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Ortega-Cebrián S, Soler-Rich R, Orozco L, Rodas G. Evaluation of Patellar Tendon Structural Changes following Biological Treatments: Secondary Analysis of Double-Blinded Clinical Trial of Bone Marrow Mesenchymal Stromal Cells and Leukocyte-Poor Platelet-Rich Plasma. Biomedicines 2024; 12:1599. [PMID: 39062172 PMCID: PMC11275081 DOI: 10.3390/biomedicines12071599] [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: 06/04/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Objective quantification of tendon structural changes through imaging is only achieved by evaluating tendon structure using ultrasound tissue characterization (UTC) technology. This study compares the effects of bone marrow mesenchymal stromal cells (BM-MSC) and leukocyte-poor platelet-rich plasma (Lp-PRP) on tendon structure and clinical outcomes in male patients with patellar tendinopathy measured with UTC at 3, 6, and 12 months after treatment. This is a double-blinded clinical trial with a randomized active control study with 20 male patients diagnosed with patellar tendinopathy who underwent BM-MSC and Lp-PRP. Bilateral ultrasound tissue characterization scans of the patellar tendon were carried out after 3, 6, and 12 months, as well as tests for strength and pain. UTC patellar tendon was analyzed at the insertion, proximal, and mid-tendon. BM-MSC showed a greater capacity to promote further positive changes than Lp-PRP. Lp-PRP presented higher disorganized echo-type II in the mid-tendon (p = 0.04; ES = 1.06) and III (p = 0.02; ES = -1.47) after 3 months in the Lp-PRP group. Similar results were seen after 6 and 12 months. Pain and strength data show improvement in the treated tendon. BM-MSC treatment demonstrates a superior capacity to promote tendon regeneration and organization, restore strength, and reduce pain compared to Lp-PRP, after 3, 6, and 12 months in male patients with patellar tendinopathy.
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Affiliation(s)
- Silvia Ortega-Cebrián
- Physiotherapy Department, Facultat Fisioteràpia, Universitat Internacional de Catalunya (UIC), Carrer Josep Trueta, Sant Cugat de Vallès, 08017 Barcelona, Spain
- Medical Department of Football Club Barcelona (FIFA Medical Center of Excellence), Barça Innovation Hub of Football Club Barcelona, 08970 Barcelona, Spain
| | - Robert Soler-Rich
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, 08022 Barcelona, Spain
| | - Lluis Orozco
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, 08022 Barcelona, Spain
| | - Gil Rodas
- Medical Department of Football Club Barcelona (FIFA Medical Center of Excellence), Barça Innovation Hub of Football Club Barcelona, 08970 Barcelona, Spain
- Sports and Exercise Medicine Unit, Hospital Clinic and Sant Joan de Déu, 08029 Barcelona, Spain
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Xu W, Xu J, Zhou Y, Yang W, Huang H, Xue J, Zhang J. Diagnostic Value of Superb Microvascular Imaging of the Rotator Cuff Interval for the Early Diagnosis of Frozen Shoulder. Int J Gen Med 2024; 17:3039-3046. [PMID: 39006912 PMCID: PMC11246654 DOI: 10.2147/ijgm.s465952] [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: 02/26/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
Purpose To explore the early diagnostic value of superb microvascular imaging (SMI) features within the rotator cuff gap for frozen shoulder. Patients and Methods This prospective study enrolled patients with acute early-stage frozen shoulder seeking treatment at Zhabei Central Hospital in Jing'an District, Shanghai, between July 2021 and December 2022 were enrolled in this study. Healthy controls were collected in a 1:1 ratio from the same hospital's physical examination center. All participants underwent SMI and power Doppler ultrasound (PDUS) of the rotator cuff gap. Results The study included 79 patients with frozen shoulder and 77 healthy controls. Compared with the healthy control group, the patient group had a higher proportion of hypoechoic rotator cuff gap (81.0% vs 48.1%, P<0.001), a thicker coracohumeral ligament (2.60±1.01 vs 2.03±0.97, P<0.001), a thicker glenohumeral joint capsule (3.10±0.99 vs 2.46±1.17, P<0.001), and elevated blood grading using SMI (P<0.001) and PDUS (P=0.014). The highest area under the curve (AUC) was observed for SMI blood flow grading (AUC=0.824, 95% CI: 0.755-0.880, P<0.001), resulting in 82% sensitivity and 77% specificity when using a cutoff of 1. SMI blood flow grading was associated with external rotation <30° (P=0.007) and abduction <30° (P=0.013) but not with internal rotation <30° (P=0.630) or flexion <30° (P=0.562). Conclusion The grading of SMI blood flow may emerge as a valuable predictive indicator for the early stages of frozen shoulder. This simple ultrasound technique holds the potential to enhance the diagnostic process, enabling early initiation of treatment and potentially improving patient outcomes.
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Affiliation(s)
- Weihua Xu
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jiayu Xu
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Yingying Zhou
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Weiwei Yang
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Hui Huang
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jun Xue
- Ultrasound Medicine Department, Zhabei Central Hospital in Jing'an District, Shanghai, People's Republic of China
| | - Jing Zhang
- Ultrasound Medicine Department, Daning Community Health Service Center in Jing'an District, Shanghai, People's Republic of China
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Cushman DM, Vomer R, Teramoto M, O'Sullivan M, Mulvey J, Eby SF, McAuliffe S. Sonographic Assessment of Asymptomatic Patellar and Achilles Tendons to Predict Future Pain: A Systematic Review and Meta-analysis. Clin J Sport Med 2024:00042752-990000000-00196. [PMID: 38864880 DOI: 10.1097/jsm.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/10/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Patients with clinical tendinopathy often demonstrate significant abnormalities with ultrasound (US) imaging. Tendon abnormalities likely precede pain in these patients. The purpose of this review was to systematically evaluate the available literature regarding the utility of US imaging as a method to predict Achilles and patellar tendon pain. DESIGN Systematic review and meta-analysis. Inclusion criteria were as follows: prospective studies of Achilles and patellar tendon pain development with baseline US measurements, follow-up clinical measurements, and English-language studies published after 2000. Exclusion criteria were prior rupture or surgery and presence of rheumatologic disorder. SETTING N/A. PATIENTS Athletes without Achilles or patellar tendon pain at baseline. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Risk ratios (RRs) were identified for the development of pain in those with Achilles or patellar tendon sonographic abnormalities. RESULTS This review of 16 studies included 810 Achilles and 1156 patellar tendons from a variety of sports and demonstrated that the RR for pain development from abnormal Patellar and Achilles tendons was 6.07 [95% confidence interval (CI), 2.88-12.81; P < 0.001] and 3.96 [95% CI, 2.21-7.09; P < 0.001], respectively. The positive and negative predictive values of an abnormal US finding were 27.2% and 92.0% for the Achilles tendon and 27.2% and 93.5% for the patellar tendon, respectively. CONCLUSIONS This systematic review and meta-analysis identified that the use of asymptomatic US scanning of the Achilles or patellar tendon has a low positive predictive value but a high negative predictive value for the future development of pain.
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Affiliation(s)
- Daniel M Cushman
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Rock Vomer
- Department of Family and Community Health, Division of Sports Medicine, Duke University, Durham, North Carolina
- Department of Orthopedics, Division of Sports Medicine, Duke University, Durham, North Carolina
| | - Masaru Teramoto
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Maddie O'Sullivan
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Jade Mulvey
- School of Medicine, University of Utah, Salt Lake City, Utah
| | - Sarah F Eby
- Department of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Sean McAuliffe
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
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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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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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Sleeswijk Visser TSO, O'Neill S, Colaris JW, Eygendaal D, de Vos RJ. Normative ultrasound values for Achilles tendon thickness in the general population and patients with Achilles tendinopathy: A large international cross-sectional study. Scand J Med Sci Sports 2024; 34:e14665. [PMID: 38773808 DOI: 10.1111/sms.14665] [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: 12/21/2023] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/24/2024]
Abstract
The objective of the study was to obtain adjusted ultrasonographic reference values of the Achilles tendon thickness (maximum anterior-posterior distance) in adults without (previous) Achilles tendinopathy (AT) and to compare these reference values with AT patients. Six hundred participants were consecutively included, comprising 500 asymptomatic individuals and 100 patients with clinically diagnosed chronic AT. The maximum tendon thickness was assessed using Ultrasound Tissue Characterization. A multiple quantile regression model was developed, incorporating covariates (personal characteristics) that were found to have a significant impact on the maximum anterior-posterior distance of the Achilles tendon. A 95% reference interval (RI) was derived (50th, 2.5th-97.5th percentile). In asymptomatic participants median (95% RI) tendon thickness was 4.9 (3.8-6.9) mm for the midportion region and 3.7 (2.8-4.8) mm for the insertional region. Age, height, body mass index, and sex had a significant correlation with maximum tendon thickness. Median tendon thickness for the midportion region was calculated with the normative equation -2.1 + AGE × 0.021 + HEIGHT × 0.032+ BMI × 0.028 + SEX × 0.05. For the insertional region, the normative equation was -0.34 + AGE × 0.010+ HEIGHT × 0.018 + BMI × 0.022 + SEX × -0.05. In the equations, SEX is defined as 0 for males and 1 for females. Mean (95% CI) difference in tendon thickness compared to AT patients was 2.7 mm (2.3-3.2, p < 0.001) for the midportion and 1.4 mm (1.1-1.7, p < 0.001) for the insertional region. Compared to the asymptomatic population 73/100 (73%) AT patients exhibited increased tendon thickening, with values exceeding the 95% RI. This study presents novel reference values for the thickness of midportion and insertional region of the Achilles tendon, which were adjusted for personal characteristics. Our novel web-based openly accessible calculator for determining normative Achilles tendon thickness (www.achillestendontool.com) will be a useful resource in the diagnostic process. Trial registration number: This trial is registered in the Netherlands Trial Register (NL9010).
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Affiliation(s)
- Tjerk S O Sleeswijk Visser
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Seth O'Neill
- Department of Life Sciences, School of Allied Health, University of Leicester, Leicester, UK
| | - Joost W Colaris
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Sharif F, Ahmad A, Shabbir A. Does the ultrasound imaging predict lower limb tendinopathy in athletes: a systematic review. BMC Med Imaging 2023; 23:217. [PMID: 38129787 PMCID: PMC10740248 DOI: 10.1186/s12880-023-01181-5] [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: 02/22/2022] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND To conduct a systematic review looking into the possibility of US imaging to anticipate and identify future patellar or Achilles tendinopathy symptoms. METHODS The studies that were taken into consideration for this review were prospective studies that employed baseline US imaging of the patellar OR Achilles tendons in asymptomatic patients and follow-up measures of pain and/or function. Two impartial reviewers evaluated the study's quality using the Critical Appraisal Skills Programme instrument. RESULTS Participants in the included studies in this review came from various sports. The systematic review revealed a link between baseline tendon abnormalities in the US and a higher chance of developing both patellar and Achilles tendinopathy as well as their future occurrence. Nine of the included studies examined the patellar tendon alone, eight the patellar and Achilles tendon together, and four the Achilles tendon exclusively. For both tendons, US administration is done in a largely consistent manner. The tendon abnormalities of tendon thickness, hypoechogenicity and vascularity at baseline were associated with an increased risk of both Achilles and patellar tendinopathy. CONCLUSIONS This systematic review shows that abnormal tendon structures seen by US in asymptomatic persons can predict the development of tendinopathy.
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Affiliation(s)
- Faiza Sharif
- University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan.
| | - Ashfaq Ahmad
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
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Klich S, Michalik K, Rajca J, Ficek K, Fernández-de-Las-Peñas C, Kawczynski A, Madeleine P. Fatigue-induced Alterations of the Patellar Tendon in Elite Sprint Track Cyclists. Int J Sports Med 2023; 44:995-1002. [PMID: 36690028 DOI: 10.1055/a-2018-2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aims to investigate morphological and mechanical properties and echogenicity of the patellar tendon (PT) after acute fatigue-induced alterations in sprint track cyclists. Fourteen elite track cyclists participated in this study. The exercise protocol consisted of three maximal start accelerations (over a distance of 62.5 m), one maximal start acceleration (at both 125 m and 250 m), and sprints from the standing start. Immediately after testing all measurements, PT stiffness and thickness were set at 5-10-15-20 mm distal from the apex of the patella and 5-10 mm proximal to the tibial tuberosity. CSA was set at proximal, middle, and distal, while echogenicity was at proximal and distal points. The results showed significant increases in PT stiffness at all reference points after start acceleration (p<0.001). PT thickness showed similar results for stiffness, except for location placed at TT-5 (p<0.001). CSA increased significantly in proximal, middle, and distal regions (p<0.001), while echogenicity of the tendon increased in proximal and distal regions (p<0.001) after start acceleration. Regional-dependent alterations of PT thickness and stiffness may be related to anatomical and physiological mechanisms due to acute isometric contraction in the initial phase of standing start. Tendon echogenicity might be also useful in monitoring tendon mechanical properties and defining acute fatigue-induced changes.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
| | - Kamil Michalik
- Department of Human Motor Skills, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
| | - Jolanta Rajca
- Department of Science, Innovation and Development, Galen-Orthopaedics, Bieruń, Poland
| | - Krzysztof Ficek
- Department of Physiotherapy, Jerzy Kukuczka Academy of Physical Education In Katowice, Katowice, Poland
- Department of Science, Innovation and Development, Galen-Orthopaedics, Bieruń, Poland
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional En Docencia, Clínica E Investigación En Fisioterapia: Terapia Manual, Punción Seca Y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Adam Kawczynski
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Pascal Madeleine
- Health Science and Technology, Aalborg University, Aalborg, Denmark
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Nutarelli S, da Lodi CMT, Cook JL, Deabate L, Filardo G. Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231173659. [PMID: 37347023 PMCID: PMC10280536 DOI: 10.1177/23259671231173659] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/09/2023] [Indexed: 06/23/2023] Open
Abstract
Background Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes' careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures. Purpose To determine the prevalence and incidence of PT in athletes and the general population. Design Systematic review; Level of evidence, 3. Methods A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population. Results A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes' populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes <18 years was 10.1%, while it was 21.3% in athletes ≥18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations (P = .004). Conclusion This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged ≥18 years than there are <18 years. Volleyball and basketball players are most affected by PT.
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Affiliation(s)
- Sebastiano Nutarelli
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- School of Public Health, Physiotherapy
and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Jill L. Cook
- La Trobe University Sport and Exercise
Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury
Drive, Bundoora, Victoria, Australia
| | - Luca Deabate
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences,
Università della Svizzera Italiana, Lugano, Switzerland
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Cencini S, Perrott M, Docking S, Cook J. Proximal patellar tendon abnormalities on ultrasound can develop in male adolescent basketball players: A longitudinal study. Phys Ther Sport 2023; 60:63-69. [PMID: 36682095 DOI: 10.1016/j.ptsp.2022.11.004] [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: 05/13/2022] [Revised: 11/19/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Adolescent patellar tendinopathy is reported but the pubertal-stage of onset of abnormal tendon structure has not been investigated with grayscale ultrasound. AIMS To investigate abnormal tendon structure using grayscale ultrasound and its association with pubertal-stage and pain. METHODS Forty-three male basketball players aged 13.7 years (SD 1.0) had patellar tendon ultrasound scans every 6 months for 2.5 years. Pubertal-stage (peak height velocity) was calculated using the Mirwauld equation. Tendon thickness, hypoechogenicity and pain during single leg decline squat (SLDS) were recorded. Tendons were classified: hypoechoic, normal or immature. RESULTS Two tendons were hypoechoic at baseline. Six developed hypoechogenicity over 2.5 years (eight tendons [9%], six participants [14%]), all in peri and post-PHV players. Twenty-six tendons (17 participants) were classified as immature during the study. Hypoechoic tendons were thicker (5.3 mm SD 1.2) than normal (3.9 mm SD 0.7) tendons (p < 0.001). There was no difference in the proportion of participants reporting pain during SLDS in the hypoechoic (N = 3) and normal (N = 11) groups (p = 0.33), or in hypoechoic tendon thickness between those reporting pain (6.5 mm, SD 1.7) or not (5.2 mm, SD 0.9, p = 0.17). DISCUSSION This study using grayscale ultrasound found that basketball players with hypoechogenicity were peri or post-PHV. Abnormal structure was not always associated with pain.
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Affiliation(s)
- Sebastiano Cencini
- Department of Medicine, Surgery and Neuroscience, University of Siena, (Santa Maria alle Scotte Hospital), Siena, Italy
| | - Margaret Perrott
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.
| | - Sean Docking
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; Monash Department of Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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Maffulli N, Nilsson Helander K, Migliorini F. Tendon appearance at imaging may be altered, but it may not indicate pathology. Knee Surg Sports Traumatol Arthrosc 2023; 31:1625-1628. [PMID: 36800008 DOI: 10.1007/s00167-023-07339-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Both in tendon repair following a tear and in tendinopathy, recovery from pain and restoration of (acceptable) function does not go hand in hand with the appearance of the affected tendon at imaging. The tendon may remain altered for a long while and possibly forever, indicating a possible dissociation between morphology and symptoms. The predictive value of asymptomatic abnormal findings remains limited, and interventions in such instances are inappropriate and not supported by current evidence. Once an initial imaging investigation has depicted the condition of the tendon, additional imaging investigations are unlikely to provide further information or change prognosis in patients in whom abnormalities compatible with a diagnosis of tendinopathy have been identified by either ultrasonography or MRI. Patient education and close clinical monitoring are recommended. This is applicable to the patellar tendon, Achilles tendon, rotator cuff, for both tendon repair and tendinopathy. Given the modest risk of sonographic abnormalities to develop in symptomatic tendinopathy, planning and trying to implement any form of intervention may not be warranted. The current evidence mostly arises from low-quality studies, with heterogeneous risk factors and populations, and caution must be maintained when interpreting the significance of such incidental findings in athletes.
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Affiliation(s)
- Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke-on-Trent, ST4 7QB, England.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England.
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
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12
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Crawford SK, Thelen D, Yakey JM, Heiderscheit BC, Wilson JJ, Lee KS. Regional shear wave elastography of Achilles tendinopathy in symptomatic versus contralateral Achilles tendons. Eur Radiol 2023; 33:720-729. [PMID: 35760909 PMCID: PMC9771859 DOI: 10.1007/s00330-022-08957-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Ultrasound often corroborates clinical diagnosis of Achilles tendinopathy (AT). Traditional measures assess macromorphological features or use qualitative grading scales, primarily focused within the free tendon. Shear wave imaging can non-invasively quantify tendon elasticity, yet it is unknown if proximal structures are affected by tendon pathology. The purpose of the study was to determine the characteristics of both traditional sonographic measures and regional shear wave speed (SWS) between limbs in patients with AT. METHODS Twenty patients with chronic AT were recruited. Traditional sonographic measures of tendon structure were measured. Regional SWS was collected in a resting ankle position along the entire length of the tendon bilaterally. SWS measures were extracted and interpolated across evenly distributed points corresponding to the free tendon (FT), soleus aponeurosis (SA), and gastrocnemius aponeurosis (GA). Comparisons were made between limbs in both traditional sonographic measures and regional SWS. RESULTS Symptomatic tendons were thicker (10.2 (1.9) vs. 6.8 (1.8) mm; p < 0.001) and had more hyperemia (p = 0.001) and hypoechogenicity (p = 0.002) than the contralateral tendon. Regional SWS in the FT was lower in the symptomatic limb compared to the contralateral limb (11.53 [10.99, 12.07] vs. 10.97 [10.43, 11.51]; p = 0.03). No differences between limbs were found for the SA (p = 0.13) or GA (p = 0.99). CONCLUSIONS Lower SWS was only observed in the FT in AT patients, indicating that alterations in tendon elasticity associated with AT were localized to the FT and did not involve the proximal passive tendon structures. KEY POINTS • Baseline characteristics of a pilot sample of 20 subjects suffering from chronic Achilles tendinopathy showed differences in conventional sonographic measures of tendon thickness, qualitatively assessed hypoechogenicity, hyperemia, and quantitative measures of shear wave speed. • Regional shear wave speeds were lower in the free tendon but not in the proximal regions of the soleus or gastrocnemius aponeuroses in Achilles tendinopathy patients. • Using shear wave imaging to estimate tendon stiffness may prove beneficial for clinical validation studies to address important topics such as return to activity and the effectiveness of rehabilitation protocols.
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Affiliation(s)
- Scott K Crawford
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Darryl Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Janice M Yakey
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, E3/311, 600 Highland Ave, Madison, WI, 53792, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - John J Wilson
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth S Lee
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, E3/311, 600 Highland Ave, Madison, WI, 53792, USA.
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13
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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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14
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Cushman DM, Petrin Z, Cummings K, Eby SF, English J, Teramoto M. Sonographic Screening of Distance Runners for the Development of Future Achilles and Patellar Tendon Pain. Clin J Sport Med 2022; 32:493-500. [PMID: 34759186 PMCID: PMC9085961 DOI: 10.1097/jsm.0000000000000984] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The 2 primary aims of this study were to identify ultrasonographic tendon abnormalities in asymptomatic runners and to examine the likelihood of developing pain in runners with ultrasound abnormalities compared with those without abnormalities. DESIGN Longitudinal, prospective cohort study. SETTING 2019 Salt Lake City Marathon. PARTICIPANTS Recreational half-marathon and full-marathon runners. ASSESSMENT OF RISK FACTORS The Achilles and patellar tendons of asymptomatic runners were examined with ultrasound imaging before a running event. Runners were monitored for self-reported outcomes of pain in the examined tendons at 1, 3, 6, and 12 months after the event. MAIN OUTCOME MEASURES Development of pain based on the presence of asymptomatic tendon abnormalities. RESULTS One hundred thirty-eight runners (36.2 ± 12.0 years, 49.3% men, and 31.2% full-marathon runners) were included. Ultrasound abnormalities of the Achilles and patellar tendons were identified in 24.6% and 39.1% of the runners before the race, respectively. Ultrasound abnormalities were significantly associated with approximately a 3-fold increase [hazard ratio (HR) = 2.55, P = 0.004] in the hazard of developing pain in the Achilles tendon and patellar tendon (HR = 1.67, P = 0.042) over the year after the race. Positive and negative predictive values of developing pain over the year were 34.1% and 87.2%, respectively, for abnormal findings in the Achilles tendon, and 22.9% and 85.0%, respectively, for the patellar tendon. CONCLUSIONS The presence of ultrasonographic abnormalities is associated with increased development of pain in the Achilles and patellar tendons within 1 year of a marathon or half marathon.
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Affiliation(s)
- Daniel M Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Ziva Petrin
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Bellevue, Washington
| | - Keith Cummings
- Proliance Orthopaedics & Sports Medicine, Bellevue, Washington; and
| | - Sarah F Eby
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Joy English
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
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15
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The prevalence of neovascularity in rotator cuff tendinopathy: comparing conventional Doppler with superb microvascular imaging. Clin Radiol 2022; 77:e442-e448. [DOI: 10.1016/j.crad.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/16/2022] [Indexed: 11/21/2022]
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16
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Lu C, Fan Y, Yu G, Chen H, Sinclair J, Fan Y. Asymptomatic foot and ankle structural injuries: a 3D imaging and finite element analysis of elite fencers. BMC Sports Sci Med Rehabil 2022; 14:50. [PMID: 35346343 PMCID: PMC8962477 DOI: 10.1186/s13102-022-00444-y] [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: 04/28/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Fencing is a highly asymmetrical combat sport, that imposes high mechanical demands over repeated exposures on the musculoskeletal structures, a primary cause of injuries in fencers. However, there are limited epidemiological studies on the structural injuries of the foot and ankle in fencers. This study aimed to investigate foot and ankle structural injuries, and explore how metatarsophalangeal joint structural changes may affect the mechanisms of foot and ankle injuries in asymptomatic fencers. METHODS 3D images of foot and ankle morphology using computed tomography were obtained from ten elite fencers. We then constructed finite element models of the first metatarsophalangeal joint in the foot of their trail legs. The validated models were used to simulate stress distribution changes from different ankle joint angles during lunging. RESULTS The findings showed that stress distribution changes at the medial and lateral sesamoid may have caused sesamoid fractures, and that habitual and concentrated stress on the metatarsal bones might have flattened the sesamoid groove. This process may damage the integrity of the first metatarsophalangeal joint, and consequently affect the efficiency of the windlass mechanism in fencers. During lunging, different ankle joint angles of the trail foot increased the total stress difference of the medial and lateral foot, and thus influenced the lunging quality and its stability. CONCLUSIONS Our findings revealed that the asymmetric nature of fencing might have caused asymptomatic foot and ankle structural injuries, and finite element analysis results indicated that this might increase the incidence of the serious injuries if unattended. Regular computed tomography examination should be introduced to monitor elite fencers' lower limb alterations, permitting unique angle adjustments in the trail foot without sacrificing technical or physiologic properties based on the exam results and reduce the lower limb injury risk.
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Affiliation(s)
- Congfei Lu
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China
| | - Yuxuan Fan
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China
| | - Genyu Yu
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China
| | - Hua Chen
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China
| | - Jonathan Sinclair
- Research Centre for Applied Sport, Physical Activity and Performance, School of Sport and Health Sciences, University of Central Lancashire, Lancashire, Preston, PR1 2HE, UK
| | - Yifang Fan
- Foot Research Laboratory, Key Laboratory of Sport and Health Science of Fujian Province, School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, 350117, China.
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18
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Millet GP, Brocherie F, Burtscher J. Olympic Sports Science-Bibliometric Analysis of All Summer and Winter Olympic Sports Research. Front Sports Act Living 2021; 3:772140. [PMID: 34746779 PMCID: PMC8564375 DOI: 10.3389/fspor.2021.772140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: The body of scientific literature on sports and exercise continues to expand. The summer and winter Olympic games will be held over a 7-month period in 2021-2022. Objectives: We took this rare opportunity to quantify and analyze the main bibliometric parameters (i.e., the number of articles and citations) across all Olympic sports to weigh and compare their importance and to assess the structure of the "sport sciences" field. The present review aims to perform a bibliometric analysis of Olympic sports research. We quantified the following topics: (1) the most investigated sports; (2) the main journals in which the studies are published; (3) the main factors explaining sport-specific scientific attractiveness; (4) the influence of being in the Olympic programme, economic weight, and local influences on research output; and (5) which research topic is the most investigated across sports. Methods: We searched 116 sport/exercise journals on PubMed for the 40 summer and 10 winter Olympic sports. A total of 34,038 articles were filtered for a final selection of 25,003 articles (23,334 articles on summer sports and 1,669 on winter sports) and a total of 599,820 citations. Results and Discussion: Nine sports [football (soccer), cycling, athletics, swimming, distance & marathon running, basketball, baseball, tennis, and rowing] were involved in 69% of the articles and 75% of the citations. Football was the most cited sport, with 19.7 and 26.3% of the total number of articles and citations, respectively. All sports yielded some scientific output, but 11 sports (biathlon, mountain biking, archery, diving, trampoline, skateboarding, skeleton, modern pentathlon, luge, bobsleigh, and curling) accumulated a total of fewer than 50 publications. While ice hockey is the most prominently represented winter sport in the scientific literature, winter sports overall have produced minor scientific output. Further analyses show a large scientific literature on team sports, particularly American professional sports (i.e., baseball, basketball, and ice hockey) and the importance of inclusion in the Olympic programme to increasing scientific interest in "recent" sports (i.e., triathlon and rugby sevens). We also found local/cultural influence on the occurrence of a sport in a particular "sport sciences" journal. Finally, the relative distribution of six main research topics (i.e., physiology, performance, training and testing, injuries and medicine, biomechanics, and psychology) was large across sports and reflected the specific performance factors of each sport.
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Affiliation(s)
- Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Franck Brocherie
- Laboratory Sport Expertise and Performance (EA 7370), French Institute of Sport, Paris, France
| | - Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland.,Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
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19
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Cushman DM, Petrin Z, Eby S, Clements ND, Haight P, Snitily B, Teramoto M. Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners. PHYSICIAN SPORTSMED 2021; 49:410-419. [PMID: 33153352 PMCID: PMC8648045 DOI: 10.1080/00913847.2020.1847004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001).Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.
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Affiliation(s)
- Daniel M Cushman
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Ziva Petrin
- Rutgers New Jersey Medical School, Department of Physical Medicine & Rehabilitation
| | - Sarah Eby
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Nathan D. Clements
- University of Texas, San Antonio, Department of Physical Medicine & Rehabilitation
| | | | | | - Masaru Teramoto
- University of Utah Division of Physical Medicine & Rehabilitation
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20
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Comparison of Pain Measures Between Tendons of Elite Basketball Players With Different Sonographic Patterns. J Sport Rehabil 2021; 29:142-147. [PMID: 30526260 DOI: 10.1123/jsr.2018-0240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/04/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT The prevalence and negative consequences of the symptoms surrounding patellar tendinopathy constitute an important problem for sports medicine professionals. The identification of potential pain mediators is, therefore, of major interest to improve both the prevention and management of this injury. OBJECTIVE To compare the pain experienced by elite male adult basketball players and patterns of patellar tendon abnormalities. Also, to identify whether structural and vascular sonographic abnormalities (focal area of hypoechogenicity, thickening, and neovascularization [NV]) are equal in determining pain perceptions. DESIGN An observational study with professional basketball teams (ACB-Spanish league). PARTICIPANTS A total of 73 male basketball players (mean age 26.8 y). MAIN OUTCOME MEASURES Patellar tendon ultrasonography images. Pain scores were compared between the identified patterns. Multiple regression analysis was used to examine the relative importance of abnormalities. RESULTS Of the 146 tendons, 91 had some degree of sonographic abnormality. Three main patterns were identified: I (1 structural abnormality without NV), II (2 structural abnormalities without NV), and III (2 structural abnormalities and NV). A total of 31 tendons (21.2%) exhibited pattern I, 46 (31.5%) presented pattern II, and 13 tendons (8.9%) exhibited pattern III. The mean visual analog scale and the Victorian Institute of Sport assessment questionnaire-patellar tendon (VISA-P) scores for pattern III were significantly different (P < .05) compared with patterns I and II; however, the pain pressure threshold (PPT) scores were not. NV was significantly associated with worsened scores for all pain measures; however, the focal area of hypoechogenicity was only associated with PPT scores. CONCLUSION Patterns of sonographic abnormalities, including NV, demonstrated greater pain. Although NV determined scores for the visual analog scale, VISA-P, and PPT, the presence of focal area of hypoechogenicity on its own is a determining factor for the PPT. This study suggests that the combination of 2 or more sonographic abnormalities may help explain pain variations among basketball players.
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21
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Rodas G, Soler-Rich R, Rius-Tarruella J, Alomar X, Balius R, Orozco L, Masci L, Maffulli N. Effect of Autologous Expanded Bone Marrow Mesenchymal Stem Cells or Leukocyte-Poor Platelet-Rich Plasma in Chronic Patellar Tendinopathy (With Gap >3 mm): Preliminary Outcomes After 6 Months of a Double-Blind, Randomized, Prospective Study. Am J Sports Med 2021; 49:1492-1504. [PMID: 33783227 DOI: 10.1177/0363546521998725] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar tendinopathy is common. The success of traditional management, including isometric or eccentric exercises combined with shockwave therapy and even surgery, is limited. Therefore, it is important to determine whether biological treatments such as ultrasound-guided intratendinous and peritendinous injections of autologous expanded bone marrow mesenchymal stem cells (BM-MSCs) or leukocyte-poor platelet-rich plasma (Lp-PRP) improve clinical outcomes in athletic patients with patellar tendinopathy. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A prospective, double-blinded, randomized, 2-arm parallel group, active controlled, phase 1/2 single-center clinical study was performed in patients who had proximal patellar tendinopathy with a lesion >3 mm. A total of 20 participants (age 18-48 years) with pain for >4 months (mean, 23.6 months) and unresponsive to nonoperative treatments were randomized into 2 groups. Of these, 10 participants were treated with BM-MSC (20 × 106 cells) and 10 with Lp-PRP. Both groups performed the same postintervention rehabilitation protocol. Outcomes included the Victorian Institute of Sport Assessment for pain (VISA-P), self-reported tendon pain during activity (visual analog scale [VAS]), muscle function by dynamometry, tendon thickness and intratendinous vascularity by ultrasonographic imaging and Doppler signal, ultrasound tissue characterization (UTC) echo type changes, and magnetic resonance imaging (MRI) T2-weighted mapping changes. Participants were followed longitudinally for 6 months. RESULTS The average VAS scores improved in both groups at all time points, and there was a significant reduction in pain during sporting activities (P < .05). In both groups, the average mean VISA-P scores at 6 months were significantly increased compared with baseline (66 BM-MSC group and 72.90 Lp-PRP group), with no significant differences in VAS or VISA-P scores between the groups. There were statistically significant greater improvements in tendon structure on 2-dimensional ultrasound and UTC in the BM-MSC group compared with the Lp-PRP group at 6 months. Similarly, the BM-MSC group demonstrated significant evidence of restoration of tendon structure on MRI compared with the Lp-PRP group at 6 months. Only the participants in the BM-MSC group showed evidence of normalization of tendon structure, with statistically significant differences between the groups on T2-weighted, fat-saturated sagittal and coronal scans and hypersignal in T2-weighted on spin-echo T2-weighted coronal MRI scan. Both treatments were safe, and no significant adverse events were reported in either group. CONCLUSION Treatment with BM-MSC or Lp-PRP in combination with rehabilitation in chronic patellar tendinopathy is effective in reducing pain and improving activity levels in active participants. Participants who received BM-MSC treatment demonstrated greater improvement in tendon structure compared with those who received Lp-PRP. REGISTRATION 2016-001262-28 (EudraCT identifier); NCT03454737 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Gil Rodas
- Medical Department FC Barcelona, Barcelona, Spain.,Sports Medicine Unit, Clínic Hospital and Sant Joan de Déu Hospital, Barcelona, Spain
| | - Robert Soler-Rich
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, Barcelona, Spain
| | - Joan Rius-Tarruella
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, Barcelona, Spain
| | - Xavier Alomar
- Diagnóstico por la Imagen, Clínica Creu Blanca, Barcelona, Spain
| | - Ramon Balius
- Consell Català de l'Esport, Generalitat de Catalunya, Barcelona, Spain
| | - Lluís Orozco
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, Barcelona, Spain
| | - Lorenzo Masci
- Institute of Sports Exercise and Health (ISEH), London, UK
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Surgery and Dentistry, Salerno, Italy.,Centre for Sports and Exercise Medicine, Queen Mary University of London, London, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Staffordshire, UK
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22
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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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Physical Activity and Investigation With Magnetic Resonance Imaging Partly Explain Variability in the Prevalence of Patellar Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals. J Orthop Sports Phys Ther 2021; 51:216-231. [PMID: 33779217 DOI: 10.2519/jospt.2021.10054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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 pooled prevalence of, and factors associated with, the presence of patellar tendon abnormalities observed on imaging in people without symptoms. DESIGN Systematic review with stratified meta-analysis and meta-regression. LITERATURE SEARCH We searched Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science from 1980 to August 2020. STUDY SELECTION CRITERIA We included studies that reported the prevalence of asymptomatic patellar tendon abnormalities on imaging. We excluded studies of participants with current tendon pain, a history of tendon pain, or other systemic conditions. DATA SYNTHESIS Stratification and meta-regression of studies based on study-level descriptive statistics (mean age, body mass index, proportion of female participants, physical activity participation, imaging modality) were performed using a random-effects model to account for between-study heterogeneity. Risk of bias was assessed using the modified Newcastle-Ottawa scale. RESULTS Meta-analysis of 64 studies (7125 limbs from 4616 participants) found significant between-study heterogeneity (I2≥90%, P<.01), which precluded a summary prevalence estimate. Heterogeneity was partially explained by studies that included participants who were physically active and studies that assessed tendon abnormalities using magnetic resonance imaging compared to ultrasound (P<.05). Mean age, body mass index, proportion of female participants, and sample size did not explain the remaining heterogeneity. CONCLUSION There was substantial variability in the reported prevalence of asymptomatic patellar tendon abnormalities. A clear and valid method is needed to assess and report the presence of patellar tendon abnormalities to increase research capacity and establish the clinical value of imaging the patellar tendon. J Orthop Sports Phys Ther 2021;51(5):216-231. Epub 28 Mar 2021. doi:10.2519/jospt.2021.10054.
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Szaro P, Ghali Gataa K. The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging. Sci Rep 2021; 11:6131. [PMID: 33731785 PMCID: PMC7969943 DOI: 10.1038/s41598-021-85604-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
This comparative study aimed to investigate how tendinopathy-related lesions change correlations in the dimensions of the Achilles tendon. Our experimental group included 74 patients. The mean age was 52.9 ± 10.4 years. The control group included 81 patients with a mean age was 35.2 ± 13.6 years, p < .001. The most significant difference in correlation was the thickness of the tendon and the midportion's width, which was more significant in the tendinopathy (r = .49 vs. r = .01, p < .001). The correlation was positive between width and length of the insertion but negative in normal tendons (r = .21 vs. r = − .23, p < .001). The correlation was between the midportions width in tendinopathy and the tendon's length but negative in the normal tendon (r = .16 vs. r = − .23, p < .001). The average thickness of the midportion in tendinopathy was 11.2 ± 3.3 mm, and 4.9 ± 0.5 mm in the control group, p < .001. The average width of the midportion and insertion was more extensive in the experimental group, 17.2 ± 3.1 mm vs. 14.7 ± 1.8 mm for the midportion and 31.0 ± 3.9 mm vs. 25.7 ± 3.0 mm for insertion, respectively, p < .001. The tendon's average length was longer in tendinopathy (83.5 ± 19.3 mm vs. 61.5 ± 14.4 mm, p < .001). The dimensions correlations in normal Achilles tendon and tendinopathic tendon differ significantly.
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Affiliation(s)
- Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.
| | - Khaldun Ghali Gataa
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Karanasios S, Korakakis V, Moutzouri M, Drakonaki E, Koci K, Pantazopoulou V, Tsepis E, Gioftsos G. Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review. J Hand Ther 2021; 35:541-551. [PMID: 33814224 DOI: 10.1016/j.jht.2021.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/24/2021] [Accepted: 02/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing. PURPOSE To review the diagnostic accuracy of examination tests used in LET. DESIGN Systematic review following PRISMA-DTA guidelines. METHODS We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET. RESULTS Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%). CONCLUSIONS Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO ID CRD42020160402.
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Affiliation(s)
| | | | - Maria Moutzouri
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | - Eleni Drakonaki
- Medical School of the European University Cyprus, Engomi, Nicosia Cyprus
| | - Klaudia Koci
- Physiotherapy Department, University of West Attica, Egaleo, Greece
| | | | - Elias Tsepis
- Physiotherapy Department, University of Patras, Greece
| | - George Gioftsos
- Physiotherapy Department, University of West Attica, Egaleo, Greece
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Bezuglov E, Khaitin V, Lazarev A, Brodskaia A, Lyubushkina A, Kubacheva K, Waśkiewicz Z, Petrov A, Maffulli N. Asymptomatic Foot and Ankle Abnormalities in Elite Professional Soccer Players. Orthop J Sports Med 2021; 9:2325967120979994. [PMID: 33614799 PMCID: PMC7869170 DOI: 10.1177/2325967120979994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Professional soccer players are often evaluated with asymptomatic lesions of the ankle and foot, and such abnormalities may eventually become clinically relevant. Purpose To ascertain the prevalence of foot and ankle abnormalities in elite professional adult soccer players. Study Design Case series; Level of evidence, 4. Methods Professional adult male elite soccer players (n = 37) underwent magnetic resonance imaging (MRI) scans of both their feet and ankles. All competed for their respective national junior or adult soccer teams. MRI scans were performed with 1.5-T scanners and analyzed independently by 2 experienced radiologists. Results The MRI scans of 86.5% of the players showed degenerative joint disease (DJD) in at least 1 of the joints of the foot and ankle. Articular cartilage lesions in the joints of the foot and ankle were evident in 42% of the scans. Of all lesions, 17% were grade 3 or 4 (Noyes and Stabler classification) cartilage lesions and accompanied by subchondral bone marrow edema. The greater the age, weight, and height of the players, the greater was the odds ratio of DJD of the ankle joint. Synovitis in at least 1 of the joints of the foot was detected in 64% of the MRI scans. Leg dominance significantly correlated with bone marrow edema of the talus. Conclusion Elite professional soccer players are often evaluated with a high prevalence of asymptomatic osteochondral lesions with subchondral bone marrow edema in the foot and ankle. These osteochondral lesions may remain asymptomatic or, with the continuing high-intensity stresses that modern professional soccer demands of its athletes, may evolve and cause foot and ankle pain. It is unclear whether and which interventions can be implemented to prevent the occurrence of these abnormalities in the first place.
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Affiliation(s)
- Eduard Bezuglov
- Department of Sport Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Federal Research and Clinical Center of Sports Medicine and Rehabilitation of Federal Medical Biological Agency, Moscow, Russia.,High Performance Sports Laboratory, Moscow Witte University, Moscow, Russia
| | - Vladimir Khaitin
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia.,Football Club Zenit St. Petersburg, St. Petersburg, Russia
| | - Artemii Lazarev
- Department of Sport Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,High Performance Sports Laboratory, Moscow Witte University, Moscow, Russia
| | - Alesia Brodskaia
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - Anastasiya Lyubushkina
- High Performance Sports Laboratory, Moscow Witte University, Moscow, Russia.,Smart Recovery Clinic, Moscow, Russia
| | - Kamila Kubacheva
- St. Petersburg State Public Institution City Hospital No. 40, St. Petersburg, Russia
| | - Zbigniew Waśkiewicz
- Department of Sport Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,Institute of Sport Science, Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Arseniy Petrov
- Georg-August University of Göttingen, Göttingen, Germany
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
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Klich S, Ficek K, Krymski I, Klimek A, Kawczyński A, Madeleine P, Fernández-de-Las-Peñas C. Quadriceps and Patellar Tendon Thickness and Stiffness in Elite Track Cyclists: An Ultrasonographic and Myotonometric Evaluation. Front Physiol 2020; 11:607208. [PMID: 33381054 PMCID: PMC7767861 DOI: 10.3389/fphys.2020.607208] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Track cyclists are required to perform short- and long-term efforts during sprint and endurance race events, respectively. The 200 m flying sprint races require maximal power output and anaerobic capacity, while the 4,000 m pursuit cyclists demand a high level of aerobic capacity. Our goal was to investigate spatial changes in morphological and mechanical properties displayed using 3D topographical maps of the quadriceps muscle and tendons after 200 m flying start and 4,000 m individual pursuit race in elite track cyclists. We hypothesized a non-uniform distribution of the changes in the quadriceps muscle stiffness (QMstiff), and acute alterations in quadriceps tendon (QTthick) and patellar tendon (PTthick) thickness. Fifteen men elite sprint and 15 elite men endurance track cyclists participated. Sprint track cyclists participated in a 200 m flying start, while endurance track cyclists in 4,000 m individual pursuit. Outcomes including QTthick (5–10–15 mm proximal to the upper edge of the patella), PTthick (5–10–15–20 mm inferior to the apex of the patella)—using ultrasonography evaluation, QMstiff, and quadriceps tendon stiffness (QTstiff) were measured according to anatomically defined locations (point 1–8) and patellar tendon stiffness (PTstiff)—using myotonometry, measured in a midway point between the patella distal and the tuberosity of tibial. All parameters were assessed before and after (up to 5 min) the 200 m or 4,000 m events. Sprint track cyclists had significantly larger QTthick and PTthick than endurance track cyclists. Post-hoc analysis showed significant spatial differences in QMstiff between rectus femoris, vastus lateralis, and vastus medialis in sprint track cyclists. At before race, sprint track cyclists presented significantly higher mean QTthick and PTthick, and higher QMstiff and the QTstiff, as compared with the endurance track cyclists. The observed changes in PTThick and QTThick were mostly related to adaptation-based vascularity and hypertrophy processes. The current study suggests that assessments using both ultrasonography and myotonometry provides crucial information about tendons and muscles properties and their acute adaptation to exercise. Higher stiffness in sprint compared with endurance track cyclists at baseline seems to highlight alterations in mechanical properties of the tendon and muscle that could lead to overuse injuries.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Krzysztof Ficek
- Department of Physiotherapy, Academy of Physical Education in Katowice, Katowice, Poland.,Galen Orthopedic Center, Bieruń, Poland
| | | | - Andrzej Klimek
- Biomedical Science Institute, University School of Physical Education in Kraków, Kraków, Poland
| | - Adam Kawczyński
- Department of Paralympic Sport, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Pascal Madeleine
- Department of Health Science and Technology, Sport Sciences-Performance and Technology, Aalborg University, Aalborg, Denmark
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
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Akpinar B, Baron S, Alaia MJ, Jazrawi LM. Clinical and Biomechanical Outcomes following Knee Extensor Mechanism Reconstruction. Arthrosc Sports Med Rehabil 2020; 2:e553-e561. [PMID: 33134994 PMCID: PMC7588626 DOI: 10.1016/j.asmr.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 07/01/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate clinical and biomechanical outcomes after knee extensor mechanism reconstruction (KEMR). Methods Patients who underwent KEMR at our institution from 2011 to 2018 were identified. Patient-reported outcomes (Kujala, Lysholm, Tegner Activity Scale) were compiled at clinical follow-up. Isokinetic testing was conducted using the BioDex system 4 pro dynamometer at slow (60°/s), intermediate (180°/s), and fast (300°/s) speeds in a 9-patient subset. Results From 2011 to 2018, 12 patients (12 knees, 10 male, 5 right, mean age: 54.3 ± standard deviation: 15.2 years) with KEM injuries requiring tendon reconstruction with a 1-year minimum follow up were identified. Postoperative follow-up was 42.6 months (range: 12.0-93.0 months). Procedures included patellar (7) and quadriceps tendon reconstruction (5). Postoperative versus preoperative Tegner Activity Scale scores demonstrated significant improvement (3.5 ± 2.5 vs 1.5 ± 1.2, n = 8, P = .05). Postoperative versus preoperative Kujala scores significantly improved (70.3 ± 11.7 vs 43.6 ± 15.7, n = 8, P = .010). There was significant improvement in preoperative to postoperative KEMR extension lag (29.4 ± 22.2° vs 0.83 ± 1.9°, P = .002). Clinically, there was no difference in passive range of motion between the operative and contralateral knee. BioDex testing demonstrated decreased maximum work generated from the operative versus contralateral knee at slow (70.4 ± 30.4 Joules vs 101.9 ± 40.6 J; P = .028), intermediate (52.0 ± 45.4 J vs 69.8 ± 63.7 J; P = .038), and fast (43.8 ± 41.7 J vs 57.5 ± 53.8 J; P = .050) speeds. Range of motion was less in the operative versus contralateral knee at all speeds: P = .011, .038, and .024. The average peak torque generated per body weight was smaller in the operative versus contralateral knee at slow speed (P = .038). Conclusions Patients undergoing KEMR in this study have significantly improved clinical outcomes despite having strength deficits that persist postoperatively. Level of Evidence Therapeutic Case Series, Level IV.
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Affiliation(s)
- Berkcan Akpinar
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A
| | - Samuel Baron
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, New York, U.S.A
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Docking SI, Girdwood MA, Cook J, Fortington LV, Rio E. Reduced Levels of Aligned Fibrillar Structure Are Not Associated With Achilles and Patellar Tendon Symptoms. Clin J Sport Med 2020; 30:550-555. [PMID: 30067515 DOI: 10.1097/jsm.0000000000000644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether the mean cross-sectional area (mCSA) of aligned fibrillar structure (AFS) was associated with the presence and severity of symptoms. DESIGN Prospective cohort study. PARTICIPANTS One hundred seventy-five elite male Australian football players completed monthly Oslo Sports Trauma Research Center overuse injury questionnaires for both the Achilles and patellar tendon over the season to ascertain the presence and severity of symptoms. At the start of the preseason, participants underwent ultrasound tissue characterization (UTC) imaging of the Achilles and patellar tendon. MAIN OUTCOME MEASURES Images were classified as normal or abnormal based on gray-scale ultrasound. Based on UTC quantification, the mCSA of AFS was compared between those with and without current symptoms. RESULTS No difference in the mCSA of AFS was observed between those with or without tendon symptoms (P < 0.05). Similar to previous findings, 80% to 92% of abnormal tendons had similar amounts of mCSA of AFS compared with normal tendon. If reduced mCSA of AFS was present, it was not associated with the presence or severity of symptoms. CONCLUSIONS The prevalence, development, or severity of symptoms was not associated with decreased levels of AFS in the Achilles or patellar tendon. This suggests that a lack of structural integrity is not linked to symptoms and questions the rationale behind regenerative medicine. Most tendons are able to compensate for areas of disorganization and maintain tissue homeostasis.
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Affiliation(s)
- Sean I Docking
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Michael A Girdwood
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Lauren V Fortington
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
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Rabba S, Petrucci V, Petrizzi L, Giommi DW, Busoni V. B-Mode Ultrasonographic Abnormalities and Power Doppler Signal in Suspensory Ligament Branches of Nonlame Working Quarter Horses. J Equine Vet Sci 2020; 94:103254. [PMID: 33077065 DOI: 10.1016/j.jevs.2020.103254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 11/18/2022]
Abstract
Information concerning B-mode ultrasonographic abnormalities and power Doppler (PD) signal in suspensory ligament branches of nonlame working Quarter Horses are not reported. The aims of this study were to investigate the prevalence of B-mode ultrasonographic abnormalities and PD signal in suspensory ligament branches in a group of nonlame working Quarter Horses and to compare B-mode findings with PD findings of horses in two different training (barrel racing and team roping). Twenty-one Quarter Horses in training, 14 barrel racing (Group B) and seven team roping horses (Group R), were assessed by ultrasound for screening purpose. A total of 168 suspensory ligament branches were examined (B-mode and PD examinations). B-mode lesions were seen more frequently in forelimbs (25 branches) than in hindlimbs (10 branches). Power Doppler signal was not detected in suspensory ligament branches that were normal at B-mode, whereas it was visible in 22 of the 35 branches abnormal at B-mode. Horses of Group R showed more B-mode abnormalities and more PD signal in branches abnormal in B-mode.
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Affiliation(s)
- Silvia Rabba
- Diagnostic Imaging Section, Department of Clinical Sciences of Companion Animals and Equids, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium; Department of Diagnostic Imaging, Istituto Veterinario di Novara, Granozzo con Monticello (NO), Italy.
| | | | - Lucio Petrizzi
- Veterinary Teaching Hospital, University of Teramo, Teramo, Italy
| | | | - Valeria Busoni
- Diagnostic Imaging Section, Department of Clinical Sciences of Companion Animals and Equids, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
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Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review. ACTA ACUST UNITED AC 2020; 56:medicina56080378. [PMID: 32731400 PMCID: PMC7466193 DOI: 10.3390/medicina56080378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022]
Abstract
Tendinopathy is a common disease that affects athletes, causing pain and dysfunction to the afflicted tendon. A clinical diagnose is usually combined with imaging and, among all the existing techniques, ultrasound is widely adopted. The aim of this review is to sum up the existing evidence on ultrasound as an imaging tool and guide for treatments in lower limbs tendinopathy. Using three different databases—PubMed, MEDLINE and CENTRAL—a literature search has been performed in May 2020 combining MeSH terms and free terms with Boolean operators. Authors independently selected studies, conducted quality assessment, and extracted results. Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages. The main parameters considered by ultrasound imaging are tendon thickness, hypoechogenicity of tendon structure and neovascularization of the tendon bound tissue. Ultrasound-guide is also used in many tendinopathy treatments and the available studies gave encouraging results, even if further studies are needed in this field.
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Gatz M, Betsch M, Bode D, Schweda S, Dirrichs T, Migliorini F, Tingart M, Quack V. Intra individual comparison of unilateral Achilles tendinopathy using B-mode, power Doppler, ultrasound tissue characterization and shear wave elastography. J Sports Med Phys Fitness 2020; 60:1462-1469. [PMID: 32586084 DOI: 10.23736/s0022-4707.20.11031-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The asymptomatic side of unilateral Achilles tendinopathy (AT) is used as a reference in ultrasound. However, this procedure has not been evaluated in a comparative analysis using B-mode (B-US), power Doppler (PD-US), ultrasound tissue characterization (UTC) and shear wave elastography (SWE). METHODS Retrospective cross-sectional study. Tendons were assigned to 3 groups: 1) asymptomatic side of unilateral AT N.=55; 2) symptomatic side of unilateral AT N.=55; and 3) young reference group N.=29. The following parameters were analyzed separately for the insertion and midportion: UTC (echo type I, II, III, IV), B-US (diameter, cross sectional area), PD-US (Öhberg Score) and SWE (SWE 3 mm, SWE area) using a Wilcoxon Test (group 1 vs. 2) and a Kruskal-Wallis Test (group 1 vs. 2 vs. 3). RESULTS The Wilcoxon Test making an isolated comparison between group 1 vs. 2 revealed a significant difference for all parameters of B-US, PD-US, UTC and SWE (P<0.001, P=0.042), except for the insertion in UTC. However, in the overall analysis including the reference group, the Kruskal-Wallis Test could only detect a significant difference between group 1 vs. 2 for PD-US (P<0.001). Thus, group 1 and 2 had significantly more pathological parameters in B-US (P<0.001, P=0.027), SWE (P<0.001, P=0.008) and UTC (type I, III, IV P<0.001) in both, insertion and midportion, compared to the reference group. CONCLUSIONS The asymptomatic side of unilateral AT seems to show subclinical tendons alterations in B-US, SWE and UTC in comparison to a young and healthy control group. The asymptomatic side of unilateral AT especially with detectable neovascularization might be at risk for future symptoms. Further studies must examine whether the asymptomatic side can still serve as a reference for intra individual comparison in clinical evaluation.
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Affiliation(s)
- Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany -
| | - Marcel Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniela Bode
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Schweda
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Valentin Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
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Rabello LM, van den Akker-Scheek I, Kuipers IF, Diercks RL, Brink MS, Zwerver J. Bilateral changes in tendon structure of patients diagnosed with unilateral insertional or midportion achilles tendinopathy or patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2020; 28:1631-1638. [PMID: 30937472 PMCID: PMC7176591 DOI: 10.1007/s00167-019-05495-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Changes in tendon structure are commonly seen in patients with unilateral achilles (AT) or patellar (PT) tendinopathy but might also be present on the asymptomatic side, indicating a higher risk for developing symptoms. The aim of this study is to compare tendon structure of the symptomatic side with the asymptomatic side in AT and PT patients and control subjects. METHODS A total of 46 patients with unilateral AT (16 insertional and 30 midportion) and 38 with unilateral PT were included. For the control group, a total of 18 Achilles tendons and 25 patellar tendons were scanned. Tendon structure was assessed using ultrasound tissue characterisation (UTC), which quantifies tendon organisation dividing the structure into four different echo types (I-IV). RESULTS There were significant differences in echo types I, III, and IV between symptomatic and asymptomatic sides and controls. Additionally, there was a significant difference between the symptomatic and the asymptomatic side for all tendinopathy locations. In the insertional AT tendon portion, the symptomatic side showed a higher percentage of echo type III. For the midportion AT, the symptomatic side showed a lower percentage of echo type I and a higher percentage of echo types III and IV. For the patellar tendon, the symptomatic side showed a higher percentage of echo types III and IV. All differences were higher than the minimal detectable changes. CONCLUSION Although patients have symptoms unilaterally, the tendon structures are compromised on both sides. These results stress the importance of monitoring both symptomatic and asymptomatic tendon structures and in addition highlight that the asymptomatic side should not be used as reference in clinical practice. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Lucas Maciel Rabello
- Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - I van den Akker-Scheek
- Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Ireen F Kuipers
- Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - R L Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Michel S Brink
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - J Zwerver
- Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Adaptation of Tendon Structure and Function in Tendinopathy With Exercise and Its Relationship to Clinical Outcome. J Sport Rehabil 2020; 29:107-115. [PMID: 30860421 DOI: 10.1123/jsr.2018-0353] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/08/2019] [Accepted: 02/06/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Exercise is seen as the most evidence-based treatment for managing tendinopathy and although the type of exercise used to manage tendinopathy may induce adaptation in healthy tendons, it is not clear whether these adaptations occur in tendinopathy and if so whether they are associated with improved clinical outcomes. OBJECTIVE The aim of the study was to synthesize available evidence for adaptation of the Achilles tendon to eccentric exercise and the relationship between adaptation (change in tendon thickness) and clinical outcomes among people with Achilles tendinopathy. EVIDENCE ACQUISITION The search was performed in September 2018 in several databases. Studies investigating the response (clinical outcome and imaging on ultrasound/magnetic resonance imaging) of pathological tendons (tendinopathy, tendinosis, and partial rupture) to at least 12 weeks of eccentric exercise were included. Multiple studies that investigated the same interventions and outcome were pooled and presented in effect size estimates, mean difference, and 95% confidence intervals if measurement scales were the same, or standard mean difference and 95% confidence intervals if measurements scales were different. Where data could not be pooled the studies were qualitatively synthesized based on van Tulder et al. EVIDENCE SYNTHESIS Eight studies met the inclusion and exclusion criteria and were included in the review. There was strong evidence that Achilles tendon thickness does not decrease in parallel with improved clinical outcomes. CONCLUSIONS Whether a longer time to follow-up is more important than the intervention (ie, just the time per se) for a change in tendon thickness remains unknown. Future studies should investigate whether exercise (or other treatments) can be tailored to optimize tendon adaptation and function, and whether this relates to clinical outcomes.
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Fallows R, Lumsden G. Pitfalls in the study of neovascularisation in achilles and patellar tendinopathy: a review of important factors for clinicians to consider and the need for greater standardisation. PHYSICAL THERAPY REVIEWS 2019. [DOI: 10.1080/10833196.2019.1690216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Richard Fallows
- Telford Musculoskeletal Services, Shropshire Community Health NHS Trust, Shropshire, UK
| | - Gordon Lumsden
- Physiotherapy Department, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
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Benítez-Martínez JC, Valera-Garrido F, Martínez-Ramírez P, Ríos-Díaz J, Del Baño-Aledo ME, Medina-Mirapeix F. Lower Limb Dominance, Morphology, and Sonographic Abnormalities of the Patellar Tendon in Elite Basketball Players: A Cross-Sectional Study. J Athl Train 2019; 54:1280-1286. [PMID: 31483151 DOI: 10.4085/1062-6050-285-17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Patellar tendinopathy is common in basketball players, and structural ultrasound abnormalities can be found in symptomatic and asymptomatic tendons. Lower limb dominance may also be a critical load factor, potentially leading to overloading of the patellar tendon. OBJECTIVE To describe and compare the prevalence by lower limb dominance of patellar tendons with structural and vascular abnormalities and to describe the morphologic measures of tendons without abnormalities among adult male elite basketball players. DESIGN Cross-sectional study. SETTING Medical center of a professional basketball team in the Spanish league. PATIENTS OR OTHER PARTICIPANTS A total of 73 adult male elite basketball players (146 patellar tendons; age = 26.8 ± 4.9 years, height = 198.0 ± 0.1 cm, mass = 95.4 ± 11.4 kg). MAIN OUTCOME MEASURE(S) We used ultrasound to screen the patellar tendons for the presence of structural and vascular abnormalities. Tendons were categorized as abnormal if they demonstrated a focal area of hypoechogenicity, thickening, or neovascularization. We also examined the cross-sectional area and thickness of tendons without abnormalities. Prevalence and morphologic measures were compared by limb dominance. RESULTS A total of 35 players (48%) had bilateral abnormalities, whereas 21 (28.7%) had unilateral abnormalities. Among the 91 abnormal tendons, 90 (61.6% of 146 tendons) exhibited a focal area of hypoechogenicity, 59 (40.4% of 146 tendons) exhibited thickening, and 14 (9.6% of 146 tendons) exhibited neovascularization. No group differences were detected between the dominant and nondominant limbs. Among the 55 normal patellar tendons, 34 were bilateral (from 17 players) and 21 were unilateral. Approximately 25% (n = 14) of all 55 normal tendons had a cross-sectional area that was greater than 182.8 mm2 and a thickness greater than 7.2 mm. Among the 34 bilateral normal tendons, no group differences were observed between the dominant and nondominant limbs for either cross-sectional area or thickness. CONCLUSIONS The prevalence of abnormal tendons was high among adult male elite basketball players, and bilateral presentations were more frequent. Structural abnormalities were most common.
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Affiliation(s)
| | | | | | - José Ríos-Díaz
- Centro de CC de la Salud San Rafael, Universidad Antonio de Nebrija, Madrid, Spain
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Mersmann F, Pentidis N, Tsai MS, Schroll A, Arampatzis A. Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes. Front Physiol 2019; 10:963. [PMID: 31427983 PMCID: PMC6687848 DOI: 10.3389/fphys.2019.00963] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/11/2019] [Indexed: 12/28/2022] Open
Abstract
High mechanical strain is thought to be one of the main factors for the risk of tendon injury, as it determines the mechanical demand placed upon the tendon by the working muscle. The present study investigates the association of tendon mechanical properties including force, stress and strain, and measures of tendon micromorphology and neovascularization, which are thought to be indicative of tendinopathy in an adolescent high-risk group for overuse injury. In 16 adolescent elite basketball athletes (14–15 years of age) we determined the mechanical properties of the patellar tendon by combining inverse dynamics with magnetic resonance and ultrasound imaging. Tendon micromorphology was determined based on a spatial frequency analysis of sagittal plane ultrasound images and neovascularization was quantified as color Doppler area. There was a significant inverse relationship between tendon strain and peak spatial frequency (PSF) in the proximal tendon region (r = −0.652, p = 0.006), indicating locally disorganized collagen fascicles in tendons that are subjected to high strain. No such associations were present at the distal tendon site and no significant correlations were observed between tendon force or stress and tendon PSF as well as between tendon loading and vascularity. Our results suggest that high levels of tendon strain might associate to a micromorphological deterioration of the collagenous network in the proximal patellar tendon, which is also the most frequent site affected by tendinopathy. Neovascularization of the tendon on the other hand seems not to be directly related to the magnitude of tendon loading and might be a physiological response to a high frequency of training in this group. Those findings have important implications for our understanding of the etiology of tendinopathy and for the development of diagnostical tools for the assessment of injury risk.
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Affiliation(s)
- Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nikolaos Pentidis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Meng-Shiuan Tsai
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Splittgerber LE, Ihm JM. Significance of Asymptomatic Tendon Pathology in Athletes. Curr Sports Med Rep 2019; 18:192-200. [DOI: 10.1249/jsr.0000000000000600] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Quantification of Achilles and patellar tendon structure on imaging does not enhance ability to predict self-reported symptoms beyond grey-scale ultrasound and previous history. J Sci Med Sport 2019; 22:145-150. [DOI: 10.1016/j.jsams.2018.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 07/03/2018] [Accepted: 07/22/2018] [Indexed: 02/06/2023]
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40
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King D, Yakubek G, Chughtai M, Khlopas A, Saluan P, Mont MA, Genin J. Quadriceps tendinopathy: a review-part 1: epidemiology and diagnosis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:71. [PMID: 30963066 DOI: 10.21037/atm.2019.01.58] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Overuse injuries of the extensor mechanism of the knee are common in both athletes and non-athletes and usually occur during activities associated with repetitive loading, stress, and knee extension. Historically, they have been labeled as Jumper's knee due to the high prevalence seen in the athletic community. In many published reports, the name "patellar tendinopathy" is used to describe this disorder of the quadriceps tendon at the patellar insertion, and the names are often used interchangeably. Numerous reports have been published describing extensor mechanism injuries in athletes, but there is a paucity of studies that focus on quadriceps tendinopathy. In addition, there is no universally accepted classification system for tendon pathology. Therefore, we performed a comprehensive literature review of these studies. This review consists of 2 parts. In the first part we review: (I) epidemiology and (II) diagnosis of quadriceps tendinopathy in the athlete as well as the general population. In the second part we discuss: (I) classification; (II) prognosis; and (III) treatment results.
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Affiliation(s)
- Dominic King
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - George Yakubek
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul Saluan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Jason Genin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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Fazekas ML, Sugimoto D, Cianci A, Minor JL, Corrado GD, d'Hemecourt PA. Ultrasound examination and patellar tendinopathy scores in asymptomatic college jumpers. PHYSICIAN SPORTSMED 2018; 46:477-484. [PMID: 30122090 DOI: 10.1080/00913847.2018.1513756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the prevalence of hypoechoic areas by US and its' association with VISA-P scores among asymptomatic jumpers while highlighting sex comparisons. DESIGN Cross-sectional study. SETTING Pre-participation exam at a National Collegiate Athletic Association (NCAA) division I college. PARTICIPANTS Thirty-one college athletes who engage in jumping sports. MAIN OUTCOME MEASURES Hypoechoic images of patellar tendon captured by ultrasound examination were compared to a self-reported knee functional survey, the Victorian Institute of Sport Assessment for patellar tendinopathy (VISA-P) scale (0-100). RESULTS With a total of 31 athletes (13 males and 18 females), prevalence rate of the hypoechoic areas of patellar tendon was 19.4% (6/31) in the right knee and 29.0% (9/31) in the left knee. There was no proportional difference in a comparison of prevalence rate of hypoechoic area [(+) or (-)] by sex in either right or left knee. The VISA-P scores were significantly lower in US (+) than US (-) in the right knee (p = 0.003, Cohen's d = 1.675), but not the left knee (p = 0.250, Cohen's d = 0.512). The receiver operating characteristics curve analysis indicated the most sensitive and specific VISA-P values based on status [(+) or (-)] of hypoechoic area was 89.5 with 86.4% and 77.7% of sensitivity and specificity. CONCLUSION In short, hypoechoic areas were detected by US examination among self-reported asymptomatic jumpers. There was an association between hypoechoic areas and VISA-P scores in the right knee, but not in left knee. VISA-P scores may be used as a screening tool for the presence of hypoechoic areas.
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Affiliation(s)
- Matthew L Fazekas
- a Department of Orthopaedic Surgery , Joe DiMaggio Children's Hospital , Hollywood , FL , USA
| | - Dai Sugimoto
- b The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.,c Division of Sports Medicine, Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.,d Department of Orthopaedic Surgery , Harvard Medical School , Boston , MA , USA
| | - Andrea Cianci
- c Division of Sports Medicine, Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA
| | - Jonathan L Minor
- e Sports Medicine, Rehabilitation, and Concussion Center , Tucson , AZ , USA
| | - Gianmichel D Corrado
- b The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.,c Division of Sports Medicine, Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.,d Department of Orthopaedic Surgery , Harvard Medical School , Boston , MA , USA
| | - Pierre A d'Hemecourt
- b The Micheli Center for Sports Injury Prevention , Waltham , MA , USA.,c Division of Sports Medicine, Department of Orthopaedics , Boston Children's Hospital , Boston , MA , USA.,d Department of Orthopaedic Surgery , Harvard Medical School , Boston , MA , USA
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Noback PC, Freibott CE, Tantigate D, Jang E, Greisberg JK, Wong T, Vosseller JT. Prevalence of Asymptomatic Achilles Tendinosis. Foot Ankle Int 2018; 39:1205-1209. [PMID: 29855207 DOI: 10.1177/1071100718778592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most patients who sustain Achilles tendon ruptures (ATRs) have no clinical symptoms prior to ATR. The objective of this study was to define the prevalence of ultrasound-detectable Achilles tendinopathy in asymptomatic patients in an at-risk group. METHODS This was a cross-sectional study that collected data from a group of volunteers. All participants were given IPAQ questionnaires to gauge daily activity level, in addition to a demographic form. Participants underwent a physical examination, Silfverskiold test, and an ultrasonographic examination to evaluate for presence of Achilles tendinopathy. Fifty-one volunteers (30 female, 21 male) and 102 Achilles tendons were assessed in this study. The mean age was 27.4±6.3, with an average BMI of 23.5±3.9. Ninety-two percent of participants were categorized as having moderate or high activity levels per the iPAQ questionnaire. RESULTS Sixteen tendons had at least 1 abnormality: 10 (9.8%) had hypoechoic foci, 9 (8.8%) had calcifications, 1 (0.9%) had increased vascularity, and 1 (0.9%) had a low-grade interstitial tear. Approximately 40% of patients were noted to have a gastroc equinus contracture on Silfverskiold testing. In addition, 14.7% of patients with a gastroc equinus had a hypoechoic focus compared to 8.6% of patients without gastroc equinus ( P = .5003). Logistic regression analysis demonstrated that an increased BMI was a significant risk factor for having an Achilles tendon abnormality on ultrasonography ( P < .01, odds ratio = 1.41). CONCLUSION In this study, 16% of the Achilles tendons were abnormal and had at least 1 abnormality on ultrasonography. This group of patients was generally young, healthy, and active, thus a group at risk for ATRs. Only 40% of patients had gastrocnemius equinus, although a slightly higher non-significant percentage of those with hypoechoic foci had gastrocnemius equinus. It may be advantageous to prophylactically treat these patients with rehabilitation exercises to minimize the risk of ATR. LEVEL OF EVIDENCE Level II, comparative prognostic study.
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Affiliation(s)
- Peter C Noback
- 1 Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Christina E Freibott
- 1 Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Direk Tantigate
- 1 Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Eugene Jang
- 1 Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Justin K Greisberg
- 1 Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Tony Wong
- 1 Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - J Turner Vosseller
- 1 Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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Matthews W, Ellis R, Furness J, Hing W. Classification of Tendon Matrix Change Using Ultrasound Imaging: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2059-2080. [PMID: 30007477 DOI: 10.1016/j.ultrasmedbio.2018.05.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound imaging (US) is an accurate and reliable method used to diagnose tendinopathy. This systematic review was aimed at identifying common criteria and parameters used to diagnose tendinopathy, the methodological quality of studies and the predictive value of US. Nineteen studies met the inclusion criteria, with the Achilles, quadriceps and patella tendons being investigated. Overall, there was significant heterogeneity between the criteria used to diagnose tendinopathy utilising US. The methodological quality of included studies was "good." Additionally, meta-analysis revealed that US-identified abnormalities were predictive of future symptoms, and classification of tendinopathy using three US defined parameters indicated a higher relative risk of developing clinical tendinopathy compared with the use of two US-defined parameters. Further research into the development of a standardised US criterion that incorporates both clinical and US findings is required to allow for greater consistency in the diagnosis of tendinopathy.
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Affiliation(s)
- Wesley Matthews
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia.
| | - Richard Ellis
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - James Furness
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
| | - Wayne Hing
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, Queensland, Australia
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Quantitative Analysis of Patellar Tendon Abnormality in Asymptomatic Professional “Pallapugno” Players: A Texture-Based Ultrasound Approach. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8050660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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45
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Wezenbeek E, Willems T, Mahieu N, De Muynck M, Vanden Bossche L, Steyaert A, De Clercq D, Witvrouw E. The Role of the Vascular and Structural Response to Activity in the Development of Achilles Tendinopathy: A Prospective Study. Am J Sports Med 2018; 46:947-954. [PMID: 29373799 DOI: 10.1177/0363546517750854] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several risk factors have been suggested in the development of Achilles tendinopathy, but large-scale prospective studies are limited. PURPOSE To investigate the role of the vascular response to activity of the Achilles tendon, tendon thickness, ultrasound tissue characterization (UTC) of tendon structure, and foot posture as possible risk factors in the development of Achilles tendinopathy. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The study began with 351 first-year students at Ghent University. After 51 students were excluded, 300 were tested in the academic years 2013-2014 and 2014-2015 and were followed prospectively for 2 consecutive years by use of a multilevel registration method. Of those, 250 students were included in the statistical analysis. At baseline, foot posture index and UTC were investigated bilaterally. Blood flow and tendon thickness were measured before and after a running activity. Cox regression analyses were performed to identify significant contributors to the development of Achilles tendinopathy. RESULTS During the 2-year follow-up, 27 of the included 250 participants developed Achilles tendinopathy (11%). Significant predictive effects were found for female sex and blood flow response after running ( P = .022 and P = .019, respectively). The risk of developing Achilles tendinopathy increased if the blood flow increase after running was reduced, regardless of sex, foot pronation, and timing of flow measurements. The model had a predictive accuracy of 81.5% regarding the development of Achilles tendinopathy, with a specificity of 85.0% and a sensitivity of 50.0%. CONCLUSION This prospective study identified both female sex and the diminished blood flow response after running as significant risk factors for the development of Achilles tendinopathy. UTC of tendon structure, Achilles tendon thickness, and foot posture did not significantly contribute to the prediction of Achilles tendinopathy. A general evaluation of tendon structure by UTC, measurement of tendon thickness, or determination of the foot posture index will not allow clinicians to identify patients at risk for developing Achilles tendinopathy. Furthermore, it may be possible to improve blood flow after activity by using noninvasive techniques (such as prostaglandins, compression stockings, heat, massage, and vibration techniques). These techniques may be useful in the prevention and management of Achilles tendinopathy, but further research is needed.
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Affiliation(s)
- Evi Wezenbeek
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Tine Willems
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nele Mahieu
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Martine De Muynck
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luc Vanden Bossche
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Adelheid Steyaert
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dirk De Clercq
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Giacchino M, Caresio C, Gorji NE, Molinari F, Massazza G, Minetto MA. Quantitative analysis of patellar tendon size and structure in asymptomatic professional players: sonographic study. Muscles Ligaments Tendons J 2018; 7:449-458. [PMID: 29387638 DOI: 10.11138/mltj/2017.7.3.449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Ultrasonographic abnormalities of the patellar tendon frequently occur in asymptomatic athletes and it is not always clear whether they precede (and may predict) the development of tendinopathy. Objective This study aimed to investigate by ultrasonography the prevalence of patellar tendon abnormalities in players of "pallapugno" and to establish whether structural tendon abnormalities predict tendinopathy development. Methods Ultrasound B-mode images of the patellar tendon of both sides were acquired in fourteen throwers. Qualitative assessments of tendon structure and neovascularization and quantitative assessments of tendon thickness, cross sectional area (CSA), and echo-intensity were performed. Results Qualitative assessments showed a subclinical tendinopathy of the non-dominant tendon in 5 out of 14 throwers (35% of cases), while quantitative assessments showed abnormalities of the non-dominant tendon in 8 out of 14 players (57% of cases). Echo-intensity and CSA were the quantitative variables most discriminant between asymptomatic players without structural tendon abnormalities and those with tendon abnormalities. Two players (2 out of 8 cases: 25%) developed a clinical tendinopathy after a follow-up of six months. Conclusion The prevalence of subclinical tendinopathy in the non-dominant patellar tendon of throwers was high. Patellar tendon abnormalities at baseline seem to increase the risk of development of subsequent patellar tendinopathy. Level of evidence II b (individual cohort study).
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Affiliation(s)
| | - Cristina Caresio
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Negar E Gorji
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Filippo Molinari
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Marco Alessandro Minetto
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
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Sanz-López F, Berzosa C, Hita-Contreras F, Martínez-Amat A. Effects of eccentric overload training on patellar tendon and vastus lateralis in three days of consecutive running. Knee 2017; 24:570-579. [PMID: 28342723 DOI: 10.1016/j.knee.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/31/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The analysis of structural changes in patellar tendon and muscle of healthy subjects in response to mechanical loads provides useful insight into the mechanism underlying overuse injuries. METHODS Changes produced in tendon and muscles structures after eccentric overload training and three consecutive running days were examined. Twenty healthy subjects were recruited and divided into two groups. One group (ECC) performed eccentric overload squat training (six weeks). After such training, the ECC group performed three running sessions on consecutive days, as did the control group (CONT). The structure of their patellar tendons and vastus lateralis muscles was quantified using ultrasound and Doppler imaging. Images were obtained before and after eccentric training for the ECC group and on every day of running performance for both groups. RESULTS After eccentric training, the ECC group experienced an increase in cross-sectional area (CSA) of patellar tendon (P=0.012). After every day of running, the ECC group experienced a decrease in CSA (P=0.027). In the CONT group, after one day of running a significant increase was observed in anteroposterior width of their patellar tendon (P=0.028), as well as a decrease in pennation angle of vastus lateralis muscle (P=0.028) within three days of running sessions. CONCLUSIONS Eccentric overload training brought about changes in the patellar tendon consistent with an improvement in the quality of the tissue. The ECC group in our study showed a more normalised pattern than the CONT group in the running performance, in agreement with previous research. LEVEL OF EVIDENCE Level 3, controlled trial.
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Affiliation(s)
- Fernando Sanz-López
- ValorA Research Group, Health Sciences Faculty, Universidad San Jorge, Zaragoza, Spain.
| | - César Berzosa
- ValorA Research Group, Health Sciences Faculty, Universidad San Jorge, Zaragoza, Spain
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain; Research Group CTS-026: Study Group on Physical Activity, Physiotherapy and Health, Jaén, Spain
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain; Research Group CTS-026: Study Group on Physical Activity, Physiotherapy and Health, Jaén, Spain
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Winters M, Bon P, Bijvoet S, Bakker EW, Moen MH. Are ultrasonographic findings like periosteal and tendinous edema associated with medial tibial stress syndrome? A case-control study. J Sci Med Sport 2017; 20:128-133. [DOI: 10.1016/j.jsams.2016.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/22/2016] [Accepted: 07/10/2016] [Indexed: 11/26/2022]
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Mc Auliffe S, Mc Creesh K, Purtill H, O'Sullivan K. A systematic review of the reliability of diagnostic ultrasound imaging in measuring tendon size: Is the error clinically acceptable? Phys Ther Sport 2016; 26:52-63. [PMID: 28162938 DOI: 10.1016/j.ptsp.2016.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 11/21/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnostic ultrasound (US) is a commonly used imaging modality for visualising tendon pathology and morphology. In comparison to magnetic resonance imaging (MRI), diagnostic US is perceived to have a higher risk of error when evaluating tendon size. AIM To systematically assess the evidence regarding the Intra rater and Inter rater reliability of diagnostic US measurements of tendon size. DATA SOURCES Eight electronic databases were searched using an agreed set of keywords. Studies which investigated the reliability of tendon size (thickness or cross sectional area) using diagnostic US were eligible. RESULTS Combined Inter rater and Intra rater ICC values for tendon thickness ranged from 0.45 to 0.99. Combined Inter rater and Intra rater ICC values for tendon cross-sectional area (CSA) ranged from 0.58 to 0.92. Overall, Intra rater ICC values (0.59-0.99) were marginally higher than Inter rater values (0.45-0.99) across all tendon sites. Percentage co-efficient of variation (CV%) for tendon thickness and CSA ranged from 0 to 35% across all tendons. Percentage standard error of the mean SEM% values for tendon thickness ranged from 3.33% to 7.39%. CONCLUSIONS The findings of this review suggest diagnostic US measures of tendon size are reliable, both in terms of relative and absolute reliability. However, the findings must be considered in light of the presence of tendon abnormalities in a large percentage of asymptomatic populations.
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Affiliation(s)
- Sean Mc Auliffe
- Department of Clinical Therapies, University of Limerick, Ireland.
| | - Karen Mc Creesh
- Department of Clinical Therapies, University of Limerick, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Ireland
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McAuliffe S, McCreesh K, Culloty F, Purtill H, O'Sullivan K. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis. Br J Sports Med 2016; 50:1516-1523. [DOI: 10.1136/bjsports-2016-096288] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2016] [Indexed: 12/22/2022]
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