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Römer C, Legerlotz K, Czupajllo J, Fischer T, Wolfarth B, Lerchbaumer MH. Acute Effects of Running on Shear Wave Elastography Measures of the Achilles Tendon and Calf Muscles in Professional Female Handball and Volleyball Players. Diagnostics (Basel) 2023; 13:2957. [PMID: 37761324 PMCID: PMC10530130 DOI: 10.3390/diagnostics13182957] [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: 07/06/2023] [Revised: 08/27/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Shear Wave Elastography (SWE) is currently used to detect tissue pathologies, i.e., tendinopathy. For preventive medicine, it is important to examine the sensitivity of SWE and to investigate how stiffness measures are affected by methodological variables. The aim of this study is to examine shear wave elastography (SWE) measures in order to compare the pre- and post-running values and to determine the correlation between the shear wave speed values (m/s). SWE examinations of the Achilles tendon (AT), soleus muscle (MS) and gastrocnemius muscle (MG)) were performed in 24 healthy professional female athletes. Measurements of the shear wave speed (m/s) were taken before and after incremental treadmill running until exhaustion. Correlations were investigated using the Pearson correlation coefficient and were examined for significance using the Student's t-test. The pre- and post-exercise shear wave speed did not differ. The pre-exercise and post-exercise stiffness for MS (r = 0.613), MG (r = 0.609) and AT (r = 0.583) correlated strongly. The pre-exercise values and changes in stiffness showed a significant correlation (p < 0.001). In professional athletes, acute exercise induces different tissue stiffness changes in AT, MS and MG for each individual. Thus, exercise activity immediately prior to the SWE measurement needs to be factored in when evaluating tissue stiffness.
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Affiliation(s)
- Claudia Römer
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Thomas Fischer
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
- Department of Radiology, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
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Sprague AL, Couppé C, Pohlig RT, Cortes DC, Silbernagel KG. Relationships between tendon structure and clinical impairments in patients with patellar tendinopathy. J Orthop Res 2022; 40:2320-2329. [PMID: 34996130 PMCID: PMC9259765 DOI: 10.1002/jor.25262] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023]
Abstract
The clinical relevance of altered tendon structure in patellar tendinopathy is contested since structural change persists after symptom resolution. The purpose of this study was to explore the relationships between tendon structure and clinical impairments in patellar tendinopathy. In this retrospective, secondary analysis of individuals with patellar tendinopathy (n = 41), tendon structure (thickness, cross-sectional area [CSA], shear modulus, and viscosity), symptom severity, lower extremity function (counter-movement jump [CMJ] height), and quadriceps muscle performance (knee extension force and central activation ratio [CAR]) were recorded for the symptomatic limb. Relationships among structure, symptom severity, lower extremity function, and quadriceps muscle performance were examined using sequential regression models. Adjusting for age, sex, body mass index, and pain levels, there were significant positive relationships for thickness (p < 0.001, β = 0.718) and viscosity (p = 0.006, β = 0.496) with CMJ height. There were significant negative relationships between CSA with both CMJ height (p = 0.001, β = -0.538) and CAR (p = 0.04, β = -0.517). This is the first study to demonstrate relationships between tendon structure and lower extremity function or quadriceps muscle performance in patients with patellar tendinopathy. Clinical significance: Since structural changes persist after symptom resolution, addressing these changes may assist in restoring lower extremity function and quadriceps muscle performance.
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Affiliation(s)
- Andrew L. Sprague
- Department of Physical Therapy, University of Delaware,
Newark, DE, USA
- Department of Biomechanics and Movement Science, University
of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Pittsburgh,
Pittsburgh, PA, USA
| | - Christian Couppé
- Department of Orthopaedic Surgery M, Faculty of Health and
Medical Sciences, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital and
Center for Healthy Aging, University of Copenhagen, Copenhagen, DK
- Department of Physical and Occupational Therapy, Bispebjerg
Hospital, Copenhagen, DK
- IOC Research Center Copenhagen Center for Injury Prevention
and Protection of Athlete Health, Bispebjerg Hospital, Copenhagen, DK
| | - Ryan T. Pohlig
- Biostatistic Core Facility, College of Health Sciences,
University of Delaware, Newark, DE, USA
| | - Daniel C. Cortes
- Department of Mechanical Engineering, Penn State
University, State College, PA, USA
| | - Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware,
Newark, DE, USA
- Department of Biomechanics and Movement Science, University
of Delaware, Newark, DE, USA
- Department of Biomedical Engineering, University of
Delaware, Newark, DE, USA
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3
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Dickson DM, Smith SL, Hendry GJ. Strain sonoelastography in asymptomatic individuals and individuals with knee osteoarthritis: an evaluation of quadriceps and patellar tendon. Rheumatol Int 2022; 42:2241-2251. [PMID: 35974116 PMCID: PMC9548467 DOI: 10.1007/s00296-022-05184-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
An advanced ultrasound imaging technique, sonoelastography (SE) is used to evaluate tissue elasticity. To determine SE potential to detect pathological-related changes, and characteristics related to tendon pathology we aimed to (1) compare quadriceps and patellar tendon findings in individuals with knee osteoarthritis (KOA) and asymptomatic older adults (AC), and (2) explore associations between SE, participant characteristics (age, BMI, and leg circumference) and KOA status. 84 participants (47; KOA and 37; asymptomatic older adults) underwent SE examination of quadriceps (distal) and patellar (distal, proximal) tendon in a supine position with the knee bent at 30°. Colour score (CS) and Elasticity Ratio (ER) analysis were performed by a blinded experienced operator using Esaote Mylab 70 XVG Ultrasound equipment. Significantly reduced elasticity in the distal quadriceps (median (IQR) 2(2), 3(1), p = 0.033 for KOA and AC, respectively) and proximal patellar (3(1), 3(0), p = 0.001) tendons and more elastic distal patellar (1.50 (0.55), 1.87 (0.72), p = 0.034) tendons were observed in the KOA group. Significant associations) were identified between SE and participant BMI (Rs = − 0.249–0.750, p < 0.05) and leg circumference (Rs = − 0.260–0.903, p < 0.05). Age, BMI and KOA status, were independent explanatory variables of SE CS findings at the distal quadriceps tendon patellar tendon, proximal patellar tendon and distal patellar tendon, explaining 66%, 81% and 64% of variance, respectively. Age, BMI and KOA status were independent explanatory variables of SE ER findings at the distal patellar tendon explaining 19% of variance. Potentially clinically relevant altered tendon stiffness were observed between individuals with KOA and asymptomatic controls. Key KOA risk factors and participant characteristics explained variance in tendon stiffness. Findings provide context for future studies to investigate the potential for targeted SE detected early clinical management based on associated participant characteristics.
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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 Recover and Inflammation Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, 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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Götschi T, Hanimann J, Schulz N, Huser S, Held V, Frey WO, Snedeker JG, Spörri J. Patellar Tendon Shear Wave Velocity Is Higher and has Different Regional Patterns in Elite Competitive Alpine Skiers than in Healthy Controls. Front Bioeng Biotechnol 2022; 10:858610. [PMID: 35757800 PMCID: PMC9218688 DOI: 10.3389/fbioe.2022.858610] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Competitive alpine skiers are exposed to enormous forces acting on their bodies–particularly on the knee joint and hence the patellar tendon - during both the off-season preparation and in-season competition phases. However, factors influencing patellar tendon adaptation and regional pattern differences between alpine skiers and healthy controls are not yet fully understood, but are essential for deriving effective screening approaches and preventative countermeasures. Thirty elite competitive alpine skiers, all members of the Swiss Alpine Ski Team, and 38 healthy age-matched controls were recruited. A set of two-dimensional shear wave elastography measurements of the PT was acquired and projected into three-dimensional space yielding a volumetric representation of the shear wave velocity profile of the patellar tendon. Multivariate linear models served to quantify differences between the two cohorts and effects of other confounding variables with respect to regional shear wave velocity. A significant (p < 0.001) intergroup difference was found between skiers (mean ± SD = 10.4 ± 1.32 m/s) and controls (mean ± SD = 8.9 ± 1.59 m/s). A significant sex difference was found within skiers (p = 0.024), but no such difference was found in the control group (p = 0.842). Regional SWV pattern alterations between skiers and controls were found for the distal region when compared to the mid-portion (p = 0.023). Competitive alpine skiers exhibit higher SWV in all PT regions than healthy controls, potentially caused by long-term adaptations to heavy tendon loading. The presence of sex-specific differences in PT SWV in skiers but not in controls indicates that sex effects have load-dependent dimensions. Alterations in regional SWV patterns between skiers and controls suggest that patellar tendon adaptation is region specific. In addition to the implementation of 3D SWE, deeper insights into long-term tendon adaptation and normative values for the purpose of preventative screening are provided.
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Affiliation(s)
- Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jonas Hanimann
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicole Schulz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Simon Huser
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Victoria Held
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Schneebeli A, Folli A, Falla D, Barbero M. Reliability of Sonoelastography Measurements of Lower Limb Tendon Properties: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1131-1150. [PMID: 33516588 DOI: 10.1016/j.ultrasmedbio.2020.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
This study investigated the reliability of sonoelastography techniques in quantifying lower limb tendon elasticity. A literature search was conducted using PubMed, Web of Science and CINAHL. The quality of the selected papers was evaluated using the Guidelines for Reporting Reliability and Agreement Studies and the Quality Appraisal Tool for Studies of Diagnostic Reliability checklist. Reliability values were extracted and synthesized. Twenty-four studies were included and were divided by the two main technologies used: strain and shear-wave elastography. The overall methodological quality was questionable; all studies were at risk of bias. Highly variable results ranging from poor to excellent reliability were found for both technologies and for all tendons considered. Intra-rater reliability of strain elastography on the Achilles tendon and shear-wave elastography on the patellar and quadriceps tendon was adequate. Inter-rater, inter-session and inter-machine reliability was insufficient. Caution should be used when interpreting results from sonoelastography studies measuring lower limb tendon elasticity.
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Affiliation(s)
- Alessandro Schneebeli
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland.
| | - Anna Folli
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
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Bravo-Sánchez A, Abián P, Sánchez-Infante J, Jimenez F, Abián-Vicén J. Influence of Bias in the Assessment of Patellar Tendon Stiffness: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1151-1162. [PMID: 33589353 DOI: 10.1016/j.ultrasmedbio.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
The aim of the present study was to provide a systematic review and meta-analysis of the main biases in practical applications of the different types of elastography in assessment of the stiffness of healthy patellar tendons. A literature search on four databases (Scopus, Web of Science, Pubmed and SportDiscus) was conducted on March 25, 2020. After analysis of 1,052 resultant articles, studies were included if they met two inclusion criteria: (1) studies were observational or randomized controlled trials; (2) studies included outcomes of patellar tendon stiffness. Twenty-one studies met the inclusion criteria and were included in this meta-analysis. Four meta-analyses were performed with respect to assessment procedure and participant characteristics. This meta-analysis found a low effect of examined portion of patellar tendon (standardized mean difference [SMD] = 0.27, 95% confidence interval [CI]: 0.01-0.54, n = 379, Z = 2.01, p = 0.04) and a high effect of knee flexion angle during assessment (SMD = -2.12; 95% CI: -2.67 to -1.58, n = 97, Z = 7.68, p < 0.01) in stiffness outcomes. The risk of bias was generally low, but the heterogenicity of the results downgraded the level of evidence. There is evidence in the elastography assessment of patellar tendon suggesting that the knee position and patellar tendon portion evaluated influence stiffness outcomes for patellar tendon in healthy volunteers.
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Affiliation(s)
- Alfredo Bravo-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, Madrid, Spain
| | - Jorge Sánchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Fernando Jimenez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain.
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Mannarino P, da Matta TT, de Oliveira LF. An 8-week resistance training protocol is effective in adapting quadriceps but not patellar tendon shear modulus measured by Shear Wave Elastography. PLoS One 2019; 14:e0205782. [PMID: 30990803 PMCID: PMC6467440 DOI: 10.1371/journal.pone.0205782] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 03/15/2019] [Indexed: 01/13/2023] Open
Abstract
Habitual loading and resistance training (RT) can lead to changes in muscle and tendon morphology as well as in its mechanical properties which can be measured by Shear Wave Elastography (SWE) technique. The objective of this study was to analyze the Vastus Lateralis (VL) and patellar tendon (PT) mechanical properties adaptations to an 8-week RT protocol using SWE. We submitted 15 untrained health young men to an 8-week RT directed for knee extensor mechanism. VL and PT shear modulus (μ) were assessed pre and post intervention with SWE. PT thickness (PTT), VL muscle thickness (VL MT) and knee extension torque (KT) were also measure pre and post intervention to ensure the RT efficiency. Significant increases were observed in VL MT and KT (pre = 2.40 ± 0.40 cm and post = 2.63 ± 0.35 cm, p = 0.0111, and pre = 294.66 ± 73.98 Nm and post = 338.93 ± 76.39 Nm, p = 0.005, respectively). The 8-week RT was also effective in promoting VL μ adaptations (pre = 4.87 ± 1.38 kPa and post = 9.08.12 ± 1.86 kPa, p = 0.0105), but not in significantly affecting PT μ (pre = 78.85 ± 7.37 kPa and post = 66.41 ± 7.25 kPa, p = 0.1287) nor PTT (baseline = 0.364 ± 0.053 cm and post = 0.368 ± 0.046 cm, p = 0.71). The present study showed that an 8-week resistance training protocol was effective in adapting VL μ but not PT μ. Further investigation should be conducted with special attention to longer interventions, to possible PT differential individual responsiveness and to the muscle-tendon resting state tension environment.
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Affiliation(s)
- Pietro Mannarino
- Department of Orthopaedic Surgery, Clementino Fraga Filho University Hospital, Rio de Janeiro, RJ, Brazil
- Biomedical Engineering Program, UFRJ, Rio de Janeiro, RJ, Brazil
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Relationships between Quadriceps Tendon Elasticity and Knee Flexion Angle in Young Healthy Adults. ACTA ACUST UNITED AC 2019; 55:medicina55020053. [PMID: 30781444 PMCID: PMC6409608 DOI: 10.3390/medicina55020053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 01/14/2023]
Abstract
Background and objectives: Although tendon elasticity by elastography is useful for diagnosing tendon disorders and planning rehabilitation regimens of the tendon, there are few reports on the quadriceps tendon. Moreover, relationships between the quadriceps tendon elasticity and knee angle have not been investigated. The purpose of this study was to clarify the relationship between quadriceps tendon elasticity and knee flexion angle in young healthy adults using elastography, and to investigate the difference in elasticity by sex and leg dominance. Materials and Methods: A total of 40 knees in 20 young healthy adults were included in this study (age: 25.5 (23.3⁻27.5) years). At knee flexion of 30°, 60°, and 90°, quadriceps tendon elasticity was measured using ShearWave™ Elastography during the ultrasound examination. Results: There were significant differences in the elasticity between all angles (p < 0.001). Elasticity was increased more at 60° than at 30° and at 90° than at 60°. Elasticity in men was higher than that in women at 60° (p = 0.029). There were no differences (p = 0.798) in elasticity at each angle between the dominant and non-dominant legs. Conclusions: The quadriceps tendon elasticity increased according to the knee flexion angle in young healthy adults. Moreover, elasticity was affected by sex, but not by leg dominance. Clinically, in a rehabilitation regimen, attention should be paid to exercises that could increase stiffness accompanying flexion of the knee to avoid further tendon damage as risk management in the acute phase.
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Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO. Sci Rep 2018; 8:17064. [PMID: 30459432 PMCID: PMC6244233 DOI: 10.1038/s41598-018-34719-7] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022] Open
Abstract
The purposes of this study were to compare Young’s modulus values determined by shear wave ultrasound elastography (SWUE) with stiffness index obtained using a hand-held MyotonPRO device on the resting stiffness of gastrocnemius muscle belly and Achilles tendon; and to examine the test-retest reliability of those stiffness measurement using hand-held MyotonPRO. Twenty healthy volunteers participated in the study. The measurement values of muscle and tendon was determined in dominant legs. Each marker point was assessed using MyotonPRO and SWUE, respectively. Intra-operator reliability of MyotonPRO was established in 10 of the subjects. The correlation coefficients between the values of muscle and tendon stiffness indices determined by MyotonPRO and SWUE were calculated. Significant correlations were found for muscle and tendon stiffness and Young’s modulus ranged from 0.463 to 0.544 (all P < 0.05). The intra-operator reliability ranged from good to excellent (ICC(3,1) = 0.787~0.928). These results suggest that the resting stiffness of gastrocnemius muscle belly and Achilles tendon measured by MyotonPRO is related to the Young’s modulus of those quantified by SWUE. The MyotonPRO shows good intra-operator repeatability. Therefore, the present study shows that MyotonPRO can be used to assess mechanical properties of gastrocnemius muscle belly and Achilles tendon with a resting condition.
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