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Zellers JA, Li R, Vaidya R, Lohse K, North A, Cui S, Houston B, Chen M, Zheng J, Baxter J. Minimal effect of scanning parameters on ultrasound shear wave elastography variability in tendons. Knee Surg Sports Traumatol Arthrosc 2024; 32:2431-2439. [PMID: 39031721 PMCID: PMC11368612 DOI: 10.1002/ksa.12325] [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: 01/09/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Ultrasound shear wave elastography has potential use in assessing tendon tissue; however, reducing measurement variability remains challenging. The primary purpose of this study was to identify the amount of variability accounted for by ultrasound parameter (frequency, harmonics and CrossXBeam) settings on shear wave speed at two testing sites. METHODS Shear wave elastography images of the Achilles tendon were obtained from individuals with healthy tendons (n = 28) at two testing sites with standardised image acquisition/postprocessing protocols. Images were acquired at a range of frequencies (7-15 MHz) with CrossXBeam (a filtering technique) and harmonics settings toggled on and off. Variance decomposition analysis was performed to identify the amount of variability in shear wave speed accounted for by scan acquisition settings and testing sites. RESULTS Shear wave speed variance was primarily attributed to participants (56.87% of variance; residual error: 35%). All scanning parameters, testing site and interaction terms each accounted for less than 2.5% of the variance. A statistically significant, negative relationship was observed between shear wave speed and image quality (p = 0.001) suggesting poor image quality yields higher shear wave speed estimates. CONCLUSION The findings of this study suggest that natural variation in Achilles tendon mechanics between individuals without tendon pathology accounts for most of the shear wave speed variability. Optimising image quality, which may be observed in higher frequencies, should be considered to improve shear wave speed estimation. Clinically, this study highlights the need to take multiple images, maintain consistent ultrasound settings when tracking patient progress over time and use caution when comparing raw values from tendon scans performed in different clinics with shear wave elastography. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Ran Li
- Mallinkrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Rachana Vaidya
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Andrew North
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephane Cui
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Bryson Houston
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Menghan Chen
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jie Zheng
- Mallinkrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Josh Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tobaly D, Tétreault P, Cloutier G, Choinière M, Grondin P, Freire V, Julien AS, Bureau NJ. Assessing the treatment response of lateral elbow tendinopathy using time-dependent ultrasonography, Doppler imaging, and elastography. Insights Imaging 2024; 15:113. [PMID: 38734857 PMCID: PMC11088583 DOI: 10.1186/s13244-024-01695-8] [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: 02/09/2024] [Accepted: 04/13/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE To investigate the structural alterations, neovascularity, and elasticity of tendons and the relationship between elasticity and the Patient Rated Tennis Elbow Evaluation score after undergoing US-guided fenestration or surgery in patients with chronic lateral elbow tendinopathy. METHODS Participants from the per-protocol population of a randomized trial conducted between October 2016 and June 2020 were included. The surgery and fenestration groups included 24 (mean age, 50 ± 7 years [standard deviation], 10 men) and 29 (47 ± 8 years, 18 men) participants, respectively. Ultrasound exams were performed at baseline, 6 months, and 12 months. Statistical analyses included linear mixed effects and generalized equation estimation models. RESULTS Fenestration had no significant impact on tendon thickness (p = 0.46). Conversely, surgery significantly increased tendon thickness at 6 months (p < 0.0001) and remained elevated at 12 months (p = 0.04). Tendon echostructure exhibited a group effect (p = 0.03), indicating a higher proportion of pathological scores in the surgery group post-intervention compared to the fenestration group. Both groups showed a similar reduction in neovascularity from 6 to 12 months postintervention (p = 0.006). Shear-wave velocity increased in the fenestration group at 6 months (p = 0.04), while the surgery group experienced a nonsignificant decrease at 6 months, with some improvement at 12 months (p = 0.08). Changes in shear-wave velocity did not correlate with clinical outcome. CONCLUSIONS Fenestration and surgery reduced tendon neovascularity over time. Unlike surgery, fenestration did not impact tendon size while improving tendon echostructure and elasticity. CRITICAL RELEVANCE STATEMENT Fenestration and surgery equally alleviated symptoms and decreased tendon neovascularity in lateral elbow tendinopathy; however, fenestration did not alter tendon thickness and improved echostructure and shear-wave velocity, suggesting shear-wave velocity's potential for quantitatively monitoring tendon elasticity during healing. KEY POINTS Reliable markers for monitoring healing response and informing treatment protocols in elbow tendinopathy are lacking. Fenestration and surgery reduced tendon neovascularity, while fenestration improved tendon echostructure and shear-wave velocity. Shear-wave velocity may provide quantitative measures to monitor tendon elasticity in response to treatment.
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Affiliation(s)
- David Tobaly
- Department of Radiology, St Mary's Hospital Center, 3830 Lacombe Avenue, Montreal, QC, H3T 1M5, Canada
| | - Patrice Tétreault
- Department of Orthopedics, Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montreal, QC, H2X 0C1, Canada
| | - Guy Cloutier
- Research Center, Centre hospitalier de l'Université de Montréal (CHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
| | - Manon Choinière
- Research Center, Centre hospitalier de l'Université de Montréal (CHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada
- Department of Anesthesiology and Pain Medicine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Philippe Grondin
- Department of Orthopedics, Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montreal, QC, H2X 0C1, Canada
| | - Véronique Freire
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montreal, QC, H2X 0C1, Canada
| | - Anne-Sophie Julien
- Department of Mathematics and Statistic, Université Laval, 1045 avenue de la Médecine, Quebec City, QC, G1V 0A6, Canada
| | - Nathalie J Bureau
- Research Center, Centre hospitalier de l'Université de Montréal (CHUM), 900 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.
- Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), 1000 rue Saint-Denis, Montreal, QC, H2X 0C1, Canada.
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McNish R, Lohse K, Pruthi S, Hastings MK, Zheng J, Zellers JA. Achilles tendon assessment on quantitative MRI: Sources of variability and relationships to tendinopathy. Scand J Med Sci Sports 2024; 34:e14650. [PMID: 38712745 PMCID: PMC11081531 DOI: 10.1111/sms.14650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024]
Abstract
Quantitative MRI (qMRI) measures are useful in assessing musculoskeletal tissues, but application to tendon has been limited. The purposes of this study were to optimize, identify sources of variability, and establish reproducibility of qMRI to assess Achilles tendon. Additionally, preliminarily estimates of effect of tendon pathology on qMRI metrics and structure-function relationships between qMRI measures and ankle performance were examined. T1, T1ρ, T2, and T2* maps of the Achilles tendon were obtained using a 3T MRI scanner. In participants with asymptomatic tendons (n = 21), MRI procedures were repeated twice, and region of interest selection was performed by three raters. Variance decomposition and reproducibility statistics were completed. To estimate the effect of pathology, qMRI measures from individuals with asymptomatic tendons were compared to qMRI measures from a pilot group of individuals with Achilles tendinopathy (n = 7). Relationships between qMRI and ankle performance measures were assessed. Between-participant variation accounted for the majority of variability (46.7%-64.0%) in all qMRI measures except T2*. ICCs met or exceeded 0.7 for all qMRI measures when averaged across raters or scans. Relaxation times were significantly longer in tendinopathic tendons (mean (SD) T1: 977.8 (208.6) ms, T1ρ: 35.4 (7.1) ms, T2: 42.8 (7.9) ms, T2*: 14.1 (7.6) ms, n = 7) compared to asymptomatic control tendons (T1: 691.7 (32.4) ms, T1ρ: 24.0 (3.6) ms, T2: 24.4 (7.5) ms, T2*: 9.5 (3.4) ms, n = 21) (p < 0.011 for all comparisons). T1 related to functional performance measures in symptomatic and asymptomatic groups. Study findings suggest that qMRI is reliable to assess the Achilles tendon. qMRI quantitatively assesses the presence of tendon pathology and relates to functional performance outcomes, supporting the utility of incorporating qMRI in research and clinic.
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Affiliation(s)
- Reika McNish
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Saksham Pruthi
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Sukanen M, Khair RM, Ihalainen JK, Laatikainen-Raussi I, Eon P, Nordez A, Finni T. Achilles tendon and triceps surae muscle properties in athletes. Eur J Appl Physiol 2024; 124:633-647. [PMID: 37950761 PMCID: PMC10858159 DOI: 10.1007/s00421-023-05348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE The aim of this study was to investigate internal Achilles tendon (AT) displacement, AT shear wave velocity (SWV), and triceps surae (TS) muscle shear modulus in athletes. METHODS Internal AT displacement was assessed using ultrasound during isometric contraction. Shear wave elastography was used to assess AT SWV (m × s-1) at rest and TS muscle shear modulus (kPa) during passive ankle dorsiflexion. RESULTS A total of 131 athletes participated in this study. Athletes who had not exercised within two days had greater AT non-uniformity and mean anterior tendon displacement, and lower SWV at the proximal AT measurement site (mean difference [95% CI]: 1.8 mm [0.6-2.9], p = 0.003; 1.6 mm [0.2-2.9], p = 0.021; - 0.9 m × s-1 [- 1.6 to - 0.2], p = 0.014, respectively). Male basketball players had a lower mean AT displacement compared to gymnasts (- 3.7 mm [- 6.9 to - 0.5], p = 0.042), with the difference localised in the anterior half of the tendon (- 5.1 mm [- 9.0 to - 1.1], p = 0.022). Male gymnasts had a smaller absolute difference in medial gastrocnemius-minus-soleus shear modulus than basketball players (59.6 kPa [29.0-90.2], p < 0.001) and track and field athletes (52.7 kPa [19.2-86.3], p = 0.004). Intraclass correlation coefficients of measurements ranged from 0.720 to 0.937 for internal AT displacement, from 0.696 to 0.936 for AT SWE, and from 0.570 to 0.890 for TS muscles. CONCLUSION This study provides a reliability assessment of muscle and tendon SWV. The relative differences in passive TS muscle shear modulus suggest sport-specific adaptation. Importantly, in healthy individuals, lower AT displacement after exercise may reflect the time required for tendon recovery.
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Affiliation(s)
- Maria Sukanen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Ra'ad M Khair
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Johanna K Ihalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | - Pauline Eon
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, F-44000, Nantes, France
| | - Antoine Nordez
- Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, F-44000, Nantes, France
- Institut Universitaire de France, Paris, France
| | - Taija Finni
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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5
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Dickson DM, Smith SL, Hendry GJ. Association between quadriceps tendon elasticity and neuromuscular control in individuals with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2024; 111:106159. [PMID: 38101187 DOI: 10.1016/j.clinbiomech.2023.106159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Knee osteoarthritis is a complex condition with established risk factors such as female sex, increasing age and body mass index, reduced quadriceps muscle strength and knee injury. Despite known associated risks, the role and behaviour of knee tendons in knee osteoarthritis remains unclear. This study explores the association between quadriceps tendon elasticity, muscle strength, neuromuscular control, proprioception and patient reported outcome measures in individuals with knee osteoarthritis. METHODS Adults with doctor-diagnosed knee osteoarthritis were recruited from rheumatology clinics and general practitioner practices. Quadriceps tendon elasticity was estimated using sonoelastography. Neuromuscular control data including electromyography, electromechanical delay and proprioception measures were included. Participants completed the Knee Injury and Osteoarthritis Outcome Score. Associations between elasticity values, physical and neuromuscular data and patient reported outcomes scores were evaluated using Spearman's correlations. FINDINGS Thirty-nine adults with knee osteoarthritis were eligible for inclusion. Increased tendon stiffness was negatively associated with rate of force development, time to half peak force and passive positioning sense in individuals with knee osteoarthritis. Similarly, patient reported symptoms were found to be associated with sonoelastography findings with moderate-strong associations observed between activities of daily living sport and recreation, pain and symptoms and between neuromuscular control measures and muscle strength. INTERPRETATION Stiffer tendon identified within the knee osteoarthritis group was associated with reduced neuromuscular control and knee joint proprioception. Stiffer quadriceps tendon may contribute to the poorer reported symptoms by knee osteoarthritis individuals. These findings may impact disease symptoms and progression which could lead to further joint impairment.
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Affiliation(s)
- Diane M Dickson
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK.
| | - Stephanie L Smith
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK; Pain Centre Versus Arthritis, Academic Rheumatology, Injury Recovery and Inflammation Sciences, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham NG5 1PB, UK
| | - Gordon J Hendry
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK
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6
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Kriener K, Whiting H, Storr N, Homes R, Lala R, Gabrielyan R, Kuang J, Rubin B, Frails E, Sandstrom H, Futter C, Midwinter M. Applied use of biomechanical measurements from human tissues for the development of medical skills trainers: a scoping review. JBI Evid Synth 2023; 21:2309-2405. [PMID: 37732940 DOI: 10.11124/jbies-22-00363] [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: 09/22/2023]
Abstract
OBJECTIVE The objective of this review was to identify quantitative biomechanical measurements of human tissues, the methods for obtaining these measurements, and the primary motivations for conducting biomechanical research. INTRODUCTION Medical skills trainers are a safe and useful tool for clinicians to use when learning or practicing medical procedures. The haptic fidelity of these devices is often poor, which may be because the synthetic materials chosen for these devices do not have the same mechanical properties as human tissues. This review investigates a heterogeneous body of literature to identify which biomechanical properties are available for human tissues, the methods for obtaining these values, and the primary motivations behind conducting biomechanical tests. INCLUSION CRITERIA Studies containing quantitative measurements of the biomechanical properties of human tissues were included. Studies that primarily focused on dynamic and fluid mechanical properties were excluded. Additionally, studies only containing animal, in silico , or synthetic materials were excluded from this review. METHODS This scoping review followed the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Sources of evidence were extracted from CINAHL (EBSCO), IEEE Xplore, MEDLINE (PubMed), Scopus, and engineering conference proceedings. The search was limited to the English language. Two independent reviewers screened titles and abstracts as well as full-text reviews. Any conflicts that arose during screening and full-text review were mediated by a third reviewer. Data extraction was conducted by 2 independent reviewers and discrepancies were mediated through discussion. The results are presented in tabular, figure, and narrative formats. RESULTS Data were extracted from a total of 186 full-text publications. All of the studies, except for 1, were experimental. Included studies came from 33 countries, with the majority coming from the United States. Ex vivo methods were the predominant approach for extracting human tissue samples, and the most commonly studied tissue type was musculoskeletal. In this study, nearly 200 unique biomechanical values were reported, and the most commonly reported value was Young's (elastic) modulus. The most common type of mechanical test performed was tensile testing, and the most common reason for testing human tissues was to characterize biomechanical properties. Although the number of published studies on biomechanical properties of human tissues has increased over the past 20 years, there are many gaps in the literature. Of the 186 included studies, only 7 used human tissues for the design or validation of medical skills training devices. Furthermore, in studies where biomechanical values for human tissues have been obtained, a lack of standardization in engineering assumptions, methodologies, and tissue preparation may implicate the usefulness of these values. CONCLUSIONS This review is the first of its kind to give a broad overview of the biomechanics of human tissues in the published literature. With respect to high-fidelity haptics, there is a large gap in the published literature. Even in instances where biomechanical values are available, comparing or using these values is difficult. This is likely due to the lack of standardization in engineering assumptions, testing methodology, and reporting of the results. It is recommended that journals and experts in engineering fields conduct further research to investigate the feasibility of implementing reporting standards. REVIEW REGISTRATION Open Science Framework https://osf.io/fgb34.
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Affiliation(s)
- Kyleigh Kriener
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Harrison Whiting
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, Royal Brisbane Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Nicholas Storr
- Gold Coast University Hospital, Southport, QLD Australia
| | - Ryan Homes
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Raushan Lala
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Robert Gabrielyan
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Jasmine Kuang
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Bryn Rubin
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
- Ochsner Clinical School, Jefferson, LA, United States
| | - Edward Frails
- Department of Chemical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Hannah Sandstrom
- Department of Exercise Science and Sport Management, Kennesaw State University, Kennesaw, GA, United States
| | - Christopher Futter
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Anaesthesia and Intensive Care Program, Herston Biofabrication institute, Brisbane, QLD, Australia
| | - Mark Midwinter
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
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Alabau-Dasi R, Dominguez-Maldonado G, Gijon-Nogueron G, Ortega-Avila AB, Delacroix S. How susceptible are our Achilles Tendons? Sonoanatomical assessment. A cross-sectional study. J Tissue Viability 2023; 32:572-576. [PMID: 37722941 DOI: 10.1016/j.jtv.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE the aim of this study is to observe whether there are ultrasound changes between men and women in the Achilles tendon at rest, at maximum passive force is applied and during walking. MATERIAL AND METHODS it was a cross-sectional study involving 27 healthy young participants recruited as volunteers between April to July 2022. A variety of data was recorded: (age, Body Mass Index, sex, smoking, current injury status, allergies, medications, previous surgeries, type of sport, and number of weekly workouts) and ultrasound measurements at rest and at passive force (Cross Sectional Area Achilles Tendon length, tendon thickness, Cross Sectional Area and pennation angle of the soleus muscle to the Achilles Tendon). RESULTS women demonstrated a statistically significant lower proximal and median thickness both at rest (4.5 vs 5.1 mm with p < 0.001 for proximal thickness; 4.4 vs 5.3 mm with p < 0.001 for median thickness) as well as during maximum eccentric contraction (4.3 vs 4.8 mm with p=<0.001 for proximal thickness; 4.1 vs 4.8 mm with p < 0.001 for median thickness). CONCLUSION there are significant sonoanatomical differences in vivo Achilles tendon between men and women.
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Affiliation(s)
- Raquel Alabau-Dasi
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain.
| | - Gabriel Dominguez-Maldonado
- Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Universidad de Sevilla, Departamento de Podología, Spain.
| | - Gabriel Gijon-Nogueron
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain; Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA platform BIONAND, Malaga, Spain.
| | - Ana Belen Ortega-Avila
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain; Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA platform BIONAND, Malaga, Spain.
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8
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Zellers JA, Edalati M, Eekhoff JD, McNish R, Tang SY, Lake SP, Mueller MJ, Hastings MK, Zheng J. Quantative MRI predicts tendon mechanical behavior, collagen composition, and organization. J Orthop Res 2023; 41:2329-2338. [PMID: 36324161 PMCID: PMC10151441 DOI: 10.1002/jor.25471] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/06/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
Quantitative magnetic resonance imaging (qMRI) measures have provided insights into the composition, quality, and structure-function of musculoskeletal tissues. Low signal-to-noise ratio has limited application to tendon. Advances in scanning sequences and sample positioning have improved signal from tendon allowing for evaluation of structure and function. The purpose of this study was to elucidate relationships between tendon qMRI metrics (T1, T2, T1ρ and diffusion tensor imaging [DTI] metrics) with tendon tissue mechanics, collagen concentration and organization. Sixteen human Achilles tendon specimens were collected, imaged with qMRI, and subjected to mechanical testing with quantitative polarized light imaging. T2 values were related to tendon mechanics [peak stress (rsp = 0.51, p = 0.044), equilibrium stress (rsp = 0.54, p = 0.033), percent relaxation (rsp = -0.55, p = 0.027), hysteresis (rsp = -0.64, p = 0.007), linear modulus (rsp = 0.67, p = 0.009)]. T1ρ had a statistically significant relationship with percent relaxation (r = 0.50, p = 0.048). Collagen content was significantly related to DTI measures (range of r = 0.56-0.62). T2 values from a single slice of the midportion of human Achilles tendons were strongest predictors of tendon tensile mechanical metrics. DTI diffusivity indices (mean diffusivity, axial diffusivity, radial diffusivity) were strongly correlated with collagen content. These findings build on a growing body of literature supporting the feasibility of qMRI to characterize tendon tissue and noninvasively measure tendon structure and function. Statement of Clinical Significance: Quantitative MRI can be applied to characterize tendon tissue and is a noninvasive measure that relates to tendon composition and mechanical behavior.
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Affiliation(s)
- Jennifer A. Zellers
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Masoud Edalati
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
| | - Jeremy D. Eekhoff
- Department of Biomedical Engineering; Washington University in St. Louis
| | - Reika McNish
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
| | - Simon Y. Tang
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Spencer P. Lake
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
- Department of Mechanical Engineering & Materials Science; Washington University in St. Louis
| | - Michael J. Mueller
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
| | - Mary K. Hastings
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Jie Zheng
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
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Obrecht M, Zurbruegg S, Accart N, Lambert C, Doelemeyer A, Ledermann B, Beckmann N. Magnetic resonance imaging and ultrasound elastography in the context of preclinical pharmacological research: significance for the 3R principles. Front Pharmacol 2023; 14:1177421. [PMID: 37448960 PMCID: PMC10337591 DOI: 10.3389/fphar.2023.1177421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/16/2023] [Indexed: 07/18/2023] Open
Abstract
The 3Rs principles-reduction, refinement, replacement-are at the core of preclinical research within drug discovery, which still relies to a great extent on the availability of models of disease in animals. Minimizing their distress, reducing their number as well as searching for means to replace them in experimental studies are constant objectives in this area. Due to its non-invasive character in vivo imaging supports these efforts by enabling repeated longitudinal assessments in each animal which serves as its own control, thereby enabling to reduce considerably the animal utilization in the experiments. The repetitive monitoring of pathology progression and the effects of therapy becomes feasible by assessment of quantitative biomarkers. Moreover, imaging has translational prospects by facilitating the comparison of studies performed in small rodents and humans. Also, learnings from the clinic may be potentially back-translated to preclinical settings and therefore contribute to refining animal investigations. By concentrating on activities around the application of magnetic resonance imaging (MRI) and ultrasound elastography to small rodent models of disease, we aim to illustrate how in vivo imaging contributes primarily to reduction and refinement in the context of pharmacological research.
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Affiliation(s)
- Michael Obrecht
- Diseases of Aging and Regenerative Medicines, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Stefan Zurbruegg
- Neurosciences Department, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Nathalie Accart
- Diseases of Aging and Regenerative Medicines, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Christian Lambert
- Diseases of Aging and Regenerative Medicines, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Arno Doelemeyer
- Diseases of Aging and Regenerative Medicines, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Birgit Ledermann
- 3Rs Leader, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Nicolau Beckmann
- Diseases of Aging and Regenerative Medicines, Novartis Institutes for BioMedical Research, Basel, Switzerland
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Faria A, Gabriel R, Brás R, Moreira H, Soares M, Ditroilo M. Free-oscillation technique: The effect of the magnitude of the impulse applied on muscle and tendon stiffness around the ankle. PLoS One 2023; 18:e0286847. [PMID: 37327246 PMCID: PMC10275422 DOI: 10.1371/journal.pone.0286847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/24/2023] [Indexed: 06/18/2023] Open
Abstract
The importance of the muscle-tendon complex in sport and for activities of everyday living is well recognised. The free oscillation technique is frequently used to determine the musculo-articular "apparent" stiffness (obtained from vertical ground reaction force) and other parameters. However, an in-depth understanding of the muscle-tendon complex can be gained by separating the muscle (soleus) and the tendon (Achilles tendon) components and studying the "true" stiffness for each of these components (by considering the ankle joint moment arms), which can be valuable in improving our understanding of training, injury prevention, and recovery programs. Hence, this study aimed to investigate if muscle and tendon stiffness (i.e., "true" stiffness) are similarly affected by different impulse magnitudes when using the free-oscillation technique. Three impulse magnitudes (impulse 1, 2 and 3), corresponding to peak forces of 100, 150 and 200 N, were used to estimate the stiffness of the ankle joint in 27 males, using multiple loads (10, 15, 20, 25, 30, 35, and 40 kg). A significant decrease (p < 0.0005) was found in musculo-articular "apparent" stiffness (29224 ± 5087 N.m-1; 27839 ± 4914 N.m-1; 26835 ± 4880 N.m-1) between impulses 1, 2 and 3 respectively, when loads were collapsed across groups. However, significant differences (p < 0.001) were only found between the median (Mdn) of impulse 1 (Mdn = 564.31 (kN/m)/kN) and 2 (Mdn = 468.88 (kN/m)/kN) and between impulse 1 (Mdn = 564.31 (kN/m)/kN) and 3 (Mdn = 422.19 (kN/m)/kN), for "true" muscle stiffness, but not for "true" tendon stiffness (Mdn = 197.35 kN/m; Mdn = 210.26 kN/m; Mdn = 201.60 kN/m). The results suggest that the musculo-articular "apparent" stiffness around the ankle joint is influenced by the magnitude of the impulse applied. Interestingly, this is driven by muscle stiffness, whereas tendon stiffness appears to be unaffected.
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Affiliation(s)
- Aurélio Faria
- Department of Sport Sciences, CIDESD, University of Beira Interior, Covilhã, Portugal
| | - Ronaldo Gabriel
- Department of Sport Sciences, Exercise and Health – CITAB, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Rui Brás
- Department of Sport Sciences, CIDESD, University of Beira Interior, Covilhã, Portugal
| | - Helena Moreira
- Department of Sport Sciences, Exercise and Health - CIDESD, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Márcio Soares
- Department of Sport Sciences, CIDESD, University of Beira Interior, Covilhã, Portugal
| | - Massimiliano Ditroilo
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Freedman BR, Mooney DJ, Weber E. Advances toward transformative therapies for tendon diseases. Sci Transl Med 2022; 14:eabl8814. [PMID: 36070365 PMCID: PMC11041812 DOI: 10.1126/scitranslmed.abl8814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Approved therapies for tendon diseases have not yet changed the clinical practice of symptomatic pain treatment and physiotherapy. This review article summarizes advances in the development of novel drugs, biologic products, and biomaterial therapies for tendon diseases with perspectives for translation of integrated therapies. Shifting from targeting symptom relief toward disease modification and prevention of disease progression may open new avenues for therapies. Deep evidence-based clinical, cellular, and molecular characterization of the underlying pathology of tendon diseases, as well as therapeutic delivery optimization and establishment of multidiscipline interorganizational collaboration platforms, may accelerate the discovery and translation of transformative therapies for tendon diseases.
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Affiliation(s)
- Benjamin R. Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - David J. Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
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12
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Macaluso B, Hassan CR, Swanson DR, Nazemi A, Zaverukha E, Paulus M, Qin YX, Komatsu DE. Biomechanical Comparison of Krackow Repair and Percutaneous Achilles Repair System for Achilles Tendon Rupture Fixation: A Cadaveric and Finite Element Analysis Study. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221088502. [PMID: 35386585 PMCID: PMC8978323 DOI: 10.1177/24730114221088502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Open and percutaneous repair surgeries are widely used for the Achilles tendon rupture. However, prior biomechanic studies of these 2 approaches have mixed conclusions; therefore, we designed a cadaver and finite element (FE) model biomechanical study to compare the mechanical differences between the percutaneous Achilles repair system (PARS) and Krackow open repair under tensile load and rotation. Methods Sixteen Achilles tendons were extracted from fresh-frozen cadaver ankles and the calcaneums were fixed in mortar. A force control dynamic tensile mechanical test was performed at 1 Hz with 30- and 100-N cyclic loads. Initial intact baseline testing was followed by an incision on all Achilles tendons, 4 cm from the calcaneus insertion, which were then repaired using the PARS (n = 8) or Krackow (n = 8) method. Recorded force-displacement values were used to calculate mechanical parameters, and statistical significance of differences was determined by unpaired (between repair techniques) and paired (intact vs repaired) t tests. Material properties of the Achilles tendon in the FE model were modified and a 10-Nm flexion was simulated for intact and surgical groups. Results No differences were found between intact tendons assigned to PARS or Krackow repairs in Young's modulus (P = .582) and stiffness (P = .323). Pre- and postoperative Young's modulus was significantly decreased for both groups (Intact 230.60±100.76 MPa vs PARS 142.44±37.37 MPa, P < .012; Intact 207.46±81.12 MPa vs Krackow109.43±27.63 MPa, P < .002). Stiffness decreased significantly after surgery for both groups (Intact 25.33±10.89 N/mm vs PARS 6.51±1.68 N/mm, P < .003; Intact 20.30±8.65 N/mm vs Krackow 5.97±1.30 N/mm, P < .003). PARS ultimate tensile strength was significantly higher than the Krackow (PARS 280.29±47.32 N vs Krackow 196.97±54.28 N, P < .003) but not significantly different in the ultimate tensile strain. PARS had a significantly lower postoperative gap compared to Krackow (PARS 9.75±5.87 mm vs Krackow 25.19±7.72 mm, P < .001). FE analysis predicted an increased talocalcaneal contact pressure, maximum principal stress, and rotation in the Krackow vs PARS models, respectively. Conclusion Biomechanical parameters observed in this study through mechanical testing and FE analysis favor the selection of PARS over the Krackow repair based on better strength, higher failure force, and lower gap generation.Clinical Relevance: The study has analyzed two Achilles tendon repair methods using cadaver and numerical estimation and may help clinicians gain insight into selection of tendon repair approaches to generate better clinical outcomes.
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Affiliation(s)
- Bonnie Macaluso
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Chaudhry R. Hassan
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - David R. Swanson
- Department of Orthopaedics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Alireza Nazemi
- Department of Orthopaedics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Eugene Zaverukha
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Megan Paulus
- Department of Orthopaedics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Yi-Xian Qin
- Orthopaedic Bioengineering Research Laboratory, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - David E. Komatsu
- Department of Orthopaedics, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
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Tang X, Wang J, Guo R, Huang S, Qiu L. Quantitative evaluation of the Achilles tendon and supraspinatus tendon in end-stage kidney disease patients: A potential tool for predicting spontaneous tendon rupture. Ther Apher Dial 2021; 26:734-742. [PMID: 34817901 DOI: 10.1111/1744-9987.13763] [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: 07/03/2021] [Revised: 11/09/2021] [Accepted: 11/21/2021] [Indexed: 02/05/2023]
Abstract
Many cases of spontaneous tendon rupture in end-stage kidney disease (ESKD) patients have been reported worldwide. Quantitative assessment of tendon has become an important way to improve the prognosis of patients. In the recruited healthy volunteers and ESKD patients, the thickness and shear wave velocity (SWV) of supraspinatus tendons and Achilles tendons were measured and compared among groups. Potential factors related to the tendon SWV of ESKD patients were screened in multiple linear regression. There was no significant difference in the tendon thickness and supraspinatus tendon SWV among groups. SWV of Achilles tendons in long-term dialysis ESKD patients were significantly lower than those in healthy volunteers (5.1 vs. 5.6 m/s, p < 0.01). Ca2+ , creatinine, body mass index, and genders are the significant factors related to the tendon SWV. Shear wave elastography can be used as a potential tool for predicting spontaneous tendon rupture in ESKD patients.
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Affiliation(s)
- Xinyi Tang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Wang
- Department of Medical Ultrasound, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Ruiqian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Songya Huang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, China
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Wenning M, Mauch M, Heitner A, Lienhard J, Ritzmann R, Paul J. Neuromechanical activation of triceps surae muscle remains altered at 3.5 years following open surgical repair of acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 2021; 29:2517-2527. [PMID: 33660053 PMCID: PMC8298360 DOI: 10.1007/s00167-021-06512-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess whether the neuromuscular activation pattern following Achilles tendon rupture and repair may contributes to the observable functional deficits in this severe and increasingly frequent injury. METHODS In this study, the neuromuscular activation using surface EMG of n = 52 patients was assessed during a battery of functional performance tasks to assess potential alterations of muscular activation and recruitment. We analyzed the injured leg vs. the contralateral healthy leg at a mean of 3.5 years following open surgical repair. The testing battery included isokinetic strength testing, bipedal and single-legged heel-rise testing as well as gait analysis. RESULTS During isokinetic testing, we observed a higher activation integral for all triceps surae muscles of the injured side during active dorsiflexion, e.g., eccentric loading on the injured leg, while concentric plantarflexion showed no significant difference. Dynamic heel-rise testing showed a higher activation in concentric and eccentric loading for all posterior muscles on the injured side (not significant); while static heel-rise for 10 sec. revealed a significantly higher activation. Further analysis of frequency of fast Fourier-transformed EMG revealed a significantly higher median frequency in the injured leg. Gait analysis revealed a higher pre-activation of the tibialis anterior before ground contact, while medial and lateral gastrocnemius muscles of the injured leg showed a significantly higher activation during push-off phase. CONCLUSIONS The results of this study provide evidence on the neuromuscular changes 3.5 years following open surgical Achilles tendon repair. These complex neuromuscular changes are manifested to produce the maximum force output whilst protecting the previously injured tendon. The observed alterations may be related to an increased recruitment of type II muscle fibers which could make the muscles prone to fatigue. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Markus Wenning
- Rennbahnklinik, Muttenz, Basel, Switzerland.
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center Freiburg, Albert-Ludwigs University of Freiburg, Freiburg, Germany.
| | | | | | - Johannes Lienhard
- Department of Sport and Sport Science, Biomechanics and Motor Control, Albert-Ludwigs University of Freiburg, Freiburg, Germany
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