Reduced Levels of Aligned Fibrillar Structure Are Not Associated With Achilles and Patellar Tendon Symptoms

Does an Increase in Supraspinatus Tendon Thickness After Swimming Increase the Likelihood of Future Shoulder Pain?

BACKGROUND

Increase in supraspinatus tendon thickness (STT) resulting from swimming practice has been observed in those with a history of shoulder pain. The magnitude of change in STT after a swimming session and its rate of recovery may be an indicator of future shoulder pain incidence.

HYPOTHESIS

The supraspinatus tendons that demonstrate a greater increase in thickness as a result of swimming practice will have an increased likelihood of future shoulder pain in a cohort of competitive swimmers over a period of 6 months.

DESIGN

Descriptive epidemiology study.

LEVEL OF EVIDENCE

Level 2b, individual cohort studies.

METHODS

A cohort of 50 nationally qualified swimmers aged between 14 and 22 years, from 3 open National Swimming Programs in Victoria, Australia, were recruited for this study. Ultrasonographic measurements of swimmers' STT was obtained of both shoulders, before, immediately after, and 6 hours after a single swimming practice session. Data were recorded of any significant interfering shoulder pain at 3 and 6 months after the initial testing session.

RESULTS

Stepwise logistic regression models indicated that significant predictors of the likelihood of experiencing significant interfering pain were sex [significant at 6 months; odds ratio (OR) 4.2] and the extent of change in STT immediately (OR 2.3 and 1.3 per mm at 3 and 6 months, respectively) and 6 hours postpractice (OR 1.9 and 1.5 per mm at 3 and 6 months, respectively).

CONCLUSION

The current data suggest larger increases in tendon thickness after training are associated with an increased likelihood of future shoulder pain.

CLINICAL RELEVANCE

These data may be valuable for monitoring training load and identifying athletes who may have an increased likelihood of shoulder pain.

Quadriceps strength, patellar tendon quality, relative load exposure, and knee symptoms in male athletes before the anterior cruciate ligament reconstruction

Introduction

Anterior cruciate ligament (ACL) injuries cause knee instability, knee pain, weight-bearing adjustments, and functional deficits but their association to patellar tendon quality is unknown. Our purpose was to investigate quadriceps strength, patellar tendon quality, relative load exposure, perceived knee stability, knee pain, extension angle, and time from ACL injury; in addition to examining their relative associations.

Methods

Injured and uninjured legs of 81 male athletes of different sports with a unilateral ACL injury (18-45 years) were examined. Participants reported location and intensity of knee pain and their perceived stability using a numerical rating scale (NRS 0-10). Strength was tested with an isokinetic device. Tendon quality was measured using ultrasound tissue characterization. Means ± standard deviation (SD) of perceived knee stability, knee extension angle, knee pain, isokinetic quadriceps strength in relation to body mass, proportion of echo-types (I-IV), tendon volume, and number of days from ACL injury to assessment are reported. Values of effect sizes (ES) and correlations (rs) were calculated.

Results

ACL injured leg demonstrated reduced reported knee stability (6.3 ± 2.5), decreased knee extension angle (-0.7 ± 3.1° vs. -2.7 ± 2.2°; ES = 0.7; P < 0.001), greater knee pain (NRS 3.1 ± 2.2 vs. 0.0 ± 0.1; ES = 2.0; P < 0.001), and 22% lower quadriceps strength (228.0 ± 65.0 vs. 291.2 ± 52.9 Nm/kg: ES = 1.2; P < 0.001) as compared to the uninjured leg. However, patellar tendons in both legs displayed similar quality. Quadriceps strength was associated with stability (rs = -0.54; P < 0.001), pain (rs = -0.47; P < 0.001), extension angle (rs = -0.39; P < 0.001), and relative load exposure (rs = -0.34; P < 0.004). Echo-types distribution was beneficially associated with time from ACL injury (rs range: -0.20/ -0.32; P < 0.05).

Discussion

ACL injured athletes displayed knee pain, extension deficit, and weaker quadriceps in the injured leg. While there were no differences in patellar tendon quality between legs, longer time from ACL injury showed better tendon quality.

Gagnon D. To What Extent Do Musculoskeletal Ultrasound Biomarkers Relate to Pain, Flexibility, Strength, and Function in Individuals With Chronic Symptomatic Achilles Tendinopathy?

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.

Substantiating the Use of Ultrasound Tissue Characterization in the Analysis of Tendon Structure: A Systematic Review

OBJECTIVE

To determine the role of ultrasound tissue characterization (UTC) in predicting, diagnosing, and monitoring tendon structure and/or tendinopathy. In addition, this study aims to provide recommendations for standardized methodology of UTC administration and analysis.

DATA SOURCE

The PubMed, Embase, and Web of Science databases were searched (up to September 2018). All scientific literature concerning the use of UTC in assessing tendons was collected. The initial search resulted in a total of 1972 hits, and after screening by eligibility criteria, 27 articles were included.

RESULTS

In total, 18 investigating the Achilles tendon, 5 the patellar tendon, and 4 both Achilles and patellar tendons were included. The methods of UTC administration and analysis differed and were not uniform. The studies showed that the use of UTC to predict Achilles tendinopathy (AT) is inconclusive, but that a higher amount of tendon disorganization increases the risk of developing patellar tendinopathy (PT). In terms of diagnosis, UTC might provide additional information in AT cases. In addition, promising results were found for the use of UTC in both AT and PT in monitoring the effect of load or treatment on tendon structure.

CONCLUSION

More research regarding the use of UTC in predicting tendon pathology is required. Ultrasound tissue characterization seems useful as an adjunct diagnostic modality because it can be used to differentiate symptomatic from asymptomatic tendons. In addition, UTC is a promising device to be used to monitor changes in tendon structure in response to load or treatment. Moreover, we provide recommendations of a standardized protocol concerning the methods of UTC measurement and analysis.