in the respective tendon region than asymptomatic skiers (p = 0.035 and p = 0.019, respectively). Youth skiers with distal tendon complaints additionally exhibited decreased SWV in the proximal region compared to asymptomatic counterparts (p = 0.020). Cross-validated analysis of retrospective prediction indicated sensitivity and specificity in detecting tendon complaints in the range of 0.606-0.621 and 0.536-0.650, respectively. MRI detected distal tendon complaints with a sensitivity of 0.410 (12/29) but failed to detect any proximal cases. This study agrees with the most recent literature in that SWE holds promise as a valuable adjunct modality for the diagnosis of PT complaints or even the detection of subclinical prestages. However, to evaluate its prospective predictive value, long-term studies are warranted.
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Affiliation(s)
- Tobias Götschi
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Switzerland.,Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Martino V Franchi
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute of Physiology, Department of Biomedical Sciences, University of Padova, Padua, Italy
| | | | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Jess G Snedeker
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
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Wang YH, Zhou HH, Nie Z, Cui S. Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2022; 4:152-159. [PMID: 36090915 PMCID: PMC9453689 DOI: 10.1016/j.smhs.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Abstract
This comprehensive systematic review and meta-analysis assessed the prevalence of Achilles tendinopathy (AT) in physical exercise (PE). Specifically, we estimate the overall risk of AT in physical exercise and compare sport-specific estimates of AT risk. PubMed, Web of Science, Cochrane Library, and SPORTDiscus were searched before the 1st of October 2021. Random-effects, subgroup analysis, sensitivity analysis and meta-regressions were conducted, involving 16 publications. This meta-analysis found that the overall prevalence of AT was 0.06 (95%CI, 0.04–0.07). The prevalence of Achilles tendon rupture was 0.03 (95%CI, 0.02–0.05). Subgroup analysis showed that the prevalence of AT increased with age, the highest among the group aged over 45 (0.08; 95%CI, 0.04–0.11), and the lowest among the group under 18 years old (0.02; 95%CI, 0.01–0.03). The gymnastics and ball games had the highest prevalence of AT, at (0.17; 95%CI, 0.14–0.20) and (0.06; 95%CI, 0.02–0.11), respectively. The prevalence of AT in athletes (0.06; 95%CI, 0.04–0.08) was higher than that of amateur exercisers (0.04; 95%CI, 0.02–0.06) and there was no difference in the prevalence of AT between males and females. There are differences in the prevalence of AT in different ages, sport events and characteristics of participants. This systematic review and meta-analysis suggested that it was necessary to pay more attention to AT in people who were older or engaged in gymnastics.
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The Burden and Risk Factors of Patellar and Achilles Tendinopathy in Youth Basketball: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189480. [PMID: 34574403 PMCID: PMC8470990 DOI: 10.3390/ijerph18189480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Abstract
This study aimed at evaluating the burden and risk factors of patellar and Achilles tendinopathy among youth basketball players. Patellar and Achilles tendinopathy were prospectively monitored in 515 eligible male and female youth basketball players (11–18 years) through a competitive season. Overall, the season prevalence of patellar tendinopathy was 19.0% (95% CI: 15.7–22.7%), 23.2% (95% CI: 18.6–28.2%) in males and 12.5% (95% CI: 8.3–17.9%) in females. The season prevalence of Achilles tendinopathy was 4.3% (95% CI: 2.7–6.4%), 4.1% (95% CI: 2.2–7.0%) in males and 4.5% (95% CI: 2.1–8.4%) in females. Median proportion of symptoms duration was 83% of average total weeks of basketball exposure for patellar tendinopathy and 75% for Achilles tendinopathy. Median time to patellar tendinopathy onset was 8 weeks for male players and 6 weeks for female players. Higher odds of patellar tendinopathy risk were seen in males (OR: 2.23, 95% CI: 1.10–4.69) and players with previous anterior knee pain had significantly elevated odds (OR: 8.5, 95% CI: 4.58–16.89). The burden and risk of patellar tendinopathy is high among competitive youth basketball players. Risk factors include sex and previous anterior knee pain. These findings provide directions for practice and future research.
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Lalumiere M, Perrino S, Nadeau MJ, Larivière C, Lamontagne M, Desmeules F, H. Gagnon D. To What Extent Do Musculoskeletal Ultrasound Biomarkers Relate to Pain, Flexibility, Strength, and Function in Individuals With Chronic Symptomatic Achilles Tendinopathy? FRONTIERS IN REHABILITATION SCIENCES 2021; 2:726313. [PMID: 36188777 PMCID: PMC9397971 DOI: 10.3389/fresc.2021.726313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 12/12/2022]
Abstract
Introduction: Achilles tendinopathy (AT) is a chronic musculoskeletal pathology best evaluated by ultrasound imaging. This cross-sectional study aimed at better understanding the relationship between musculoskeletal ultrasound biomarkers (MUBs) of Achilles tendon and localized pain, ankle flexibility, ankle strength, and functional abilities. Method: Forty-one participants with unilateral midportion chronic AT had their tendon images analyzed bilaterally in the longitudinal and transverse planes. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and Lower Extremity Functional Scale (LEFS) assessed pain and function, respectively, during standing and walking-related activities. Ankle flexibility was evaluated by weight-bearing lunge tests, while ankle isometric peak strength was measured using an instrumented dynamometer. Achilles tendon ultrasonographic images were analyzed using geometric (thickness), composition (echogenicity), and texture (homogeneity) MUBs. Discriminative validity was evaluated using paired Student's t-tests to compare MUBs between symptomatic and asymptomatic sides. Predictive validity was evaluated by computing the Pearson product-moment correlations coefficient between MUBs and pain, ankle flexibility, ankle strength, and function. Results: Significant differences were found in MUBs between the symptomatic and asymptomatic sides, confirming the discriminative validity of the selected MUBs. On the symptomatic side, thickness was found 29.9% higher (p < 0.001), echogenicity 9.6% lower (p < 0.001), and homogeneity 3.8% higher (p = 0.001) when compared with the asymptomatic side. However, predictive validity was scarcely confirmed, as most of the correlation coefficients were found negligible for the associations investigated between MUBs with localized pain, ankle flexibility, strength, and function. Only 14 statistically significant low to moderate associations were found, with negative and positive correlations ranging between −0.31 and −0.55 and between 0.34 and 0.54, respectively. Discussion: Musculoskeletal ultrasound biomarkers have a clinical utility in visualizing in vivo tendon integrity and diagnosing AT. MUBs should be valued as part of a comprehensive neuro-musculoskeletal assessment as they complement pain, flexibility, strength, and function measures. Altogether, they may inform the development and monitoring of a personalized rehabilitation treatment plan.
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Affiliation(s)
- Mathieu Lalumiere
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Sarah Perrino
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Christian Larivière
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, QC, Canada
| | | | - François Desmeules
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, QC, Canada
| | - Dany H. Gagnon
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- *Correspondence: Dany H. Gagnon orcid.org/0000-0003-3464-4667
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Bonanno J, Cheng J, Tilley D, Abutalib Z, Casey E. Factors Associated With Achilles Tendon Rupture in Women's Collegiate Gymnastics. Sports Health 2021; 14:358-368. [PMID: 34338076 DOI: 10.1177/19417381211034510] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Achilles injury risk in women's collegiate gymnastics is 10-fold higher than in all other collegiate sports. This study aims to identify risk factors for Achilles tendon ruptures in collegiate female gymnasts. HYPOTHESIS Gymnasts with Achilles tendon ruptures will be more likely to report early gymnastics specialization, elite-level training before college, and performance of high-difficulty skills on floor and vault. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 4. METHODS Anonymous surveys were distributed to current and former collegiate female gymnasts, aged 18 to 30 years, via coaches, athletic trainers, Twitter, and ResearchMatch. Information about Achilles tendon ruptures, gymnastics-related injuries, sport specialization, event/skills participation, and medication use were collected. RESULTS A total of 581 gymnasts were included. One hundred gymnasts (17.2%; 95% CI: 14.1%-20.3%) reported Achilles tendon ruptures during collegiate training or competition. Most ruptures (91%) occurred on floor exercise; 85.7% of these occurred during back tumbling-take-off. Compared with gymnasts without ruptures during college, a greater percentage of gymnasts with ruptures competed at a Division I program, trained elite, competed difficult vaults and floor passes before and during college, competed in all 4 events during college, identified as Black/African American, and used retinoid medications. CONCLUSION Achilles tendon ruptures are more common in women's collegiate gymnastics than other sports. Competing at the elite level, performing difficult floor and vault skills, and competing in all 4 events may increase the risk for an Achilles tendon rupture. Potential nontraining risk factors include retinoid exposure and Black/African American race. Future studies regarding the mechanisms of Achilles tendon ruptures in female collegiate gymnasts are warranted. CLINICAL RELEVANCE Collegiate gymnasts who compete at the elite level, perform high levels of difficulty on floor and vault, and compete in all 4 events may be at increased risk for Achilles tendon ruptures.
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Affiliation(s)
- Joseph Bonanno
- Department of Physiatry, Hospital for Special Surgery, New York, New York
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York
| | - Dave Tilley
- Champion PT and Performance, Waltham, Massachusetts
| | - Zafir Abutalib
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York
| | - Ellen Casey
- Department of Physiatry, Hospital for Special Surgery, New York, New York
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Explaining Variability in the Prevalence of Achilles Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals. J Orthop Sports Phys Ther 2021; 51:232-252. [PMID: 33779214 DOI: 10.2519/jospt.2021.9970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the prevalence of, and factors associated with, Achilles tendon abnormalities observed on imaging in asymptomatic individuals. DESIGN Systematic review with stratified meta-analysis and meta-regression. LITERATURE SEARCH Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science were searched from 1980 to August 2020. STUDY SELECTION CRITERIA We included studies that reported the prevalence of Achilles tendon abnormalities, observed with any imaging modality, in an asymptomatic population. We excluded studies if participant mean age was younger than 12 years or if participants had current/previous lower-limb tendon injuries/symptoms or other systemic conditions. DATA SYNTHESIS Random-effects proportion meta-analysis was used to estimate prevalence. We used meta-regression for continuous variables (mean age and body mass index [BMI], sample size, proportion of female participants) and stratified categorical variables (imaging modality and participation in physical activity) to explain between-study heterogeneity. RESULTS We included 91 studies (10 156 limbs, 5841 participants). The prevalence of Achilles tendon abnormalities on imaging ranged from 0% to 80% per participant. Between-study heterogeneity was high (I2>90%, P<.001), precluding data pooling. Between-study heterogeneity was partly explained by participant mean BMI (slope, 2.8% per 1-unit increase in BMI; 95% confidence interval: 0.57%, 5.03%; P = .015) and participation in physical activity per limb, and mean age of 40 years old or older (P = .022) per participant. CONCLUSION There was substantial variability in the prevalence of Achilles tendon abnormalities on imaging in asymptomatic individuals. Higher prevalence of abnormalities was associated with older age (40 years old or older), higher BMI, and participation in physical activity. A large proportion of heterogeneity remains unaccounted for, likely due to variations in abnormality definitions and study design. J Orthop Sports Phys Ther 2021;51(5):232-252. Epub 28 Mar 2021. doi:10.2519/jospt.2021.9970.
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Quack V, Betsch M, Hellmann J, Eschweiler J, Schrading S, Gatz M, Rath B, Tingart M, Laubach M, Kuhl CK, Dirrichs T. Evaluation of Postoperative Changes in Patellar and Quadriceps Tendons after Total Knee Arthroplasty-A Comprehensive Analysis by Shear Wave Elastography, Power Doppler and B-mode Ultrasound. Acad Radiol 2020; 27:e148-e157. [PMID: 31526688 DOI: 10.1016/j.acra.2019.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES Up to now, the diagnosis of tendinopathies is based on conventional B-mode-ultrasound (B-US), Power Doppler-ultrasound (PD-US), and magnetic resonance imaging. In the past decade, Shear Wave Elastography (SWE) has been introduced in tendon imaging, for example in athletes or patients suffering from tendinopathy. SWE allows real-time quantification of tissue stiffness, and, by this, the assessment of the mechanical properties of a tendon and its changes during acute disease and tendon healing. So far there are no ultrasound-based studies that have evaluated postoperative tendon changes, anatomical and mechanical properties and tendon healing of the patellar, and quadriceps tendon following Total Knee Arthroplasty (TKA). The purpose of this prospective study was two-fold: first to analyze morphologic, vascular, and mechanical properties of patellar and quadriceps tendons in patients following TKA; and, second to evaluate possible changes thereof and their visibility in the course of time. MATERIALS AND METHODS Observational cross-sectional, IRB-approved study in 63 postoperative patients with a total of 76 total knee arthroplasties (50 unilateral, 13 bilateral) and 50 nonoperated knees for comparison, resulting in 152 postoperative patellar- and quadriceps and 100 nonoperated patellar- and quadriceps-tendons for comparative analysis. For further examination, we divided the 63 patients into two groups according to the duration since surgery (group A < 24 months; group B > 24 months). All patients completed a standardized questionnaire, furthermore the Knee Society score and the Knee Society function score. The amount of experienced pain was assessed using the ordinal numeric rating scale and the presence of anterior knee pain was examined. Subsequently every participant underwent a standardized multimodal ultrasound protocol consisting of B-US, PD-US, and SWE of the left and right patellar and quadriceps tendons. RESULTS Using the different US-modalities, operated patellar, and quadriceps tendons (n = 152) were significantly more frequent classified as pathological (B-US) (p < 0.001), the mean Ohberg score was significantly higher (PD-US) (p < 0.001), and the tendons were significantly softer (SWE) than their nonoperated counterparts (n = 100). Mean SWE-value of postoperative patellar tendons was 45.66 ± 14.84 kPa versus 60.08 ± 19.13 kPa in nonoperated knees (p < 0.001). Mean SWE-value of postoperative quadriceps tendons was 35.73 ± 15.66 kPa versus 52.69 ± 16.20 kPa in nonoperated knees (p < 0.001). Comparing the two postoperative groups (group A and B), we recognized a significant decrease of pathologically classified patellar and quadriceps tendons (B-US and PD-US) in group B. The early postoperatively reduced SWE values slightly increased during the course of time. CONCLUSION After TKA, patellar, and quadriceps tendons show significant measurable alterations in B-US, PD-US, and SWE. Especially a significant decrease of tendon stiffness in operated knees, as assessed by SWE, might be a surrogate marker for changed mechanical properties. These alterations improve, the longer ago the surgery was. The quantitative information obtained by SWE could be of particular interest in follow-up and therapy monitoring after TKA. Knowledge about tendon stiffness and it's varieties in different population groups (e.g. athletes, elderly, postoperative patients) is crucial to sonographically rate a tendon as "healthy" or "diseased."
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Affiliation(s)
- Valentin Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Julian Hellmann
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Björn Rath
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Laubach
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
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Medeiros DM. Conservative treatment of Achilles tendon partial tear in a futsal player: A case report. Physiother Theory Pract 2019; 37:1158-1165. [PMID: 31661369 DOI: 10.1080/09593985.2019.1683924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and purpose: Achilles tendon is the most commonly injured part in the lower limb, especially in athletes. Treatment options for Achilles tendinopathy and total rupture are well described; however, there is a lack of information regarding treatment protocols for partial tears. Thus, the purpose of this case report was to describe the examination, intervention and outcomes of patient who suffered an acute Achilles tendon partial tear. Case description: A case is described here, in which the diagnosis of Achilles tendon partial tear was based on both magnetic resonance imaging and physical evaluation. Both the patient and the physical therapy team opted for non-surgical treatment. A 12-week course of conservative treatment including exercise, tendon loading, electrical stimulation, and photobiomodulation is described. Outcomes: Ankle dorsiflexion range of motion and hop tests. Discussion: This case report demonstrated that non-surgical treatment for Achilles tendon partial tear was effective for this patient and enabled the athlete to return to pre-injury levels of activity 6 months following the injury.
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Affiliation(s)
- Diulian Muniz Medeiros
- Graduate Program of Rehabilitation Sciences, Physical Therapy Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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15
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Abstract
OBJECTIVES To identify all studies of gymnastics injuries and assess injury rates, types, locations, and causes. METHODS Seven electronic and two grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data, and calculated average rates weighted by study size. RESULTS One study (n = 963) of three Olympic games (2008,2012,2016) provided injury rates for females of 86.4/1000gymnasts and males 79.9. For 29 databases one study of males (n = 64) provided a rate of 8.8 injuries/1000hours/AE (AE = athletic-exposure) and three of females varied rates (8.5, 9.4, and 91). Three studies for males (n = 153) provided a weighted average rate of 1.4 injuries/1000hours/training, and for females six studies (n = 476) 1.5 injuries. Four studies of males (n = 286) provided a weighted average of 678 injuries/1000gymnasts per year and eight studies of females (n = 1,764) a rate of 306. Of 19 surveys, eight provided rates for females (n = 1,463) of 596 injuries/gymnast per year and two for males (n = 40) a rate of 1,036. In the Olympics injuries were preponderately lower limb (63%) then trunk (23%) and upper limb (14%); injury type was sprains (35%) followed by tendinopathy/arthritis/impingements (17%), contusions (10%), and fractures (7%). Five database studies provided injury location data for 274 males: averages weighted by study size were upper extremity 42.8%, lower extremity 33.6%, torso/spine 11.8%, and head/neck 4.9% and 12 studies with 843 females provided average rates for lower extremity 51%, upper extremity 30.8%, torso/spine 13% and head/neck 0.8%. Official gymnastics organizations' websites provide no readily available data about injury rates or methods of prevention. CONCLUSIONS Studies need to collect comprehensive data for injury rates by training/competitions, gender, age, injury location/type/cause. Studies could assess whether trainers and physiotherapists monitoring gymnasts closely for injury risk would reduce injuries. Studies including randomized controlled trials (RCTs) of interventions in training, videotaping and performance feedback to reduce injury rates would be helpful.
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Affiliation(s)
- Roger Edmund Thomas
- a Department of Family Medicine , University of Calgary , Calgary , Alberta , Canada
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16
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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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17
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Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther 2018; 48:A1-A38. [PMID: 29712543 DOI: 10.2519/jospt.2018.0302] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.
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18
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Martin KD, Wake J, Dawson L, Van Buren JP. Cross-sectional Area of the Achilles Tendon in a Cohort of Elite Military Warriors Using Standard Ultrasound Techniques. Mil Med 2018; 183:e744-e747. [PMID: 29548031 DOI: 10.1093/milmed/usy019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kevin D Martin
- Evans Army Community Hospital, 1650 Cochran Circle, Ft Carson, CO
| | - Jeffrey Wake
- Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Road, Parker, CO
| | - Laura Dawson
- Keller Army Community Hospital, Building 900, Washington Road, West Point, NY
| | - J Preston Van Buren
- Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Road, Parker, CO
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19
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Legerlotz K. The Effects of Resistance Training on Health of Children and Adolescents With Disabilities. Am J Lifestyle Med 2018; 14:382-396. [PMID: 33281519 DOI: 10.1177/1559827618759640] [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] [Received: 09/26/2017] [Revised: 01/16/2018] [Accepted: 01/26/2018] [Indexed: 11/15/2022] Open
Abstract
Many parents still hesitate to encourage their children to participate in resistance training programs. This is unfortunate since recent research shows that resistance training can positively affect children's health. This narrative review aims to present an overview of the health-associated effects resistance training can provide particularly in children and adolescents with disabilities by describing its effects on muscle strength, physical function, mental health, self-concept, obesity, and injury prevention. To illustrate the variety of possible fields of application, the effects of resistance training in children and adolescents suffering from Charcot-Marie-Tooth disease, cerebral palsy, Down syndrome, Ehlers-Danlos syndrome, joint hypermobility, juvenile idiopathic arthritis, obesity, and spina bifida are discussed. Although randomized controlled trials with a sufficiently large sample size are rare, the research presented in this review indicates that this mode of training might be a potent tool to improve mental and physical health by improving muscle strength, body composition, self-concept or functionality, reducing pain or injury risk, and strengthening bone or tendons even in the most vulnerable groups of children with physical or mental disability. Furthermore, it has to be emphasized that compared with other types of treatment resistance training is considered to be without adverse effects.
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Affiliation(s)
- Kirsten Legerlotz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Germany
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20
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Opdam KTM, Baltes TPA, Zwiers R, Wiegerinck JJI, van Dijk CN. Endoscopic Treatment of Mid-Portion Achilles Tendinopathy: A Retrospective Case Series of Patient Satisfaction and Functional Outcome at a 2- to 8-Year Follow-up. Arthroscopy 2018; 34:264-269. [PMID: 28822636 DOI: 10.1016/j.arthro.2017.06.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the results of endoscopic treatment in patients affected by mid-portion Achilles tendinopathy, by release of the paratenon combined with a resection of the plantaris tendon, regarding patient satisfaction, functional outcome, and pain scores. METHODS This retrospective study evaluated patients endoscopically treated for mid-portion Achilles tendinopathy between 2000 and 2013. Patient satisfaction, functional outcome, pain scores, and health-related quality of life were measured by the use of a numeric rating scale, the Foot and Ankle Outcome Score, the Victorian Institute of Sport assessment for the Achilles tendon, the numeric rating scale for pain during running and during sports, and the EuroQol 5D (EQ-5D-3L) standardized questionnaire. Additional questions were asked on the effectiveness of the treatment and sport participation. RESULTS The response rate was 76.3% (45 of 59). Thirty-five (78%) patients were treated unilaterally and 10 (22%) patients were treated bilaterally. For the unilaterally treated patients, the median time to follow-up was 67 months (interquartile range [IQR] 48-99 months), and for the bilaterally treated patients, it was 89.5 months (IQR 37.5-161.75 months). The median satisfaction score for treatment results was 9 out of 10 (IQR 7-10) and 9.5 (IQR 7-10), respectively. The median Foot and Ankle Outcome Score subscales were scored 75 to 99 and 75 to 97, the median Victorian Institute of Sport assessment for the Achilles tendon scored 81 (IQR 47-90) and 97 (IQR 87-100), and the median numeric rating scale pain scores during both running and sports were 1 (IQR 0-6.5) for the unilaterally treated patients and 0 (IQR 0-4.5) and 0 (IQR 0-1) for the bilaterally treated patients, respectively. The median EQ-5D were 0.81 (IQR 0.71-1) and 1 (IQR 0.64-1), respectively. One reoperation for recurrence of symptoms was necessary. CONCLUSIONS This study shows high patient satisfaction and good functional outcomes in patients affected by mid-portion Achilles tendinopathy who were endoscopically treated by means of release of the paratenon in combination with transection of the plantaris tendon. LEVEL OF EVIDENCE Level IV, retrospective case series (therapeutic).
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Affiliation(s)
- Kim T M Opdam
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.
| | - Thomas P A Baltes
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Ruben Zwiers
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Jan Joost I Wiegerinck
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - C Niek van Dijk
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
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21
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Coombes BK, Tucker K, Vicenzino B, Vuvan V, Mellor R, Heales L, Nordez A, Hug F. Achilles and patellar tendinopathy display opposite changes in elastic properties: A shear wave elastography study. Scand J Med Sci Sports 2017; 28:1201-1208. [PMID: 28972291 DOI: 10.1111/sms.12986] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
To compare tendon elastic and structural properties of healthy individuals with those with Achilles or patellar tendinopathy. Sixty-seven participants (22 Achilles tendinopathy, 17 patellar tendinopathy, and 28 healthy controls) were recruited between March 2015 and March 2016. Shear wave velocity (SWV), an index of tissue elastic modulus, and tendon thickness were measured bilaterally at mid-tendon and insertional regions of Achilles and patellar tendons by an examiner blinded to group. Analysis of covariance, adjusted for age, body mass index, and sex was used to compare differences in tendon thickness and SWV between the two tendinopathy groups (relative to controls) and regions. Tendon thickness was included as a covariate for analysis of SWV. Compared to controls, participants with Achilles tendinopathy had lower SWV at the distal insertion (Mean difference MD; 95% CI: -1.56; -2.49 to -0.62 m/s; P < .001) and greater thickness at the mid-tendon (MD 0.19; 0.05-0.33 cm; P = .007). Compared to controls, participants with patellar tendinopathy had higher SWV at both regions (MD 1.25; 0.40-2.10 m/s; P = .005) and greater thickness proximally (MD 0.17; 0.06-0.29 cm; P = .003). Compared to controls, participants with Achilles and patellar tendinopathy displayed lower Achilles tendon elastic modulus and higher patellar tendon elastic modulus, respectively. More research is needed to explore whether maturation, aging, or chronic load underlie these findings and whether current management programs for Achilles and patellar tendinopathy need to be tailored to the tendon.
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Affiliation(s)
- B K Coombes
- School of Biomedical Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - K Tucker
- School of Biomedical Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - B Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - V Vuvan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - R Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - L Heales
- School of Human, Health and Social Science, Division of Physiotherapy, Central Queensland University, Rockhampton, Qld, Australia
| | - A Nordez
- Faculty of Sport Sciences, Laboratory "Movement, Interactions, Performance" (EA 4334), University of Nantes, Nantes, France
| | - F Hug
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia.,Faculty of Sport Sciences, Laboratory "Movement, Interactions, Performance" (EA 4334), University of Nantes, Nantes, France.,Institut Universitaire de France (IUF), Paris, France
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22
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Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current Concepts Review Update: Insertional Achilles Tendinopathy. Foot Ankle Int 2017; 38:1160-1169. [PMID: 28789557 PMCID: PMC5956523 DOI: 10.1177/1071100717723127] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Ruth L. Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Chris C. Cychosz
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Mederic M. Hall
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA,Department of Radiology, University of Iowa, Iowa City, IA, USA
| | - Phinit Phisitkul
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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23
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Krill MK, Borchers JR, Hoffman JT, Krill ML, Hewett TE. Effect of position, time in the season, and playing surface on Achilles tendon ruptures in NFL games: a 2009-10 to 2016-17 review. PHYSICIAN SPORTSMED 2017; 45:259-264. [PMID: 28617627 DOI: 10.1080/00913847.2017.1343652] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Achilles tendon (AT) ruptures are a potentially career-altering and ending injury. Achilles tendon ruptures have a below average return-to-play rate compared to other common orthopaedic procedures for National Football League (NFL) players. The objective of this study was to monitor the incidence and injury rates (IR) of AT ruptures that occurred during the regular season in order to evaluate the influence of player position, time of injury, and playing surface on rupture rates. METHODS A thorough online review was completed to identify published injury reports and public information regarding AT ruptures sustained during regular season and post-season games in the National Football League (NFL) during the 2009-10 to 2016-17 seasons. Team schedules, player position details and stadium information was used to determine period of the season of injury and playing surface. IRs were calculated per 100 team games (TG). Injury rate ratios (IRR) were utilized to compare IRs. RESULTS During eight monitored seasons, there were 44 AT ruptures in NFL games. A majority of AT ruptures were sustained in the first eight games of the regular season (n = 32, 72.7%). There was a significant rate difference for the first and second four-game segments of the regular season compared to the last two four-game segments of the regular season. Defensive players suffered a majority of AT ruptures (n = 32, 72.7%). The IR on grass was 1.00 per 100 TG compared to 1.08 per 100 TG on artificial turf (IRR: 0.93, p = .80). CONCLUSION A significant increase in AT ruptures occurred in the first and second four game segments of the regular season compared to the last two-four game segments of the regular season. Defensive players suffered a majority of AT ruptures compared to offensive or specialist players. There was no difference between AT rupture rates and playing surface in games.
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Affiliation(s)
- Michael K Krill
- a Motion Analysis and Performance Laboratory, Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA.,b Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA
| | - James R Borchers
- c Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA.,d Department of Family Medicine , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Joshua T Hoffman
- a Motion Analysis and Performance Laboratory, Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Matthew L Krill
- a Motion Analysis and Performance Laboratory, Jameson Crane Sports Medicine Institute , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Timothy E Hewett
- e Sports Medicine Center , Mayo Clinic , Rochester , MN , USA.,f Department of Orthopedic Surgery , Mayo Clinic , Rochester , MN , USA.,g Department of Biomedical Engineering and Physiology , Mayo Clinic , Rochester , MN , USA.,h Department of Physical Medicine & Rehabilitation , Mayo Clinic , Rochester , MN , USA
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24
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Michelsen B, Diamantopoulos AP, Soldal DM, Hammer HB, Kavanaugh A, Haugeberg G. Achilles enthesitis defined by ultrasound is not associated with clinical enthesitis in patients with psoriatic arthritis. RMD Open 2017; 3:e000486. [PMID: 28879054 PMCID: PMC5574441 DOI: 10.1136/rmdopen-2017-000486] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/31/2017] [Accepted: 06/25/2017] [Indexed: 01/01/2023] Open
Abstract
Objective To compare clinical and ultrasonographic (US) evaluation of Achilles enthesitis in patients with psoriatic arthritis (PsA). Methods The Achilles insertion of outpatients with PsA was examined by clinical assessment of tenderness and US evaluation of (1) inflammatory activity (defined as the presence of power Doppler signal, tendon thickening and/or hypoechogenicity) and (2) structural damage (defined as the presence of erosions, calcifications and/or enthesophytes). Univariate and multivariate logistic regression analyses were performed0.4 to explore the associations between clinical characteristics and US scores. Results 282 Achilles tendons in 141 patients with PsA were assessed. Mean (SD) age was 52.4 (10.2) years, disease duration 9.5 (6.6) years and 50.4% were females. Palpatory tenderness was found in 88 (31.2%), US-verified inflammatory activity in 46 (16.3%) and structural damage in 148 (52.5%) of the Achilles. Total US scores, as well as their components, were similar for patients with and without palpatory tenderness. None of the clinical characteristics were associated with inflammatory activity. Age, body mass index (BMI), regular physical exercise and current use of biological disease-modifying antirheumatic drugs (bDMARDs) were associated with structural damage. Conclusion There appears to be a lack of association between clinical and US signs of Achilles enthesitis in PsA. Age, BMI, regular physical exercise and current use of bDMARDs were associated with structural damage on US.
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Affiliation(s)
- Brigitte Michelsen
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | | | - Arthur Kavanaugh
- Department of Rheumatology, Allergy and Immunology, University of California, San Diego, USA
| | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway.,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, Martina Hansens Hospital, Oslo, Norway
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25
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Lanfranchi MA, Leluc O, Tavano A, Wormser C, Morange S, Chagnaud C, Pradel V, Lafforgue P, Pham T. Are Ultrasound Findings Similar in Patients with Axial Spondyloarthritis and in Athlete Entheses? J Rheumatol 2017; 44:609-612. [PMID: 28250140 DOI: 10.3899/jrheum.160715] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Enthesitis is the spondyloarthritis (SpA) landmark, but can also be seen after entheses overuse, such as during intensive sport. METHODS We aimed to compare entheses ultrasound (US) findings in a prospective cross-sectional study of 30 axial SpA cases, 30 athletes, and 29 controls. RESULTS Mean (SD) MAdrid Sonographic Enthesis Index (MASEI) score was 26.3 (13), 12.2 (7), and 10.4 (6) in patients with SpA, athletes, and non-athlete control groups, respectively (p < 0.0001). CONCLUSION The MASEI score was significantly higher in patients with SpA compared with healthy controls, athletes, and non-athletes, and can be of value to distinguish SpA from healthy subjects, whatever their physical activity.
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Affiliation(s)
- Marie-Alix Lanfranchi
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Olivier Leluc
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Alice Tavano
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Cécile Wormser
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Sophie Morange
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Christophe Chagnaud
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Vincent Pradel
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Pierre Lafforgue
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France.,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University
| | - Thao Pham
- From the Assistance Publique-Hôpitaux de Marseille (APHM), CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; CHU Conception, Radiology Department, Clinical Investigation Center; CHU Sainte Marguerite, Public Health Department; Aix-Marseille University, Marseille, France. .,M.A. Lanfranchi, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; O. Leluc, MD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; A. Tavano, MD, APHM, CHU Conception, Radiology Department; C. Wormser, MD, APHM, CHU Conception, Radiology Department; S. Morange, MD, APHM, CHU Conception, Clinical Investigation Center; C. Chagnaud, MD, PhD, APHM, CHU Conception, Radiology Department, Aix-Marseille University; V. Pradel, MD, APHM, CHU Sainte Marguerite, Public Health Department, Aix-Marseille University; P. Lafforgue, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University; T. Pham, MD, PhD, APHM, CHU Sainte Marguerite, Rheumatology Department, Aix-Marseille University.
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Sanz-López F, Berzosa Sánchez C, Hita-Contreras F, Cruz-Diaz D, Martínez-Amat A. Ultrasound Changes in Achilles Tendon and Gastrocnemius Medialis Muscle on Squat Eccentric Overload and Running Performance. J Strength Cond Res 2016; 30:2010-8. [PMID: 26677829 DOI: 10.1519/jsc.0000000000001298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sanz-López, F, Berzosa Sánchez, C, Hita-Contreras, F, Cruz-Diaz, D, and Martínez-Amat, A. Ultrasound changes in Achilles tendon and gastrocnemius medialis muscle on squat eccentric overload and running performance. J Strength Cond Res XX(X): 000-000, 2015-Previous studies have proven the adaptation to load in the Achilles tendon and gastrocnemius muscle after different types of exercise, such as running, heel drop training, and a variety of sports. These findings have been applied to improve performance and in the treatment and prevention of overuse injuries. However, the effects that squat performance may have on the Achilles tendon and gastrocnemius muscle are still unknown. Squats are a widely used training exercise that involves calf-muscle activation. Similarly, no reports have been published regarding the adaptation to load of trained and untrained subjects during several consecutive days of running. The purpose of this study was to analyze changes in the Achilles tendon and in the pennation angles of the gastrocnemius medialis after eccentric overload training and within 3 days of running. Twenty healthy males who volunteered for this study were divided into 2 groups. Subjects in the eccentric overload training (ECC) group performed 6 weeks of eccentric overload training (twice weekly, 4 sets of 7 repetitions in a Yoyo squat device) before the running intervention. All participants, ECC and control (CONT) groups, ran on 3 consecutive days. After the eccentric training, an increase in the cross-sectional area of the Achilles tendon and in the pennation angle was observed. As for the running intervention, the behavior of tissues in both groups was similar. These results suggest that eccentric overload training with squats promotes changes in the Achilles tendon and in the pennation angle of the gastrocnemius medialis muscle. Nevertheless, significant changes in the tissue do not appear between the running performance of trained and untrained subjects.
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Affiliation(s)
- Fernando Sanz-López
- 1ValorA Research Group, Health Sciences Faculty, Universidad San Jorge, Zaragoza, Spain; 2Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain; and 3Research Group CTS-026 "Study Group on Physical Activity, Physiotherapy and Health"
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Bedi HS, Jowett C, Ristanis S, Docking S, Cook J. Plantaris Excision and Ventral Paratendinous Scraping for Achilles Tendinopathy in an Athletic Population. Foot Ankle Int 2016; 37:386-93. [PMID: 26637273 DOI: 10.1177/1071100715619989] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Achilles tendinopathy is a frequent problem in high-level athletes. Recent research has proposed a combined etiologic role for the plantaris tendon and neovascularization. Both pathologies can be observed on ultrasound imaging.(1,13) However, little is known about the change in structure of the Achilles tendon following the surgical treatment of these issues. The purpose of the study was to assess if excising the plantaris and performing ventral paratendinous "scraping" of the neovascularization improved symptoms of Achilles tendinopathy and whether there was a change in the fibrillar structure of the tendon with ultrasound tissue characterization (UTC) following this operation. METHODS This prospective consecutive case series included 15 professional/semiprofessional athletes (17 Achilles tendons) who underwent plantaris excision and paratendinous scraping to treat noninsertional Achilles tendinopathy. The plantaris tendon was excised if adherent to the Achilles tendon, and the area of neovascularization for scraping was demarcated on preoperative imaging. Preoperative and postoperative Victorian Institute of Sports Assessment-Achilles (VISA-A) scores were taken. UTC was performed on 11 of 17 tendons preoperatively and postoperatively. The mean follow-up was for 25 months. RESULTS Fourteen of 15 patients had a successful outcome after the surgery. The mean VISA-A improved from 51 to 95 (p=.0001). There was a statistically significant (p=.04) improvement in the aligned fibrillar structure of the tendon confirmed with UTC scanning following surgery from 90% (±8) to 96% (±5). CONCLUSION This group of high-level athletes derived an excellent clinical result from this operation. Furthermore, UTC scanning offered an objective method to evaluate the healing of Achilles tendons. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Charlie Jowett
- Foot and Ankle fellow, The Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Sean Docking
- Monash Tendon Research group (MONSTERs), Monash University, Victoria, Australia; Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia
| | - Jill Cook
- LaTrobe University, Victoria, Australia
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Hopkins C, Fu SC, Chua E, Hu X, Rolf C, Mattila VM, Qin L, Yung PSH, Chan KM. Critical review on the socio-economic impact of tendinopathy. Asia Pac J Sports Med Arthrosc Rehabil Technol 2016; 4:9-20. [PMID: 29264258 PMCID: PMC5730665 DOI: 10.1016/j.asmart.2016.01.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 12/16/2022] Open
Abstract
There are currently no studies that determine the total burden that tendinopathy places on patients and society. A systematic search was conducted to understand the impact of tendinopathy. It demonstrated that the current prevalence is underestimated, particularly in active populations, such as athletes and workers. Search results demonstrate that due to the high prevalence, impact on patients' daily lives and the economic impact due to work-loss, treatments are significantly higher than currently observed. A well-accepted definition by medical professionals and the public will improve documentation and increase awareness, in order to better tackle the disease burden.
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Affiliation(s)
- Chelsea Hopkins
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eldrich Chua
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaorui Hu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christer Rolf
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Ville M. Mattila
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Ling Qin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Translational Medicine Research and Development Centre, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ooi CC, Schneider ME, Malliaras P, Chadwick M, Connell DA. Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: comparison with B-mode ultrasound and color Doppler imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:15-25. [PMID: 25438847 DOI: 10.1016/j.ultrasmedbio.2014.08.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/15/2014] [Accepted: 08/24/2014] [Indexed: 06/04/2023]
Abstract
This primary aim of this study was to evaluate the diagnostic performance of axial-strain sonoelastography (ASE), B-mode ultrasound (US) and color Doppler US in confirming clinically symptomatic Achilles tendinopathy. The secondary aim was to establish the relationship between the strain ratio during sonoelastography and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores. The VISA-A questionnaire is a validated clinical rating scale that evaluates the symptoms and dysfunction of the Achilles tendon. One hundred twenty Achilles tendons of 120 consecutively registered patients with clinical symptoms of Achilles tendinopathy and another 120 gender- and age-matched, asymptomatic Achilles tendons of 120 healthy volunteers were assessed with B-mode US, ASE and color Doppler US. Symptomatic patients had significantly higher strain ratio scores and softer Achilles tendon properties compared with controls (p < 0.001). The strain ratio was moderately correlated with VISA-A scores (r = -0.62, p < 0.001). The diagnostic accuracy of B-mode US, ASE and color Doppler US in confirming clinically symptomatic Achilles tendinopathy was 94.7%, 97.8% and 82.5% respectively. There was excellent correlation between the clinical reference standard and the grade of tendon quality on ASE (κ = 0.91, p < 0.05), compared with B-mode US (κ = 0.74, p < 0.05) and color Doppler imaging (κ = 0.49, p < 0.05). ASE is an accurate clinical tool in the evaluation of Achilles tendinopathy, with results comparable to those of B-mode US and excellent correlation with clinical findings. The strain ratio may offer promise as a supplementary tool for the objective evaluation of Achilles tendon properties.
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Affiliation(s)
- Chin Chin Ooi
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Melbourne, Victoria, Australia; Department of Diagnostic Radiology, Singapore General Hospital, Singapore; Imaging at Olympic Park, Melbourne, Victoria, Australia.
| | - Michal Elisabeth Schneider
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Melbourne, Victoria, Australia
| | - Peter Malliaras
- Imaging at Olympic Park, Melbourne, Victoria, Australia; Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and the London, School of Medicine and Dentistry, Queen Mary, University of London, United Kingdom
| | | | - David Alister Connell
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Melbourne, Victoria, Australia; Imaging at Olympic Park, Melbourne, Victoria, Australia
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Cassel M, Baur H, Hirschmüller A, Carlsohn A, Fröhlich K, Mayer F. Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes. Scand J Med Sci Sports 2014; 25:e310-8. [PMID: 25212527 DOI: 10.1111/sms.12318] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/26/2022]
Abstract
Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0 ± 1.9 years; 160 ± 13 cm; 50 ± 14 kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8% and patellar tendinopathy in 5.8%. Vascularizations were visible in 3.0% of ATs and 11.4% of PTs, hypoechogenicities in 0.7% and 3.2% as well as hyperechogenicities in 0% and 0.3%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (P ≤ 0.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (P ≤ 0.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy.
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Affiliation(s)
- M Cassel
- University Outpatient Clinic, Department Sports Medicine, University of Potsdam, Potsdam, Germany
| | - H Baur
- Applied Research and Development Physiotherapy, Health Section, Bern University of Applied Sciences, Bern, Switzerland
| | - A Hirschmüller
- Department of Orthopaedics and Traumatology, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - A Carlsohn
- Institute of Health Sciences, University of Education Schwäbisch Gmünd, Schwäbisch Gmünd, Germany
| | - K Fröhlich
- University Outpatient Clinic, Department Sports Medicine, University of Potsdam, Potsdam, Germany
| | - F Mayer
- University Outpatient Clinic, Department Sports Medicine, University of Potsdam, Potsdam, Germany
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Pingel J, Harrison A, Simonsen L, Suetta C, Bülow J, Langberg H. The microvascular volume of the Achilles tendon is increased in patients with tendinopathy at rest and after a 1-hour treadmill run. Am J Sports Med 2013; 41:2400-8. [PMID: 23940204 DOI: 10.1177/0363546513498988] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Achilles tendinopathy (AT) is initiated asymptomatically and is therefore often discovered at a very late stage. PURPOSE To elucidate whether the microvascular volume (MV) of the Achilles tendon is elevated in patients with AT compared with healthy controls during pre-exercise rest, after acute exercise, and 24 hours after exercise. Additionally, this study investigated the muscle activation pattern of the gastrocnemius muscle and the relative elasticity of the Achilles tendon during a 1-hour treadmill run in healthy patients and in patients with AT. STUDY DESIGN Controlled laboratory study. METHODS Real-time harmonic contrast-enhanced ultrasound (CEU) measurements of the MV of the Achilles tendon were taken in 18 volunteers (9 patients with AT, 9 healthy controls). The CEU analyses were conducted before exercise, immediately after a 1-hour treadmill run, and 24 hours after exercise. Surface electromyography (EMG) signals of the gastrocnemius were recorded continuously during the 1-hour treadmill run. RESULTS In both the controls and the patients with AT, the MV of the Achilles tendon was increased after exercise as compared with before exercise (P < .005). Additionally, the MV signal was significantly larger in the patients with AT before, immediately after, and 24 hours after the running exercise compared with values in healthy controls (P < .0001). The muscle activation pattern differed in patients with AT compared with controls in that controls had increased EMG amplitudes at the end of the 1-hour treadmill run in the medial and lateral gastrocnemius (P < .0001). Moreover, patients with AT had approximately 15% less elastic Achilles tendons at the beginning of the 1-hour treadmill run, a condition that did not change because of exercise. CONCLUSION Acute exercise increases the MV of the Achilles tendon in healthy patients and patients with AT in a similar manner. However, patients with AT have a significantly larger MV at all time points compared with healthy patients, supporting the hypothesis that microvascular changes may be involved in the pathogenesis of tendinopathy. CLINICAL RELEVANCE This study underlines that tendon flexibility is altered in patients with AT and that CEU is a promising tool to establish the early diagnosis of this condition.
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Affiliation(s)
- Jessica Pingel
- Jessica Pingel, Institute of Sports Medicine, University of Copenhagen, Bispebjerg Bakke 23, Building 8, 1st Floor, DK-2400 Copenhagen, Denmark.
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Notarnicola A, Maccagnano G, Di Leo M, Tafuri S, Moretti B. Overload and neovascularization of Achilles tendons in young artistic and rhythmic gymnasts compared with controls: an observational study. Musculoskelet Surg 2013; 98:115-20. [PMID: 23716192 DOI: 10.1007/s12306-013-0275-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
The incidence of Achilles tendinopathy is very high in young female gymnasts (17.5 %). According to literature, ecography screenings show the tendons thickening, but at the same time it does not reveal a direct link to the clinical picture. The neovessels are involved in the pathophysiological process of Achilles tendinopathy. For this reason, we wanted to verify there between perfusion tendon values and the type of sport activity. We performed a clinical observational study monitoring the oximetry of the Achilles tendon and the epidemiological data of 52 elite female (artistic and rhythmic) gymnasts versus 21 age-matched controls. Analyzing the main limb, we revealed statistically higher oximetry values in the artistic gymnasts group (69.5 %) compared to the rhythmic gymnasts group (67.1 %) (t = 2.13; p = 0.01) and the sedentary group (66.2 %) (t = 2.70; p = 0.004), but we did not find any differences between rhythmic gymnasts group and the sedentary group (t = 0.68; p = 0.24). The multiple logistic regression model highlighted that the oximetry value of the main limb is not influenced by age, knowledge of the main limb, years of general and gymnastic sports activity (p > 0.05). We discovered an increase of Achilles tendon perfusion in the main limb in the artistic gymnast group. We hypothesize that specific figures of artistic sports activity are responsible for muscle overload and gastrocnemius-soleus group and, at the same time, these figures cause hyperperfusion of the tendon. Prospective longitudinal studies could explain if this could become a predictive sign of the next Achilles tendinopathy onset.
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Affiliation(s)
- A Notarnicola
- Course of Motor and Sports Sciences, Faculty of Medicine and Surgery, University of Study of Bari, Lungomare Starita 1, 70123, Bari, Italy,
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Wearing SC, Hooper SL, Grigg NL, Nolan G, Smeathers JE. Overweight and obesity alters the cumulative transverse strain in the Achilles tendon immediately following exercise. J Bodyw Mov Ther 2012; 17:316-21. [PMID: 23768275 DOI: 10.1016/j.jbmt.2012.11.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/26/2012] [Accepted: 11/07/2012] [Indexed: 11/20/2022]
Abstract
This research evaluated the effect of obesity on the acute cumulative transverse strain of the Achilles tendon in response to exercise. Twenty healthy adult males were categorized into 'low normal-weight' (BMI <23 kg m(-2)) and 'overweight' (BMI >27.5 kg m(-2)) groups based on intermediate cut-off points recommended by the World Health Organization. Longitudinal sonograms of the right Achilles tendon were acquired immediately prior and following weight-bearing ankle exercises. Achilles tendon thickness was measured 20-mm proximal to the calcaneal insertion and transverse tendon strain was calculated as the natural log of the ratio of post- to pre-exercise tendon thickness. The Achilles tendon was thicker in the overweight group both prior to (t18 = -2.91, P = 0.009) and following (t18 = -4.87, P < 0.001) exercise. The acute transverse strain response of the Achilles tendon in the overweight group (-10.7 ± 2.5%), however, was almost half that of the 'low normal-weight' (-19.5 ± 7.4%) group (t18 = -3.56, P = 0.004). These findings suggest that obesity is associated with structural changes in tendon that impairs intra-tendinous fluid movement in response to load and provides new insights into the link between tendon pathology and overweight and obesity.
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Affiliation(s)
- Scott C Wearing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland 4229, Australia.
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Yim ES, Corrado G. Ultrasound in sports medicine: relevance of emerging techniques to clinical care of athletes. Sports Med 2012; 42:665-80. [PMID: 22712843 DOI: 10.2165/11632680-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The applications of ultrasound in managing the clinical care of athletes have been expanding over the past decade. This review provides an analysis of the research that has been published regarding the use of ultrasound in athletes and focuses on how these emerging techniques can impact the clinical management of athletes by sports medicine physicians. Electronic database literature searches were performed using the subject terms 'ultrasound' and 'athletes' from the years 2003 to 2012. The following databases were searched: PubMed, Web of Science, Cochrane Library, CINAHL, and SPORTDiscus™. The search produced 617 articles in total, with a predominance of articles focused on cardiac and musculoskeletal ultrasound. 266 of the studies involved application of ultrasound in evaluating the cardiovascular properties of athletes, and 151 studies involved musculoskeletal ultrasound. Other applications of ultrasound included abdominal, vascular, bone density and volume status. New techniques in echocardiography have made significant contributions to the understanding of the physiological changes that occur in the athlete's heart in response to the haemodynamic stress associated with different types of activity. The likely application of these techniques will be in managing athletes with hypertrophic cardiomyopathy, and the techniques are near ready for application into clinical practice. These techniques are highly specialized, however, and will require referral to dedicated laboratories to influence the clinical management of athletes. Investigation of aortic root pathology and pulmonary vascular haemodynamics are also emerging, but will require additional studies with larger numbers and outcomes analysis to validate their clinical utility. Some of these techniques are relatively simple, and thus hold the potential to enter clinical management in a point-of-care fashion. Musculoskeletal ultrasound has demonstrated a number of diagnostic and therapeutic techniques applicable to pathology of the shoulder, elbow, wrist, hand, hip, knee and ankle. These techniques have been applied mainly to the management of impingement syndromes, tendinopathies and arthritis. Many of these techniques have been validated and have entered clinical practice, while more recently developed techniques (such as dynamic ultrasound and platelet-rich plasma injections) will require further research to verify efficacy. Research in musculoskeletal ultrasound has also been helpful in identifying risk factors for injury and, thus, serving as a focus for developing interventions. Research in abdominal ultrasound has investigated the potential role of ultrasound imaging in assessing splenomegaly in athletes with mononucleosis, in an attempt to inform decisions and policies regarding return to play. Future research will have to demonstrate a reduction in adverse events in order to justify the application of such a technique into policy. The role of ultrasound in assessing groin pain and abdominal pain in ultraendurance athletes has also been investigated, providing promising areas of focus for the development of treatment interventions and physical therapy. Finally, preliminary research has also identified the role of ultrasound in addressing vascular disease, bone density and volume status in athletes. The potential applications of ultrasound in athletes are broad, and continuing research, including larger outcome studies, will be required to establish the clinical utility of these techniques in the care of athletes.
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Affiliation(s)
- Eugene Sun Yim
- Division of Sports Medicine, Childrens Hospital Boston, Boston, MA 02115, USA.
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Patterson-Kane JC, Becker DL, Rich T. The pathogenesis of tendon microdamage in athletes: the horse as a natural model for basic cellular research. J Comp Pathol 2012; 147:227-47. [PMID: 22789861 DOI: 10.1016/j.jcpa.2012.05.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 05/14/2012] [Indexed: 12/30/2022]
Abstract
The equine superficial digital flexor tendon (SDFT) is a frequently injured structure that is functionally and clinically equivalent to the human Achilles tendon (AT). Both act as critical energy-storage systems during high-speed locomotion and can accumulate exercise- and age-related microdamage that predisposes to rupture during normal activity. Significant advances in understanding of the biology and pathology of exercise-induced tendon injury have occurred through comparative studies of equine digital tendons with varying functions and injury susceptibilities. Due to the limitations of in-vivo work, determination of the mechanisms by which tendon cells contribute to and/or actively participate in the pathogenesis of microdamage requires detailed cell culture modelling. The phenotypes induced must ultimately be mapped back to the tendon tissue environment. The biology of tendon cells and their matrix, and the pathological changes occurring in the context of early injury in both horses and people are reviewed, with a particular focus on the use of various tendon cell and tissue culture systems to model these events.
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Affiliation(s)
- J C Patterson-Kane
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Bearsden Road, Glasgow G61 1QH, UK.
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Grigg NL, Wearing SC, Smeathers JE. Achilles tendinopathy has an aberrant strain response to eccentric exercise. Med Sci Sports Exerc 2012; 44:12-7. [PMID: 21659896 DOI: 10.1249/mss.0b013e318227fa8c] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Eccentric exercise has become the treatment of choice for Achilles tendinopathy. However, little is known about the acute response of tendons to eccentric exercise or the mechanisms underlying its clinical benefit. This research evaluated the sonographic characteristics and acute anteroposterior (AP) strain response of control (healthy), asymptomatic, and symptomatic Achilles tendons to eccentric exercise. METHODS Eleven male adults with unilateral midportion Achilles tendinopathy and nine control male adults without tendinopathy participated in the research. Sagittal sonograms of the Achilles tendon were acquired immediately before and after completion of a common eccentric rehabilitation exercise protocol and again 24 h later. Tendon thickness, echogenicity, and AP strain were determined 40 mm proximal to the calcaneal insertion. RESULTS Compared with the control tendon, both the asymptomatic and symptomatic tendons were thicker (P < 0.05) and hypoechoic (P < 0.05) at baseline. All tendons decreased in thickness immediately after eccentric exercise (P < 0.05). The symptomatic tendon was characterized by a significantly lower AP strain response to eccentric exercise compared with both the asymptomatic and control tendons (P < 0.05). AP strains did not differ in the control and asymptomatic tendons. For all tendons, preexercise thickness was restored 24 h after exercise completion. CONCLUSIONS These observations support the concept that Achilles tendinopathy is a bilateral or systemic process and structural changes associated with symptomatic tendinopathy alter fluid movement within the tendon matrix. Altered fluid movement may disrupt remodeling and homeostatic processes and represents a plausible mechanism underlying the progression of tendinopathy.
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Affiliation(s)
- Nicole L Grigg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
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Reliability of sonographic assessment of tendinopathy in tennis elbow. Skeletal Radiol 2012; 41:83-9. [PMID: 21384199 DOI: 10.1007/s00256-011-1132-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/25/2011] [Accepted: 02/13/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the reliability and compute the minimum detectable change using sonographic scales to quantify the extent of pathology and hyperaemia in the common extensor tendon in people with tennis elbow. MATERIALS AND METHODS The lateral elbows of 19 people with tennis elbow were assessed sonographically twice, 1-2 weeks apart. Greyscale and power Doppler images were recorded for subsequent rating of abnormalities. Tendon thickening, hypoechogenicity, fibrillar disruption and calcification were each rated on four-point scales, and scores were summed to provide an overall rating of structural abnormality; hyperaemia was scored on a five point scale. Inter-rater reliability was established using the intraclass correlation coefficient (ICC) to compare scores assigned independently to the same set of images by a radiologist and a physiotherapist with training in musculoskeletal imaging. Test-retest reliability was assessed by comparing scores assigned by the physiotherapist to images recorded at the two sessions. The minimum detectable change (MDC) was calculated from the test-retest reliability data. RESULTS ICC values for inter-rater reliability ranged from 0.35 (95% CI: 0.05, 0.60) for fibrillar disruption to 0.77 (0.55, 0.88) for overall greyscale score, and 0.89 (0.79, 0.95) for hyperaemia. Test-retest reliability ranged from 0.70 (0.48, 0.84) for tendon thickening to 0.82 (0.66, 0.90) for overall greyscale score and 0.86 (0.73, 0.93) for calcification. The MDC for the greyscale total score was 2.0/12 and for the hyperaemia score was 1.1/5. CONCLUSION The sonographic scoring system used in this study may be used reliably to quantify tendon abnormalities and change over time. A relatively inexperienced imager can conduct the assessment and use the rating scales reliably.
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Evolution of the Achilles tendon: The athlete's Achilles heel? Foot (Edinb) 2011; 21:193-7. [PMID: 21900004 DOI: 10.1016/j.foot.2011.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 08/11/2011] [Indexed: 02/04/2023]
Abstract
The Achilles tendon is believed to have first developed two million years ago enabling humans to run twice as fast. However if the Achilles tendon is so important in terms of evolution, then why is this tendon so prone to injury - especially for those more active like athletes. The Achilles tendon had an integral role in evolving apes from a herbivorous diet to early humans who started hunting for food over longer distances, resulting in bipedal locomotion. Evolutionary advantages of the Achilles tendon includes it being the strongest tendon in the body, having an energy-saving mechanism for fast locomotion, allows humans to jump and run, and additionally is a spring and shock absorber during gait. Considering these benefits it is therefore not surprising that studies have shown athletes have thicker Achilles tendons than subjects who are less active. However, contradictory to these findings that show the importance of the Achilles tendon for athletes, it is well known that obtaining an Achilles tendon injury for an athlete can be career-altering. A disadvantage of the Achilles tendon is that the aetiology of its pathology is complicated. Achilles tendon ruptures are believed to be caused by overloading the tensed tendon, like during sports. However studies have also shown athlete Achilles tendon ruptures to have degenerative changes in the tendon. Other flaws of the Achilles tendon are its non-uniform vascularity and incomplete repair system which may suggest the Achilles tendon is on the edge of evolution. Research has shown that there is a genetic influence on the predisposition a person has towards Achilles tendon injuries. So if this tendon is here to stay in our anatomy, and it probably is due to the slow rate of evolution in humans, research in genetic modification could be used to decrease athletes' predisposition to Achilles tendinopathy.
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van Sterkenburg MN, Kerkhoffs GMMJ, van Dijk CN. Good outcome after stripping the plantaris tendon in patients with chronic mid-portion Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 2011; 19:1362-6. [PMID: 21541711 DOI: 10.1007/s00167-011-1514-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 04/12/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE Achilles tendinopathy is a problem that is generally difficult to treat. The pain is frequently most prominent on the medial side of the mid-portion of the tendon, where the plantaris tendon is running parallel to the Achilles tendon. The purpose of this study was to assess whether excision of the plantaris tendon would relieve symptoms. METHODS Three patients with pain and stiffness at the mid-portion of the Achilles tendon were treated by excision of the plantaris tendon. Preoperatively, these patients experienced recognizable tenderness on palpation of the medial side of the mid-portion of the Achilles tendon with localized nodular thickening at 4-7 cm proximal to the insertion. MRI indicated Achilles tendinopathy with the involvement of the plantaris tendon. RESULTS The plantaris tendon was bluntly retrieved and excised with a tendon stripper through a 4-cm incision in the proximal calf. We report a good-to-excellent outcome of this novel procedure in three patients with chronic mid-portion Achilles tendinopathy CONCLUSION The medial pain might be based on the involvement of the plantaris tendon in the process. LEVEL OF EVIDENCE IV.
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Wearing SC, Grigg NL, Hooper SL, Smeathers JE. Conditioning of the Achilles tendon via ankle exercise improves correlations between sonographic measures of tendon thickness and body anthropometry. J Appl Physiol (1985) 2011; 110:1384-9. [PMID: 21393469 DOI: 10.1152/japplphysiol.00075.2011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although conditioning is routinely used in mechanical tests of tendon in vitro, previous in vivo research evaluating the influence of body anthropometry on Achilles tendon thickness has not considered its potential effects on tendon structure. This study evaluated the relationship between Achilles tendon thickness and body anthropometry in healthy adults both before and after resistive ankle plantarflexion exercise. A convenience sample of 30 healthy male adults underwent sonographic examination of the Achilles tendon in addition to standard anthropometric measures of stature and body weight. A 10-5 MHz linear array transducer was used to acquire longitudinal sonograms of the Achilles tendon, 20 mm proximal to the tendon insertion. Participants then completed a series (90-100 repetitions) of conditioning exercises against an effective resistance between 100% and 150% body weight. Longitudinal sonograms were repeated immediately on completion of the exercise intervention, and anteroposterior Achilles tendon thickness was determined. Achilles tendon thickness was significantly reduced immediately following conditioning exercise (t = 9.71, P < 0.001), resulting in an average transverse strain of -18.8%. In contrast to preexercise measures, Achilles tendon thickness was significantly correlated with body weight (r = 0.72, P < 0.001) and to a lesser extent height (r = 0.45, P = 0.01) and body mass index (r = 0.63, P < 0.001) after exercise. Conditioning of the Achilles tendon via resistive ankle exercises induces alterations in tendon structure that substantially improve correlations between Achilles tendon thickness and body anthropometry. It is recommended that conditioning exercises, which standardize the load history of tendon, are employed before measurements of sonographic tendon thickness in vivo.
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Affiliation(s)
- Scott C Wearing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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van Sterkenburg MN, Kerkhoffs GMMJ, Kleipool RP, Niek van Dijk C. The plantaris tendon and a potential role in mid-portion Achilles tendinopathy: an observational anatomical study. J Anat 2011; 218:336-41. [PMID: 21323916 PMCID: PMC3058219 DOI: 10.1111/j.1469-7580.2011.01335.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2010] [Indexed: 12/28/2022] Open
Abstract
The source of pain and the background to the pain mechanisms associated with mid-portion Achilles tendinopathy have not yet been clarified. Intratendinous degenerative changes are most often addressed when present. However, it is questionable if degeneration of the tendon itself is the main cause of pain. Pain is often most prominent on the medial side, 2-7cm from the insertion onto the calcaneus. The medial location of the pain has been explained to be caused by enhanced stress on the calcaneal tendon due to hyperpronation. However, on this medial side the plantaris tendon is also located. It has been postulated that the plantaris tendon might play a role in these medially located symptoms. To our knowledge, the exact anatomy and relationship between the plantaris- and calcaneal tendon at the level of complaints have not been anatomically assessed. This was the purpose of our study. One-hundred and seven lower extremities were dissected. After opening the superficial fascia and paratendon, the plantaris tendon was bluntly released from the calcaneal tendon moving distally. The incidence of the plantaris tendon, its course, site of insertion and possible connections were documented. When with manual force the plantaris tendon could not be released, it was defined as a 'connection' with the calcaneal tendon. In all specimens a plantaris tendon was identified. Nine different sites of insertion were found, mostly medial and fan-shaped onto the calcaneus. In 11 specimens (10%) firm connections were found at the level of the calcaneal tendon mid-portion. Clinical and histological studies are needed to confirm the role of the plantaris tendon in mid-portion Achilles tendinopathy.
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van Sterkenburg MN, van Dijk CN. Injection treatment for chronic midportion Achilles tendinopathy: do we need that many alternatives? Knee Surg Sports Traumatol Arthrosc 2011; 19:513-5. [PMID: 21290104 PMCID: PMC3062026 DOI: 10.1007/s00167-011-1415-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M. N. van Sterkenburg
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands
| | - C. N. van Dijk
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, 1100 DE Amsterdam, The Netherlands
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van Sterkenburg MN, de Jonge MC, Sierevelt IN, van Dijk CN. Less promising results with sclerosing ethoxysclerol injections for midportion achilles tendinopathy: a retrospective study. Am J Sports Med 2010; 38:2226-32. [PMID: 20601592 DOI: 10.1177/0363546510373467] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Local injections of the sclerosing substance polidocanol (Ethoxysclerol) have shown good clinical results in patients with chronic midportion Achilles tendinopathy. After training by the inventors of the technique, sclerosing Ethoxysclerol injections were applied on a group of patients in our center. HYPOTHESIS Sclerosing Ethoxysclerol injections will yield good results in the majority of patients. STUDY DESIGN Case series; Level of evidence, 4. METHODS In 113 patients (140 tendons) with Achilles tendinopathy, we identified 62 patients (70 tendons) showing neovascularization on color Doppler ultrasound. Fifty-three Achilles tendons (48 patients) were treated with sclerosing Ethoxysclerol injections, with intervals of 6 weeks and a maximum of 5 sessions. Treatment was completed when neovascularization or pain had disappeared, or when there was no positive treatment effect after 3 to 4 sessions. RESULTS Forty-eight patients (20 women and 28 men) with a median age of 45 years, (range, 33-68 years) were treated. Median symptom duration was 23 months (range, 3-300 months). Fifty-three tendons were treated with a median of 3 sessions of Ethoxysclerol injections. Six weeks after the last injection, 35% of patients had no complaints, 9% had minimal symptoms, 42% were the same, and 14% had more complaints. Women were 3.8 times (95% confidence interval: 1.1-13.8) more likely to have unsatisfactory outcome than men. Pain correlated positively with neovessels on ultrasound (P < .01). At 2.7 to 5.1 year follow-up, 53% had received additional (surgical/conservative) treatment; 3 of these patients (7.5%) still had complaints of Achilles tendinopathy. In 6 patients, complaints that were still present 6 weeks after treatment had resolved spontaneously by final follow-up. CONCLUSION Our study did not confirm the high beneficial value of sclerosing neovascularization in patients with midportion Achilles tendinopathy. Despite the retrospective design of our study, we consider it important to stress that injection of Ethoxysclerol may not be as promising as was thought.
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Affiliation(s)
- Maayke N van Sterkenburg
- Academic Medical Center, Department of Orthopaedic Surgery, G4-262, PO Box 22700, 1100 DE Amsterdam, The Netherlands.
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Divani K, Chan O, Padhiar N, Twycross-Lewis R, Maffulli N, Crisp T, Morrissey D. Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon Achilles tendinopathy. ACTA ACUST UNITED AC 2010; 15:463-8. [PMID: 20427222 DOI: 10.1016/j.math.2010.03.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 03/18/2010] [Accepted: 03/24/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neovascularisation is associated with pain in Achilles tendinopathy (AT). The anatomical relationship between ultrasound (US)-defined indicators of tendinopathy and clinically determined pain sites has not been investigated. PURPOSE To measure the spatial correlation between the sites of maximum palpated tenderness, site of patient-indicated pain, maximum US-determined neovascularisation and maximum antero-posterior tendon thickness in patients with chronic recalcitrant AT (CRAT). METHODS A custom-designed measuring apparatus and clinical examination were used to measure the sites of maximum tenderness and subjectively defined pain on 29 tendons from patients diagnosed with mid-tendon CRAT. All tendons had been previously non-responsive to eccentric loading. Maximal neovascularisation and tendon thickness were measured by US scanning in conjunction with the measuring device. RESULTS A significant association exists between clinically determined pain and neovascularisation (r = 0.85, p < 0.001), patient reported pain (r = 0.91, p < 0.001), maximal tendon thickness (r = 0.91, p < 0.001), maximal thickness and maximal neovascularisation (r = 0.86, p < 0.001). CONCLUSION Sites of subjectively defined pain, clinically palpated tenderness, tendon thickness and neovascularisation are anatomically associated. Palpation can be reliably used as a clinical guide when planning interventions in patients with CRAT.
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Affiliation(s)
- Kiran Divani
- Centre for Sports and Exercise Medicine, Mile End Hospital, London E14DG, United Kingdom
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