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Sasajima S, Kubo K. Influence of preconditioning on morphological and mechanical properties of human Achilles tendon in vivo. J Biomech 2024; 170:112168. [PMID: 38810518 DOI: 10.1016/j.jbiomech.2024.112168] [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: 03/19/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
The present study aimed 1) to verify whether the effect of preconditioning was observed in the measured variables during the measurement of the human tendon in vivo (i.e., repeated contractions with breaks between trials) and 2) to determine the changes in tendon properties and their mechanisms due to submaximal repetitive contractions. Twelve healthy males participated in this study. To eliminate the effects of preconditioning, the participants rested on the measurement bed for 2 h before the start of both experiment-1 and experiment-2. In experiment-1, the measurements of elongation and hysteresis of the Achilles tendon for ramp and ballistic conditions were repeated ten times every 2 min. In experiment-2, participants performed submaximal repetitive contractions at 50 % of MVC and a frequency of 1 Hz for 10 min with a 30 s break every 2 min. Tendon mechanical properties were measured during contractions (starting 30 s and last 20 s of every 2 min), and the mean and coefficient variation (CV) of echogenicity were assessed during a 30-s rest every 2 min. In experiment-1, no significant differences in elongation and hysteresis of the tendon for ramp and ballistic contractions were found among the trials. In experiment 2, there were no significant differences in tendon elongation and hysteresis among all measurement times. Mean echogenicity increased significantly after 2 min, and CV of echogenicity decreased significantly after 4 min. These results suggest that preconditioning does not affect the elongation and hysteresis of the Achilles tendon in measuring tendon mechanical properties and submaximal repetitive contractions.
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Affiliation(s)
- Shuhei Sasajima
- Department of Life Science, The University of Tokyo, Meguro, Tokyo, Japan
| | - Keitaro Kubo
- Department of Life Science, The University of Tokyo, Meguro, Tokyo, Japan.
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Pringels L, Van Acker G, Wezenbeek E, Burssens A, Vanden Bossche L. Novel Insights Into the Intratendinous Pressure Behavior of the Achilles Tendon in Athletes. Sports Health 2024:19417381241245357. [PMID: 38610105 DOI: 10.1177/19417381241245357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND In contrast to other musculoskeletal tissues, the normal pressure behavior of the Achilles tendon is poorly understood. This study aimed to explore the normal intratendinous and perfusion pressures of the Achilles tendon at rest and during exercise, and investigate potential correlations with tendon load and morphology. HYPOTHESIS Intratendinous and perfusion pressures of the Achilles tendon exhibit similarities to other musculoskeletal tissues and depend on tendon load and morphology. STUDY DESIGN Observational study. LEVEL OF EVIDENCE Level 3. METHODS A total of 22 recreational athletes were enrolled. Demographics, activity level, and blood pressures were recorded. Achilles tendon thickness and echogenicity were assessed 25 mm proximal to the posterosuperior calcaneal border. In this region, intratendinous and perfusion pressures of the Achilles tendon were measured at rest and during isometric plantarflexion up to 50 N, using the microcapillary infusion technique. Linear mixed models were used to investigate the effects of plantarflexion force, tendon thickness, and echogenicity on intratendinous and perfusion pressures. RESULTS At rest, intratendinous and perfusion pressures of the Achilles tendon were 43.8 ± 15.2 and 48.7 ± 18.4 mmHg, respectively. Intratendinous pressure increased linearly with plantarflexion force, reaching 101.3 ± 25.5 mmHg at 50 N (P < 0.01). Perfusion pressure showed an inverse relationship, dropping below 0 mmHg at 50 N (P < 0.01). Neither intratendinous nor perfusion pressures of the Achilles tendon correlated with tendon thickness or echogenicity. CONCLUSION The normal intratendinous resting pressure of the Achilles tendon is higher than other musculoskeletal tissues, making it more susceptible to ischemia. During exercise, intratendinous pressure increases significantly to a level that lowers perfusion pressure, thereby compromising blood supply at already low plantarflexion forces. CLINICAL RELEVANCE Given the potential role of ischemia in Achilles tendinopathy, our findings caution against intratendinous injections, as they may exacerbate high intratendinous resting pressure, and against prolonged postexercise tendon stretching, as the associated rise in intratendinous pressure may impair the required hyperemic response.
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Affiliation(s)
- Lauren Pringels
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Gilles Van Acker
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Evi Wezenbeek
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Arne Burssens
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Luc Vanden Bossche
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Pringels L, Van Valckenborgh GJ, Segers P, Chevalier A, Stepman H, Wezenbeek E, Burssens A, Vanden Bossche L. Elevated fluid and glycosaminoglycan content in the Achilles tendon contribute to higher intratendinous pressures: Implications for Achilles tendinopathy. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:S2095-2546(24)00048-6. [PMID: 38582138 DOI: 10.1016/j.jshs.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/17/2024] [Accepted: 02/29/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Tendinopathy alters the compositional properties of the Achilles tendon by increasing fluid and glycosaminoglycan content. It has been speculated that these changes may affect intratendinous pressure, but the extent of this relationship remains unclear. Therefore, we aimed to investigate the impact of elevated fluid and glycosaminoglycan content on Achilles tendon intratendinous pressure and to determine whether hyaluronidase (HYAL) therapy can intervene in this potential relationship. METHODS Twenty paired fresh-frozen cadaveric Achilles tendons were mounted in a tensile-testing machine and loaded up to 5% strain. Intratendinous resting (at 0% strain) and dynamic pressure (at 5% strain) were assessed using the microcapillary infusion technique. First, intratendinous pressure was measured under native conditions before and after infusion of 2 mL physiological saline. Next, 80 mg of glycosaminoglycans were administered bilaterally to the paired tendons. The right tendons were additionally treated with 1500 units of HYAL. Finally, both groups were retested, and the glycosaminoglycan content was analyzed. RESULTS It was found that both elevated fluid and glycosaminoglycan content resulted in higher intratendinous resting and dynamic pressures (p < 0.001). HYAL treatment induced a 2.3-fold reduction in glycosaminoglycan content (p = 0.002) and restored intratendinous pressures. CONCLUSION The results of this study demonstrated that elevated fluid and glycosaminoglycan content in Achilles tendinopathy contribute to increased intratendinous resting and dynamic pressures, which can be explained by the associated increased volume and reduced permeability of the tendon matrix, respectively. HYAL degrades glycosaminoglycans sufficiently to lower intratendinous pressures and may, therefore, serve as a promising treatment.
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Affiliation(s)
- Lauren Pringels
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent 9000, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent 9000, Belgium.
| | | | - Patrick Segers
- Department of Electronics and Information Systems, Ghent University, Ghent 9000, Belgium
| | - Amélie Chevalier
- Department of Electromechanics, University of Antwerp, Antwerp 2020, Belgium
| | - Hedwig Stepman
- Department of Laboratory Medicine, Ghent University Hospital, Ghent 9000, Belgium
| | - Evi Wezenbeek
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent 9000, Belgium
| | - Arne Burssens
- Department of Orthopedic Surgery, Ghent University Hospital, Ghent 9000, Belgium
| | - Luc Vanden Bossche
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent 9000, Belgium; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent 9000, Belgium
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Pringels L, Stouthandel M, Van Hoof T, Martens M, Chevalier A, Burssens A, Wezenbeek E, Vanden Bossche L. Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion. Scand J Med Sci Sports 2023; 33:2230-2238. [PMID: 37608446 DOI: 10.1111/sms.14467] [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: 03/24/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023]
Abstract
Torsion of the Achilles tendon (AT) enhances tensile strength, but a high degree of torsion might also be a risk factor for Achilles tendinopathy, due to greater internal compression exerted during tensile loading. However, evidence supporting the grounds for this assumption is lacking. Hence, we aimed to investigate the impact of AT torsion type on intratendinous pressure. Eighteen human fresh frozen cadaveric legs were mounted in a testing rig and a miniature pressure catheter was placed through ultrasound-guided insertion in the midportion region of the AT. Intratendinous pressure was measured during a simulated straight-knee calf stretch and eccentric heel drop. The AT was then carefully dissected and classified into Type I (least), Type II (moderate), and Type III (extreme) torsion. Of the ATs examined, nine were found to have Type I torsion (50%), nine Type II (50%), and none Type III. It was found that the intratendinous pressure of the AT increased exponentially with ankle dorsiflexion during both exercises (p < 0.001) and that this increase was greater in ATs with Type II torsion than Type I torsion (p < 0.05). This study provides the first biomechanical data to support the hypothesis that in athletes with a high degree of torsion in the AT, the midportion area will experience more internal compression during exercise, for example, calf stretching and eccentric heel drops. Whether this phenomenon is also associated with an elevated risk for Achilles tendinopathy needs further prospective investigation.
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Affiliation(s)
- Lauren Pringels
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Tom Van Hoof
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Manuel Martens
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Amelie Chevalier
- Department of Electromechanics, University of Antwerp, Antwerp, Belgium
| | - Arne Burssens
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Evi Wezenbeek
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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Mylle I, Crouzier M, Hollville E, Bogaerts S, Vanwanseele B. Triceps surae muscle forces during dynamic exercises in patients with Achilles tendinopathy: A cross-sectional study. Scand J Med Sci Sports 2023; 33:2219-2229. [PMID: 37394918 DOI: 10.1111/sms.14444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/15/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE The aim of this study was to investigate the individual triceps surae muscle forces during the execution of six different functional movements and rehabilitation exercises in patients with Achilles tendinopathy compared to a control group. METHODS Triceps surae muscle forces of 15 participants with Achilles tendinopathy (AT) and 15 healthy controls were estimated through a combination of experimental data and musculo-skeletal modeling. Three-dimensional motion capture and force plates were used to collect the ankle and knee joint angles and moments during three functional movements (walking, heel walking, and toe walking) and three rehabilitation exercises (bilateral heel drop, unilateral heel drop with extended knee and with flexed knee). A dynamic optimization method was used to obtain the modeled triceps surae muscle forces. Force-sharing strategies were calculated at the peak triceps surae muscle force and compared between groups. RESULTS Lower peak triceps surae forces were obtained for the AT group during dynamic exercises. Across all exercises, the average contribution of the soleus (SOL) to the total triceps surae muscle force was the largest (60.83 ± 13.89% [AT] > 56.90 ± 16.18% [healthy]), followed by the gastrocnemius medialis (29.87 ± 10.67% [AT] < 32.19 ± 12.90% [healthy]) and the gastrocnemius lateralis (9.30 ± 4.31% [AT] < 10.91 ± 4.66% [healthy]). The triceps surae force-sharing strategy was different for the toe walking, heel walking, and the bilateral and unilateral heel drop with extended knee. CONCLUSION This study provides evidence for altered triceps surae muscle force-sharing strategies during dynamic tasks in patients with AT. The influence of altered muscle force-sharing on the subtendon nonuniformity and/or the tendon loading should be explored in future work.
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Affiliation(s)
- Ine Mylle
- Department of Movement Science, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Marion Crouzier
- Department of Movement Science, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Enzo Hollville
- French Institute of Sport (INSEP), Laboratory Sport, Expertise and Performance, Paris, France
| | - Stijn Bogaerts
- Department of Development and Regeneration, Locomotor and Neurological Disorders Research Group, KU Leuven, Leuven, Belgium
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Benedicte Vanwanseele
- Department of Movement Science, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
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Cone SG, Kim H, Thelen DG, Franz JR. 3D characterization of the triple-bundle Achilles tendon from in vivo high-field MRI. J Orthop Res 2023; 41:2315-2321. [PMID: 37366039 PMCID: PMC10686703 DOI: 10.1002/jor.25654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/06/2023] [Accepted: 06/22/2023] [Indexed: 06/28/2023]
Abstract
The Achilles tendon consists of three subtendons that transmit force from the triceps surae muscles to the calcaneus. Individual differences have been identified in Achilles subtendon morphology and twist in cadavers, which may have implications for triceps surae mechanics and function. High-field magnetic resonance imaging (MRI) can be used to identify boundaries within multi-bundle tissues, which could then enable studies of subtendon structure-function relationships in humans. The objective of this study was to use high-field MRI (7T) to image and reconstruct Achilles subtendons arising from the triceps surae muscles. We imaged the dominant lower leg of a cohort of healthy human subjects (n = 10) using a tuned musculoskeletal sequence (double echo steady state sequence, 0.4 mm isotropic voxels). We then characterized the cross-sectional area and orientation of each subtendon between the MTJ and calcaneal insertion. Image collection and segmentation was repeated to assess repeatability. Subtendon morphometry varied across subjects, with average subtendon areas of 23.5 ± 8.9 mm2 for the medial gastrocnemius, 25.4 ± 8.9 mm2 for the lateral gastrocnemius, and 13.7 ± 5.9 mm2 for the soleus subtendons. Repeatable subject-specific variations in size and position of each subtendon were identified over two visits, expanding on prior knowledge that high variability exists in Achilles subtendon morphology across subjects.
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Affiliation(s)
- Stephanie G Cone
- Department of Biomedical Engineering, University of Delaware, Newark, DE, 19713
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, 53706
| | - Hoon Kim
- Department of Sports Medicine, Soonchunhyang University, Asan, South Korea
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, 53706
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, 53706
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599
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Adam NC, Smith CR, Herzog W, Amis AA, Arampatzis A, Taylor WR. In Vivo Strain Patterns in the Achilles Tendon During Dynamic Activities: A Comprehensive Survey of the Literature. SPORTS MEDICINE - OPEN 2023; 9:60. [PMID: 37466866 DOI: 10.1186/s40798-023-00604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
Achilles' tendon (AT) injuries such as ruptures and tendinopathies have experienced a dramatic rise in the mid- to older-aged population. Given that the AT plays a key role at all stages of locomotion, unsuccessful rehabilitation after injury often leads to long-term, deleterious health consequences. Understanding healthy in vivo strains as well as the complex muscle-tendon unit interactions will improve access to the underlying aetiology of injuries and how their functionality can be effectively restored post-injury. The goals of this survey of the literature with a systematic search were to provide a benchmark of healthy AT strains measured in vivo during functional activities and identify the sources of variability observed in the results. Two databases were searched, and all articles that provided measured in vivo peak strains or the change in strain with respect to time were included. In total, 107 articles that reported subjects over the age of 18 years with no prior AT injury and measured while performing functional activities such as voluntary contractions, walking, running, jumping, or jump landing were included in this review. In general, unclear anatomical definitions of the sub-tendon and aponeurosis structures have led to considerable confusion in the literature. MRI, ultrasound, and motion capture were the predominant approaches, sometimes coupled with modelling. The measured peak strains increased from 4% to over 10% from contractions, to walking, running, and jumping, in that order. Importantly, measured AT strains were heavily dependent on measurement location, measurement method, measurement protocol, individual AT geometry, and mechanical properties, as well as instantaneous kinematics and kinetics of the studied activity. Through a comprehensive review of approaches and results, this survey of the literature therefore converges to a united terminology of the structures and their common underlying characteristics and presents the state-of-knowledge on their functional strain patterns.
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Affiliation(s)
- Naomi C Adam
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Colin R Smith
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, The University of Calgary, Calgary, Canada
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, and Berlin School of Movement Science, Berlin, Germany
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
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Mansur H, Durigan JLQ, de Noronha M, Kjaer M, Magnusson SP, de Araújo BAS, de Cássia Marqueti R. Differences in the cross-sectional area along the ankle tendons with both age and sex. J Anat 2023; 242:213-223. [PMID: 36250976 PMCID: PMC9877482 DOI: 10.1111/joa.13774] [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: 01/02/2022] [Revised: 06/14/2022] [Accepted: 09/20/2022] [Indexed: 02/01/2023] Open
Abstract
Increasing age appears to influence several morphologic changes in major tendons. However, the effects of aging on the cross-sectional area (CSA) of different ankle tendons are much less understood. Furthermore, potential differences in specific tendon regions along the length of the tendons have not been investigated in detail. Sixty healthy adult participants categorized by age as young (n = 20; mean ± SD age = 22.5 ± 4.5 years), middle-age (n = 20; age = 40.6 ± 8. 0 years), or old (n = 20; age = 69.9 ± 9.1 years), from both sexes, were included. The tendon CSA of tibialis anterior (TA), tibialis posterior (TP), fibularis (FT), and Achilles (AT) was measured from T1-weighted 1.5 T MR images in incremental intervals of 10% along its length (from proximal insertion) and compared between different age groups and sexes. The mean CSA of the AT was greater in the middle-age group than both young and old participants (p < 0.01) and large effect sizes were observed for these differences (Cohen's d > 1). Furthermore, there was a significant difference in CSA in all three groups along the length of the different tendons. Region-specific differences between groups were observed in the distal portion (90% and 100% of the length), in which the FT presented greater CSA comparing middle-age to young and old (p < 0.05). In conclusion, (1) great magnitude of morpho-structural differences was discovered in the AT; (2) there are region-specific differences in the CSA of ankle tendons within the three groups and between them; and (3) there were no differences in tendon CSA between sexes.
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Affiliation(s)
- Henrique Mansur
- Department of Physical Education, University of Brasília (UnB), Brasilia, Brazil
| | | | - Marcos de Noronha
- La Trobe University - Rural Health School, Bendigo, Victoria, Australia
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg Hospital and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
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Merza EY, Pearson SJ, Lichtwark GA, Malliaras P. The acute effects of higher versus lower load duration and intensity on morphological and mechanical properties of the healthy Achilles tendon: a randomized crossover trial. J Exp Biol 2022; 225:275126. [PMID: 35470387 PMCID: PMC9167578 DOI: 10.1242/jeb.243741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/19/2022] [Indexed: 11/20/2022]
Abstract
The Achilles tendon (AT) exhibits volume changes related to fluid flow under acute load which may be linked to changes in stiffness. Fluid flow provides a mechanical signal for cellular activity and may be one mechanism that facilitates tendon adaptation. This study aimed to investigate whether isometric intervention involving a high level of load duration and intensity could maximize the immediate reduction in AT volume and stiffness compared with interventions involving a lower level of load duration and intensity. Sixteen healthy participants (12 males, 4 females; age 24.4±9.4 years, body mass 70.9±16.1 kg, height 1.7±0.1 m) performed three isometric interventions of varying levels of load duration (2 s and 8 s) and intensity (35% and 75% maximal voluntary isometric contraction) over a 3 week period. Freehand 3D ultrasound was used to measure free AT volume (at rest) and length (at 35%, 55% and 75% of maximum plantarflexion force) pre- and post-interventions. The slope of the force–elongation curve over these force levels represented individual stiffness (N mm−1). Large reductions in free AT volume and stiffness resulted in response to long-duration high-intensity loading whilst less reduction was produced with a lower load intensity. In contrast, no change in free AT volume and a small increase in AT stiffness occurred with lower load duration. These findings suggest that the applied load on the AT must be heavy and sustained for a long duration to maximize immediate volume reduction, which might be an acute response that enables optimal long-term tendon adaptation via mechanotransduction pathways. Summary: High levels of load duration and intensity have the greatest acute effect on the free Achilles tendon volume and stiffness.
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Affiliation(s)
- Eman Y Merza
- Department of physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston Vic 3199, Melbourne, Australia
| | - Stephen J Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Greater Manchester, M5 4WT, UK
| | - Glen A Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD 4072, Brisbane, Australia
| | - Peter Malliaras
- Department of physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston Vic 3199, Melbourne, Australia
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Sahinis C, Kellis E, Dafkou K, Ellinoudis A. Reliability of Distal Hamstring Tendon Length and Cross-sectional Area Using 3-D Freehand Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2579-2588. [PMID: 34246531 DOI: 10.1016/j.ultrasmedbio.2021.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
The objective of this study was to investigate the reliability of distal hamstring tendon morphology using freehand 3-D ultrasound (US). Freehand 3-D US scans were acquired for 16 young males and females, in two sessions, spaced a week apart. The length, volume, cross-sectional area (CSA) and echo intensity (EI) of the semitendinosus (ST), biceps femoris long and short head and semimembranosus (SM) tendons were acquired. Measurements of the CSA and EI were obtained from three sites along each tendon. The intra-class correlation coefficients ranged from 0.88-0.99 of the examined variables, indicating high test-retest reliability. In addition, the minimal detectable change (MDC) ranged from 0.255-3.766 mm (MDC% of the mean: 0.406%-12.558%) for hamstring tendon length, from 0.036-0.077 mL (MDC%: 1.548%-3.178%) for tendon volume, from 0.512-1.948 mm2 (MDC%: 0.702%-3.586%) for CSA and from 0.898-2.586 au (MDC%: 1.145%-3.325%) for EI. Of the four hamstring tendons, ST had the greatest length (141.587 ± 10.701 mm) and EI (94.637 ± 5.536 au), while SM had the greatest volume (3.056 ± 0.421 mL) and CSA (115.277 ± 16.442 mm2) relative to other tendons. Freehand 3-D US appears to be a reliable tool for the evaluation of hamstring distal tendon morphology; hence, its use for in vivo evaluation of tendon properties is promising.
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Affiliation(s)
- Chrysostomos Sahinis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, Greece.
| | - Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Konstantinos Dafkou
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, Greece
| | - Athanasios Ellinoudis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres, Greece
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Merza E, Pearson S, Lichtwark G, Ollason M, Malliaras P. Immediate and long-term effects of mechanical loading on Achilles tendon volume: A systematic review and meta-analysis. J Biomech 2021; 118:110289. [PMID: 33556887 DOI: 10.1016/j.jbiomech.2021.110289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 01/07/2023]
Abstract
The Achilles tendon (AT) may experience changes in dimensions related to fluid flow under load. The extent to which fluid flow involves redistribution within or flow out of the tendon is not known and could be determined by investigating volume changes. This study aimed to synthesize data on immediate and long-term effects of loading on tendon volume among people with a healthy AT and midportion Achilles tendinopathy (MAT). A secondary aim was to synthesise data from the included studies investigating parallel change in cross-sectional area and length. Systematic electronic search was performed in MEDLINE, EMBASE, CINAHL, AMED, and Scopus from inception until May 2020. Standardized mean differences (SMDs) were calculated for intervention-induced changes from baseline for all outcomes. Methodological quality was assessed using modified version of Newcastle Ottawa Scale (NOS). Twelve studies were included in meta-analysis. For healthy AT, there were negligible to small changes in volume following cross-country running (-0.33 [95% CI = -1.11 to 0.45] (P = 0.41)) and isometric exercise (0.01 [95% CI = -0.54 to 0.55] (P = 0.98)) and a large increase at the short-term with 12-week isometric protocol (0.88 [95% CI = -0.10 to1.86] (P = 0.08)). For MAT, there was an immediate large reduction in volume with isometric exercise (-1.24 [95% CI = -1.93 to -0.55] (P = 0.0004)), small increase with eccentric exercise (0.41 [95% CI = -0.18 to 1.01](P = 0.18)) and small reduction at the short-term with long-term interventions (-0.46 [95% CI = -0.87 to -0.05] (P = 0.03)). This meta-analysis suggests that healthy AT remain isovolumetric with acute interventions while MAT exhibit immediate and short-term volume reductions in response to different interventions.
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Affiliation(s)
- Eman Merza
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Vic 3199, Melbourne, Australia.
| | - Stephen Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Greater Manchester M5 4WT, United Kingdom.
| | - Glen Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD 4072, Brisbane, Australia.
| | - Meg Ollason
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Vic 3800, Melbourne, Australia.
| | - Peter Malliaras
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Vic 3199, Melbourne, Australia.
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12
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Techniques for In Vivo Measurement of Ligament and Tendon Strain: A Review. Ann Biomed Eng 2020; 49:7-28. [PMID: 33025317 PMCID: PMC7773624 DOI: 10.1007/s10439-020-02635-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
The critical clinical and scientific insights achieved through knowledge of in vivo musculoskeletal soft tissue strains has motivated the development of relevant measurement techniques. This review provides a comprehensive summary of the key findings, limitations, and clinical impacts of these techniques to quantify musculoskeletal soft tissue strains during dynamic movements. Current technologies generally leverage three techniques to quantify in vivo strain patterns, including implantable strain sensors, virtual fibre elongation, and ultrasound. (1) Implantable strain sensors enable direct measurements of tissue strains with high accuracy and minimal artefact, but are highly invasive and current designs are not clinically viable. (2) The virtual fibre elongation method tracks the relative displacement of tissue attachments to measure strains in both deep and superficial tissues. However, the associated imaging techniques often require exposure to radiation, limit the activities that can be performed, and only quantify bone-to-bone tissue strains. (3) Ultrasound methods enable safe and non-invasive imaging of soft tissue deformation. However, ultrasound can only image superficial tissues, and measurements are confounded by out-of-plane tissue motion. Finally, all in vivo strain measurement methods are limited in their ability to establish the slack length of musculoskeletal soft tissue structures. Despite the many challenges and limitations of these measurement techniques, knowledge of in vivo soft tissue strain has led to improved clinical treatments for many musculoskeletal pathologies including anterior cruciate ligament reconstruction, Achilles tendon repair, and total knee replacement. This review provides a comprehensive understanding of these measurement techniques and identifies the key features of in vivo strain measurement that can facilitate innovative personalized sports medicine treatment.
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13
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Pizzolato C, Shim VB, Lloyd DG, Devaprakash D, Obst SJ, Newsham-West R, Graham DF, Besier TF, Zheng MH, Barrett RS. Targeted Achilles Tendon Training and Rehabilitation Using Personalized and Real-Time Multiscale Models of the Neuromusculoskeletal System. Front Bioeng Biotechnol 2020; 8:878. [PMID: 32903393 PMCID: PMC7434842 DOI: 10.3389/fbioe.2020.00878] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022] Open
Abstract
Musculoskeletal tissues, including tendons, are sensitive to their mechanical environment, with both excessive and insufficient loading resulting in reduced tissue strength. Tendons appear to be particularly sensitive to mechanical strain magnitude, and there appears to be an optimal range of tendon strain that results in the greatest positive tendon adaptation. At present, there are no tools that allow localized tendon strain to be measured or estimated in training or a clinical environment. In this paper, we first review the current literature regarding Achilles tendon adaptation, providing an overview of the individual technologies that so far have been used in isolation to understand in vivo Achilles tendon mechanics, including 3D tendon imaging, motion capture, personalized neuromusculoskeletal rigid body models, and finite element models. We then describe how these technologies can be integrated in a novel framework to provide real-time feedback of localized Achilles tendon strain during dynamic motor tasks. In a proof of concept application, Achilles tendon localized strains were calculated in real-time for a single subject during walking, single leg hopping, and eccentric heel drop. Data was processed at 250 Hz and streamed on a smartphone for visualization. Achilles tendon peak localized strains ranged from ∼3 to ∼11% for walking, ∼5 to ∼15% during single leg hop, and ∼2 to ∼9% during single eccentric leg heel drop, overall showing large strain variation within the tendon. Our integrated framework connects, across size scales, knowledge from isolated tendons and whole-body biomechanics, and offers a new approach to Achilles tendon rehabilitation and training. A key feature is personalization of model components, such as tendon geometry, material properties, muscle geometry, muscle-tendon paths, moment arms, muscle activation, and movement patterns, all of which have the potential to affect tendon strain estimates. Model personalization is important because tendon strain can differ substantially between individuals performing the same exercise due to inter-individual differences in these model components.
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Affiliation(s)
- Claudio Pizzolato
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Vickie B Shim
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - David G Lloyd
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Daniel Devaprakash
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Steven J Obst
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia
| | - Richard Newsham-West
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - David F Graham
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Thor F Besier
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ming Hao Zheng
- Centre for Orthopaedic Translational Research, School of Surgery, The University of Western Australia, Nedlands, WA, Australia
| | - Rod S Barrett
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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14
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Leitner C, Hager PA, Penasso H, Tilp M, Benini L, Peham C, Baumgartner C. Ultrasound as a Tool to Study Muscle-Tendon Functions during Locomotion: A Systematic Review of Applications. SENSORS 2019; 19:s19194316. [PMID: 31590410 PMCID: PMC6806279 DOI: 10.3390/s19194316] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/17/2019] [Accepted: 10/02/2019] [Indexed: 02/06/2023]
Abstract
Movement science investigating muscle and tendon functions during locomotion utilizes commercial ultrasound imagers built for medical applications. These limit biomechanics research due to their form factor, range of view, and spatio-temporal resolution. This review systematically investigates the technical aspects of applying ultrasound as a research tool to investigate human and animal locomotion. It provides an overview on the ultrasound systems used and of their operating parameters. We present measured fascicle velocities and discuss the results with respect to operating frame rates during recording. Furthermore, we derive why muscle and tendon functions should be recorded with a frame rate of at least 150 Hz and a range of view of 250 mm. Moreover, we analyze why and how the development of better ultrasound observation devices at the hierarchical level of muscles and tendons can support biomechanics research. Additionally, we present recent technological advances and their possible application. We provide a list of recommendations for the development of a more advanced ultrasound sensor system class targeting biomechanical applications. Looking to the future, mobile, ultrafast ultrasound hardware technologies create immense opportunities to expand the existing knowledge of human and animal movement.
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Affiliation(s)
- Christoph Leitner
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Stremayrgasse 16/II, 8010 Graz, Austria.
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010 Graz, Austria.
| | - Pascal A Hager
- Integrated Systems Laboratory, ETH Zürich, Gloriastrasse 35, 8092 Zürich, Switzerland.
| | - Harald Penasso
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010 Graz, Austria.
| | - Markus Tilp
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010 Graz, Austria.
| | - Luca Benini
- Integrated Systems Laboratory, ETH Zürich, Gloriastrasse 35, 8092 Zürich, Switzerland.
- Electrical, Electronic and Information Engineering - DEI, Università di Bologna, Viale del Risorgimento 2, 40136 Bologna, Italy.
| | - Christian Peham
- Department for Companion Animals and Horses, University of Veterinary Medicine Vienna, Veterinärplatz 1, 1210 Wien, Austria.
| | - Christian Baumgartner
- Institute of Health Care Engineering with European Testing Center of Medical Devices, Graz University of Technology, Stremayrgasse 16/II, 8010 Graz, Austria.
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15
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Hayes A, Easton K, Devanaboyina PT, Wu JP, Kirk TB, Lloyd D. A review of methods to measure tendon dimensions. J Orthop Surg Res 2019; 14:18. [PMID: 30636623 PMCID: PMC6330756 DOI: 10.1186/s13018-018-1056-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Tendons are soft tissues of the musculoskeletal system that are designed to facilitate joint movement. Tendons exhibit a wide range of mechanical properties matched to their functions and, as a result, have been of interest to researchers for many decades. Dimensions are an important aspect of tendon properties. Change in the dimensions of tissues is often seen as a sign of injury and degeneration, as it may suggest inflammation or general disorder of the tissue. Dimensions are also important for determining the mechanical properties and behaviours of materials, particularly the stress, strain, and elastic modulus. This makes the dimensions significant in the context of a mechanical study of degenerated tendons. Additionally, tendon dimensions are useful in planning harvesting for tendon transfer and joint reconstruction purposes. Historically, many methods have been used in an attempt to accurately measure the dimensions of soft tissue, since improper measurement can lead to large errors in the calculated properties. These methods can be categorised as destructive (by approximation), contact, and non-contact and can be considered in terms of in vivo and ex vivo.
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Affiliation(s)
- Alex Hayes
- Department of Mechanical Engineering, Curtin University of Technology, Perth, Western Australia, Australia. .,Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, Australia.
| | | | - Pavan Teja Devanaboyina
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jian-Ping Wu
- Academy of Advanced Interdisciplinary Studies and the Department of Biomedical Engineering of Southern University of Science and Technology, No 1088, Xueyaun Rd, Xili, Nanshan District, Shenzhen City, 518055, Guangdong Province, China
| | - Thomas Brett Kirk
- Department of Mechanical Engineering, Curtin University of Technology, Perth, Western Australia, Australia.,Faculty of Science and Engineering, Curtin University of Technology, Perth, Western Australia, Australia
| | - David Lloyd
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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16
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Shim VB, Hansen W, Newsham-West R, Nuri L, Obst S, Pizzolato C, Lloyd DG, Barrett RS. Influence of altered geometry and material properties on tissue stress distribution under load in tendinopathic Achilles tendons – A subject-specific finite element analysis. J Biomech 2019; 82:142-148. [DOI: 10.1016/j.jbiomech.2018.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/17/2018] [Accepted: 10/20/2018] [Indexed: 12/19/2022]
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17
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Obst SJ, Heales LJ, Schrader BL, Davis SA, Dodd KA, Holzberger CJ, Beavis LB, Barrett RS. Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Review with Meta-analysis. Sports Med 2018; 48:2179-2198. [DOI: 10.1007/s40279-018-0956-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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18
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Nuri L, Obst SJ, Newsham-West R, Barrett RS. Three-dimensional morphology and volume of the free Achilles tendon at rest and under load in people with unilateral mid-portion Achilles tendinopathy. Exp Physiol 2018; 103:358-369. [DOI: 10.1113/ep086673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Leila Nuri
- School of Allied Health Sciences, Menzies Health Institute Queensland; Griffith University; Gold Coast QLD 4222 Australia
| | - Steven J. Obst
- School of Health, Medical and Applied Sciences; Central Queensland University; Bundaberg QLD 4670 Australia
| | - Richard Newsham-West
- School of Allied Health Sciences, Menzies Health Institute Queensland; Griffith University; Gold Coast QLD 4222 Australia
| | - Rod S. Barrett
- School of Allied Health Sciences, Menzies Health Institute Queensland; Griffith University; Gold Coast QLD 4222 Australia
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19
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Slane LC, Slane JA, D'hooge J, Scheys L. The challenges of measuring in vivo knee collateral ligament strains using ultrasound. J Biomech 2017; 61:258-262. [PMID: 28802742 PMCID: PMC5581255 DOI: 10.1016/j.jbiomech.2017.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/10/2017] [Accepted: 07/17/2017] [Indexed: 12/13/2022]
Abstract
Ultrasound-based methods have shown promise in their ability to characterize non-uniform deformations in large energy-storing tendons such as the Achilles and patellar tendons, yet applications to other areas of the body have been largely unexplored. The noninvasive quantification of collateral ligament strain could provide an important clinical metric of knee frontal plane stability, which is relevant in ligament injury and for measuring outcomes following total knee arthroplasty. In this pilot cadaveric experiment, we investigated the possibility of measuring collateral ligament strain with our previously validated speckle-tracking approach, but encountered a number of challenges during both data acquisition and processing. Given the clinical interest in this type of tool, and the fact that this is a developing area of research, the goal of this article is to transparently describe this pilot study, both in terms of methods and results, while also identifying specific challenges to this work and areas for future study. Some challenges faced relate generally to speckle-tracking of soft tissues (e.g. the limitations of using a 2D imaging modality to characterize 3D motion), while others are specific to this application (e.g. the small size and complex anatomy of the collateral ligaments). This work illustrates a clear need for additional studies, particularly relating to the collection of ground-truth data and more thorough validation work. These steps will be critical prior to the translation of ultrasound-based measures of collateral ligament strains into the clinic.
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Affiliation(s)
- Laura C Slane
- KU Leuven, Institute for Orthopaedic Research and Training, Leuven, Belgium.
| | - Josh A Slane
- KU Leuven, Institute for Orthopaedic Research and Training, Leuven, Belgium
| | - Jan D'hooge
- KU Leuven, Lab on Cardiovascular Imaging and Dynamics, Dept. of Cardiovascular Sciences, Leuven, Belgium
| | - Lennart Scheys
- KU Leuven, Institute for Orthopaedic Research and Training, Leuven, Belgium; University Hospitals Leuven, Dept. of Orthopaedics, Campus Pellenberg, Pellenberg, Belgium
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20
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Hansen W, Shim VB, Obst S, Lloyd DG, Newsham-West R, Barrett RS. Achilles tendon stress is more sensitive to subject-specific geometry than subject-specific material properties: A finite element analysis. J Biomech 2017; 56:26-31. [DOI: 10.1016/j.jbiomech.2017.02.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022]
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21
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Nuri L, Obst SJ, Newsham-West R, Barrett RS. The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound. J Exp Biol 2017; 220:3053-3061. [DOI: 10.1242/jeb.159764] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/12/2017] [Indexed: 12/22/2022]
Abstract
Mid-portion Achilles tendinopathy (MAT) alters the normal three-dimensional (3D) morphology of the Achilles tendon (AT) at rest and under a single tensile load. However, how MAT changes the 3D morphology of AT during repeated loading remains unclear. This study compared the AT longitudinal, transverse and volume strains during repeated loading in MAT with those of the contralateral tendon in people with unilateral MAT. Ten adults with unilateral MAT performed 10 successive 25 second submaximal (50%) voluntary isometric plantarflexion contractions with both legs. Freehand 3D ultrasound scans were recorded and used to measure whole AT, free AT, and proximal AT longitudinal strains and free AT cross-sectional area (CSA) and volume strains. The free AT experienced higher longitudinal and CSA strain and reached steady state following a greater number of contractions (5 contractions) in MAT compared to the contralateral tendon (3 contractions). Further, free tendon CSA and volume strained more in MAT than contralateral tendon from the first contraction, whereas free AT longitudinal strain was not greater than the contralateral tendon until the fourth contraction. Volume loss from the tendon core therefore preceded the greater longitudinal strain in MAT. Overall, these findings suggest that the tendinopathic free AT experiences an exaggerated longitudinal and transverse strain response under repeated loading that is underpinned by an altered interaction between solid and fluid tendon matrix components. These alterations are indicative of accentuated poroelasticity and an altered local stress-strain environment within the tendinopathic free tendon matrix, which could affect tendon remodelling via mechanobiological pathways.
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Affiliation(s)
- Leila Nuri
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Steven J. Obst
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia
| | - Richard Newsham-West
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rod S. Barrett
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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