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Ito K, Go Y, Tatsumoto S, Usui C, Mizuno Y, Ikami E, Isozaki Y, Usui M, Kajihara T, Yoda T, Inoue KI, Takada M, Sato T. Gene expression profiling of the masticatory muscle tendons and Achilles tendons under tensile strain in the Japanese macaque Macaca fuscata. PLoS One 2023; 18:e0280649. [PMID: 36656905 PMCID: PMC9851512 DOI: 10.1371/journal.pone.0280649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023] Open
Abstract
Both Achilles and masticatory muscle tendons are large load-bearing structures, and excessive mechanical loading leads to hypertrophic changes in these tendons. In the maxillofacial region, hyperplasia of the masticatory muscle tendons and aponeurosis affect muscle extensibility resulting in limited mouth opening. Although gene expression profiles of Achilles and patellar tendons under mechanical strain are well investigated in rodents, the gene expression profile of the masticatory muscle tendons remains unexplored. Herein, we examined the gene expression pattern of masticatory muscle tendons and compared it with that of Achilles tendons under tensile strain conditions in the Japanese macaque Macaca fuscata. Primary tenocytes isolated from the masticatory muscle tendons (temporal tendon and masseter aponeurosis) and Achilles tendons were mechanically loaded using the tensile force and gene expression was analyzed using the next-generation sequencing. In tendons exposed to tensile strain, we identified 1076 differentially expressed genes with a false discovery rate (FDR) < 10-10. To identify genes that are differentially expressed in temporal tendon and masseter aponeurosis, an FDR of < 10-10 was used, whereas the FDR for Achilles tendons was set at > 0.05. Results showed that 147 genes are differentially expressed between temporal tendons and masseter aponeurosis, out of which, 125 human orthologs were identified using the Ensemble database. Eight of these orthologs were related to tendons and among them the expression of the glycoprotein nmb and sphingosine kinase 1 was increased in temporal tendons and masseter aponeurosis following exposure to tensile strain. Moreover, the expression of tubulin beta 3 class III, which promotes cell cycle progression, and septin 9, which promotes cytoskeletal rearrangements, were decreased in stretched Achilles tendon cells and their expression was increased in stretched masseter aponeurosis and temporal tendon cells. In conclusion, cyclic strain differentially affects gene expression in Achilles tendons and tendons of the masticatory muscles.
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Affiliation(s)
- Ko Ito
- Department of Oral and Maxillofacial Surgery, Saitama Medical University, Saitama, Japan
| | - Yasuhiro Go
- Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Science, Okazaki, Aichi, Japan
- Department of System Neuroscience, National Institute for Physiological Science, Okazaki, Aichi, Japan
- Department of Physiological Science, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, Aichi, Japan
| | - Shoji Tatsumoto
- Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Science, Okazaki, Aichi, Japan
| | - Chika Usui
- Exploratory Research Center on Life and Living Systems (ExCELLS), National Institutes of Natural Science, Okazaki, Aichi, Japan
| | - Yosuke Mizuno
- Division of Morphological Science, Biomedical Research Center, Saitama Medical University, Saitama, Japan
| | - Eiji Ikami
- Department of Oral and Maxillofacial Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuta Isozaki
- Department of Oral and Maxillofacial Surgery, Saitama Medical University, Saitama, Japan
| | - Michihiko Usui
- Division of Periodontology, Department of Cardiology and Periodontology, Kyushu Dental University, Fukuoka, Japan
| | - Takeshi Kajihara
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
| | - Tetsuya Yoda
- Department of Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ken-ichi Inoue
- Systems Neuroscience Section, Department of Neuroscience, Primate Research Institute, Kyoto University, Inuyama, Aichi, Japan
| | - Masahiko Takada
- Systems Neuroscience Section, Department of Neuroscience, Primate Research Institute, Kyoto University, Inuyama, Aichi, Japan
| | - Tsuyoshi Sato
- Department of Oral and Maxillofacial Surgery, Saitama Medical University, Saitama, Japan
- * E-mail:
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Marberry SM, Filmalter SE, Pujalte GGA, Presley JC, DeMatas KF, Montero DP, Israni K, Ball CT, Maynard JR. Self-reported foot strike patterns and sonographic evidence of Achilles tendinopathy in asymptomatic marathon runners. J Sports Sci 2022; 40:1308-1314. [PMID: 35640042 DOI: 10.1080/02640414.2022.2080158] [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: 10/18/2022]
Abstract
It is unknown whether ultrasound findings and symptoms of Achilles tendinopathy in runners correlate with foot strike patterns. We aimed to examine the relationships among Achilles tendon ultrasound findings in runners with or without Achilles tendinopathy, their foot strike patterns, and their training regimens. We recruited marathon runners 18 years of age or older with no history of Achilles tendon pain or surgery participating in the 2018 DONNA Marathon. Participants completed surveys and underwent Achilles tendon sonographic evaluations and were categorized by foot strike patterns. Seventy-nine runners were included; 22 (28%) with forefoot, 30 (38%) midfoot, and 27 (34%) hindfoot strike patterns. Foot strike pattern was not associated with tendon hyperaemia (P = 1.00) or hypoechogenicity (P = .97), and there was no association of cross-sectional area of the Achilles tendon with peak weekly distance while training. Sonographic characteristics of Achilles tendinopathy did not correlate with foot strike patterns or training regimens. Although not statistically significant, it is worth noting that cross-sectional area was 1 mm2 larger per every 1 kg/m2 increase in body mass index.
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Affiliation(s)
- Scott M Marberry
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Sara E Filmalter
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - George G A Pujalte
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - James C Presley
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Kristina F DeMatas
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Daniel P Montero
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Krishna Israni
- Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Colleen T Ball
- Biostatistics Unit, Mayo Clinic, Jacksonville, Florida, USA
| | - Jennifer R Maynard
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, USA.,Department of Family Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Patellar and Achilles Tendon Thickness Differences among Athletes with Different Numbers of Meals per Day: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042468. [PMID: 35206655 PMCID: PMC8872291 DOI: 10.3390/ijerph19042468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
The objective of this study is to analyse differences in the thickness of the patellar (PT) and Achilles tendons (AT) among athletes with different number of meals per day. The design is a cross-sectional, observational study. A total of thirty-six male athletes (with mean age groups ranging from 31 to 40) were recruited and divided into three groups based on the number of daily meals they had (3, 4 or 5 meals). PT and AT were assessed by ultrasound. There were statistically significant differences in PT when comparing groups 1 and 3, at both longitudinal (p < 0.03) and transversal (p < 0.002) planes. There were no differences when comparing groups 1 and 2 or groups 2 and 3. There was a negative correlation between the number of meals per day and tendon thicknesses in both PT (longitudinal plane: r = −0.384; p = 0.02/transversal plane: r = −0.406; p = 0.01) and AT (transversal plane: r = −0.386; p = 0.02). In conclusion, there were patellar tendon thickness differences between participants and the number of daily meals could play a key role in tendon thickness, healing and performance.
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Exercise Effects on the Biomechanical Properties of the Achilles Tendon—A Narrative Review. BIOLOGY 2022; 11:biology11020172. [PMID: 35205039 PMCID: PMC8869522 DOI: 10.3390/biology11020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/01/2022] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
Simple Summary The Achilles tendon influences the running economy because of its ability to store and release strain energy, and it remains one of the most vulnerable tendons among athletes and recreational runners. Exercised-related mechanical loading appears to induce changes in the Achilles tendon morphology and mechanical material properties. Both acute and relatively long-term exercise induces tendon adaptation, although biomechanical changes, e.g., cross-sectional area, plantarflexion moment, Young’s modulus, and stiffness, in response to exercise duration, type, and loading-regimes differ widely. Furthermore, a strong Achilles tendon can be developed by chronic exposure to habitual mechanical loading from daily exercise, which is associated with greater energy storage, release and overall health. Abstract The morphological and mechanical properties (e.g., stiffness, stress, and force) of the Achilles tendon (AT) are generally associated with its tendinosis and ruptures, particularly amongst runners. Interest in potential approaches to reduce or prevent the risk of AT injuries has grown exponentially as tendon mechanics have been efficiently improving. The following review aims to discuss the effect of different types of exercise on the AT properties. In this review article, we review literature showing the possibility to influence the mechanical properties of the AT from the perspective of acute exercise and long-term training interventions, and we discuss the reasons for inconsistent results. Finally, we review the role of the habitual state in the AT properties. The findings of the included studies suggest that physical exercise could efficiently improve the AT mechanical properties. In particular, relatively long-term and low-intensity eccentric training may be a useful adjunct to enhance the mechanical loading of the AT.
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Ying J, Fekete G. Comparison Between Ultrasonography and Magnetic Resonance Imaging in Achilles Tendon. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: This study aims was to compared the effectiveness of Magnetic Resonance Imaging (MRI) and Ultrasonography (US) imaging techniques in the diagnosis of tendon pathology. Method: The databases search of PubMed, Scopus, and Embase extracted 567 articles for a title
and abstract review. After removing and evaluating, a total of 6 articles were collected. Results and conclusion: There are three views on the diagnosis of Achilles tendon (AT) by US and MRI: US has higher sensitivity and reliability than MRI; MRI is more effective than the US, and
there is a similar diagnosis result between US and MRI. It may not be necessary to distinguish between the diagnostic role of US and MRI, since US and MRI tools can be used as effective means to provide valuable information for the diagnosis and treatment of AT.
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Affiliation(s)
- Jianhua Ying
- College of Science & Technology, Ningbo University, Ningbo, 315300, China
| | - Gusztáv Fekete
- Savaria Institute of Technology, Eötvös Loránd University, Szombathely H-9700, Hungary
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Gonzalez FM, Gleason CN, Reiter DA, Dunham J, Sayyid SK, Labib SA. In vivo Sonographic Characterization of The Achilles Tendons in Healthy Young Collegiate Athletes as a Function of Ankle Position. J Foot Ankle Surg 2021; 59:898-902. [PMID: 32624409 DOI: 10.1053/j.jfas.2020.01.009] [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] [Received: 12/19/2019] [Accepted: 01/27/2020] [Indexed: 02/03/2023]
Abstract
This study aims to describe the normative Achilles tendon properties in a collegiate subject cohort. Achilles tendon evaluations in 65 asymptomatic college-level athletes by ultrasound B mode on two tendon positions (neutral state and active maximum dorsiflexion). Correlation was made to BMI, tibial/foot length, maximal calf circumference, type of sports, resting/maximal dorsiflexion-plantar flexion angles among other factors. The mean Achilles tendon length was found to be 14.9 cm, mean transverse dimension of 1.38 cm, thickness of 0.49 cm and cross-sectional area of 0.61 cm2 in the relaxed state. Males had greater tendon length than the female athletes (15.5 (M) vs 14.3cm (F) in the relaxed position and 16.1 (M) vs 15.2cm (F) in the stretched position), tendon width (1.4 vs 1.3 cm), tendon thickness (0.51 vs 0.46 cm), tendon cross-sectional area (0.65 vs 0.57 cm2) and foot length (27.6 cm vs 26.6 cm). The Achilles tendon parameters such as length in the relaxed state had a statistically significant correlation with the height, weight, and foot length, while the tendon length in the dorsiflexed-stretched position had a statistically significant relationship to foot length, tibia length, calf circumference and range of motion (both in maximum dorsiflexion and plantar flexion positions; p < .05 for all comparison). Differences in the correlation between the Achilles tendon parameters and body habitus was recorded as a function of ankle position. Tendon dimensions and cross-sectional areas were larger in male vs female athletes. Calf circumferences and Achilles tendon resting angle were outlined. No significant difference was found in the Achilles tendon dimensions regardless of the leg dominance with similar range of motion regardless of athlete gender.
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Affiliation(s)
- Felix M Gonzalez
- Assistant Professor of Radiology, Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA.
| | - Courtney N Gleason
- Assistant Professor of Orthopedics, Department of Orthopaedic Surgery, Emory School of Medicine, Atlanta, GA
| | - David A Reiter
- Assistant Professor of Radiology and Orthopedics, Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA
| | - John Dunham
- Head Athletic Trainer, Emory University, Atlanta, GA
| | - Samia K Sayyid
- Research Assistant, Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA
| | - Sameh A Labib
- Associate Professor of Orthopedics, Department of Orthopaedic Surgery, Emory School of Medicine, Atlanta, GA
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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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Abstract
The Achilles tendon is one of the strongest and thickest tendons of the human body. Several studies have reported an immediate decrease in Achilles tendon thickness after a single bout of resistance training. However, the effects of blood flow restriction training on Achilles tendon thickness have not been investigated. The purpose of this study was to investigate the acute effects of different regimens of resistance training on Achilles tendon thickness. Fiftytwo participants (27.3 ± 7 years; 177.6 ± 11 cm; 72.2 ± 13.7 kg) were randomly allocated into one of the three groups: low-intensity exercise without (LI, n = 13) and with blood flow restriction (LI-BFR, n = 24), and high-intensity exercise (HI, n = 15). Participants from LI and LI-BFR groups performed four sets (1 x 30 + 3 x 15 reps) at 30% 1RM, while the HI group performed four sets (1 x 30 with 30% 1RM + 3 x 10 reps with 75% 1RM). All groups performed a plantar flexion exercise. For the LI-BFR group, a blood pressure cuff was placed on the dominant calf and inflated at 30% of the individual´s occlusion pressure (47.6 ± 19.8 mmHg). Sonographic images of Achilles tendon thickness were taken at pre, immediately after, 60 min and 24 h following acute bouts of exercise. Achilles tendon thickness was significantly reduced immediately after, 60 min and 24 h post-LI-BFR exercise (pre: 4.4 ± 0.4 mm vs. IA: 3.8 ± 0.4 mm vs. 60 min: 3.7 ± 0.3 mm vs. 24 h: 4.1 ± 0.3 mm; p < 0.001), whereas Achilles tendon thickness was unchanged for HI and LI groups (p > 0.05). These results suggest that blood flow restriction training may be an effective strategy to stimulate a positive response in Achilles tendon thickness.
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Morphological Characteristics of Passive and Active Structures of the Foot Across Populations With Different Levels of Physical Activity. J Sport Rehabil 2021; 30:935-941. [PMID: 33662932 DOI: 10.1123/jsr.2020-0423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Imaging diagnosis plays a fundamental role in the evaluation and management of injuries suffered in sports activities. OBJECTIVE To analyze the differences in the thickness of the Achilles tendon, patellar tendon, plantar fascia, and posterior tibial tendon in the following levels of physical activity: persons who run regularly, persons otherwise physically active, and persons with a sedentary lifestyle. DESIGN Cross-sectional and observational. PARTICIPANTS The 91 volunteers recruited from students at the university and the Triathlon Club from December 2016 to June 2019. The data were obtained (age, body mass index, and visual analog scale for quality of life together with the ultrasound measurements). RESULTS Tendon and ligament thickness was greater in the runners group than in the sedentary and active groups with the exception of the posterior tibial tendon. The thickness of the Achilles tendon was greater in the runners than in the other groups for both limbs (P = .007 and P = .005). This was also the case for the cross-sectional area (P < .01) and the plantar fascia at the heel insertion in both limbs (P = .034 and P = .026) and for patellar tendon thickness for the longitudinal measurement (P < .01). At the transversal level, however, the differences were only significant in the right limb (P = .040). CONCLUSION The thickness of the Achilles tendon, plantar fascia, and patellar tendon is greater in runners than in persons who are otherwise active or who are sedentary.
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Steinberg N, Funk S, Svorai-Band S, Yavnai N, Pantanowitz M, Zeev A, Dar G. The Influence of a 14-Week Infantry Commanders Courses on the Achilles Tendon and Patellar Tendon Structure. Mil Med 2021; 187:e377-e386. [PMID: 33533888 DOI: 10.1093/milmed/usab019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/06/2020] [Accepted: 01/15/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Alternated tendon structure may raise stress to the musculoskeletal structures and may increase the potential for overuse injury. Screening the tendon structure of soldiers pre- and post-participation in a strenuous combat course is essential. The aim of the present study was to investigate the influence of a 14-week infantry commanders courses on the Achilles tendon (AT) structure and patellar tendon (PT) structure in combat soldiers. MATERIALS AND METHODS Ninety-eight participants from an infantry commanders course were screened pre- and post-course for the AT and PT structures, using ultrasonographic tissue characterizaton (UTC) imaging to capture a 3D structure of four echo-type fibers (I-IV). RESULTS In both tendons, the mean relative frequency of echo-type I fibers significantly decreased from pre- to post-testing, with a significant increase in the relative frequency of echo-types II, III, and IV fibers. In the AT, 60.2% of the subjects showed positive differences (between pre- and post-testing in the echo-type III + IV fiber ("worsened" tendon structure), whereas in the PT, 92.2% of the subject showed an increased frequency. No significant correlation (r = 0.108; P = .324) was found between the differences of echo-type III + IV fibers of the AT and that of the PT. CONCLUSIONS Loads to the musculoskeletal structures along the combat course increased the mean relative frequency of the "reduced" echo-type fibers (III + IV) in both the AT structure and the PT structure. Yet, whereas in the AT around 40% of the soldiers showed an improved tendon structure along the course, in the PT less than 10% of the soldiers showed that improvement. Soldiers and commanders should be aware of the different influence of the loading exercises along the course on the AT and on the PT structure, as "reduced" tendons structure might put the soldiers at higher risk for injury in the future.
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Affiliation(s)
- Nili Steinberg
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
| | - Shany Funk
- Combat Fitness Department, Doctrine and Research Branch, IDF, Military post #01443, Israel
| | - Shani Svorai-Band
- Military Medical Corps, IDF Medical Corps, Tel Hashomer, Ramat Gan, Military post #02149, Israel
| | - Nirit Yavnai
- Research Directorate, IDF Medical Corps, Tel Hashomer, Ramat Gan, Military post #02149, Israel
| | - Michal Pantanowitz
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
| | - Aviva Zeev
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
| | - Gali Dar
- Department of Physical Therapy Faculty of Social Welfare, Health Studies University of Haifa, 3498838, Israel
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Salinero JJ, Lara B, Gutierrez-Hellin J, Gallo-Salazar C, Areces F, Jiménez F, Coso JD. THICKNESS AND CROSS-SECTIONAL AREA OF THE ACHILLES TENDON IN MARATHON RUNNERS: A CROSS-SECTIONAL STUDY. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-869220202605205659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: This study aimed to measure thickness and cross-sectional area of the Achilles tendon (AT), and the range of motion of the ankle joint in dorsiflexion of amateur marathon runners compared to non-active people. Objectives: To analyze the relationship between cross-sectional area and thickness of the Achilles tendon in marathon runners and age, anthropometric characteristics (height and body mass), training habits, running experience, marathon performance, and range of motion in the ankle joint. Methods: Achilles tendon thickness and cross-sectional area were measured using ultrasound images of the left leg in 97 male amateur marathon runners (age 42.0 ± 9.6 years; height 175 ± 6 cm; and body mass 73.7 ± 8.6 kg), and 47 controls (39.9 ± 11.6 years; 176 ± 7 cm; 79.6 ± 16.1 kg). Results: Achilles tendon thickness (4.81 ± 0.77 vs. 4.60 ± 0.66 mm; p = 0.01) and cross-sectional area (60.41 ± 14.36 vs. 53.62 ± 9.90 mm2; p < 0.01) were greater in the marathon runners than in non-active people. Achilles tendon thickness has been correlated, in a weak but significant manner, with years of running experience. Moreover, marathon runners showed increased ankle range of motion (81.81 ± 6.93 vs. 77.86 ± 7.27 grades; p<0.01). Conclusion: Male amateur marathon runners have hypertrophy of the Achilles tendon compared to non-active people, and this enlargement is mediated by running experience. In addition, range of motion in ankle dorsiflexion is favored by marathon training. Level of evidence III; Retrospective study.
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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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Thoirs KA, Childs J. Are Ultrasound Measurements of Achilles Tendon Size Reliable? A Systematic Review of Rater Reliability. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2476-2491. [PMID: 30154035 DOI: 10.1016/j.ultrasmedbio.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/04/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound measurements of Achilles tendon size are used to assess the tendon's response to exercise, aging, rehabilitation, tendon loading and healing. It is important to understand and minimise the measurement error that occurs with these measurements. This review identified and synthesised studies reporting on intra- and inter-rater reliability of ultrasound measurements of Achilles tendon size. Analysis of 21 studies revealed that good to excellent intra- and inter-rater reliability can be achieved for ultrasound measurements of Achilles tendon size. Reliability can be optimised by using one experienced operator, standardising transducer pressure and orientation and averaging two or three measurements. There was a high risk of methodological bias across the included studies. Reporting of reliability studies needs to be improved by the use of existing reporting guidelines and expansion of these guidelines to include important elements of ultrasound imaging.
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Affiliation(s)
- Kerry A Thoirs
- International Centre of Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia 5001, Australia.
| | - Jessie Childs
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001, Australia
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14
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Roesch HJ, Milanese S, Osborne B, Spurrier DJ, Thoirs KA. The acute effects of exercise on tendon dimensions and vascularity. An exploratory study using diagnostic ultrasound of the male Achilles tendon. J Sci Med Sport 2018; 21:982-987. [DOI: 10.1016/j.jsams.2017.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/06/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
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15
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Patel NN, Labib SA. The Achilles Tendon in Healthy Subjects: An Anthropometric and Ultrasound Mapping Study. J Foot Ankle Surg 2018; 57:285-288. [PMID: 29275904 DOI: 10.1053/j.jfas.2017.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 02/03/2023]
Abstract
Ultrasonography is an inexpensive, fast, and reliable imaging technique widely used to assess the Achilles tendon. Although significant data exists regarding pathologic tendon changes, ultrasound data from healthy individuals are more limited. We aimed to better characterize ultrasound Achilles tendon measurements in healthy individuals and identify important correlating factors. The information collected included patient demographics, body habitus, activity level, foot dominance, and resting ankle angle. Ultrasound analysis was performed bilaterally on the Achilles tendons of 50 subjects using a high-frequency transducer to measure tendon width, thickness, cross-sectional area, and length. Males had a significantly larger mean tendon length, width, thickness, and cross-sectional area. No statistically significant difference was found in any tendon dimension between the white and black participants. Similarly, no difference was found in any tendon parameter when comparing right versus left leg dominance. Healthy subjects had a mean ankle resting angle of 45.1° ± 24° with no statistically significant difference between right and left ankles. Considering all individuals, each tendon parameter (tendon length, width, thickness, and cross-sectional area) correlated positively with subject height, weight, tibia length, and foot size. Only the Achilles cross-sectional area correlated significantly with the activity level. The resting angle of the ankle correlated positively with both tendon length and thickness. In conclusion, we found significant variations in Achilles tendon anatomy in the healthy adult population. We have thoroughly characterized significant correlations between healthy tendon dimensions and various body habitus, activity levels, and ankle parameters. Greater knowledge of the normal Achilles tendon anatomy and characterization of its variations in the healthy population will potentially allow for better pathologic diagnosis and surgical repair.
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Affiliation(s)
- Nick N Patel
- Resident Physician, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Sameh A Labib
- Associate Professor, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA
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16
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John Fakoya AO, Otohinoyi DA, Fakoya FA. Correlation of some predisposing intrinsic conditions with the morphological integrity of the Achilles tendon. Ann Afr Med 2018; 17:58-63. [PMID: 29536958 PMCID: PMC5875120 DOI: 10.4103/aam.aam_49_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies have focused on ill-tendons with a little insight on how intrinsic factors correlate with the Achilles tendon (AT) morphology. AIM This study aims at establishing how blood pressure (BP), blood glucose (BG), and body mass index (BMI) correlate with the morphology of the AT with emphasis on width changes. MATERIALS AND METHODS Participants were volunteers who were recruited during and after an organized health fair by the Medical Students' body of All Saints University, School of Medicine, Commonwealth of Dominica. A total of 336 people, consisting of 135 males and 201 females volunteered for the study. The most dominant age group was between 60 and 65 years. A self-administered questionnaire was used to acquire necessary information, and a preliminary clinical procedure was used to check for BP, BG, and BMI. Ultrasound examination was done in B-mode using a linear array high-frequency probe with a mediolateral approach at the AT. RESULTS Among the participants, 42.68%, 69.75%, and 30.38% had normal BP, BG, and BMI readings, respectively. BP, BG, and BMI statistically supported the hypothesis. Individuals with extreme BP, BG, and BMI had their AT width wider when compared with individuals with normal systemic readings. Sonographic examination revealed most participants with normal tendon morphology while some identifiable changes were observed among others. CONCLUSION This study suggests that BP, BG, and BMI could affect the morphological integrity of the AT. It indicates that asymptomatic high blood sugar and BP could weaken the AT, leading to pain which may appear unrelated to the physician and patient.
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Affiliation(s)
| | - David Adeiza Otohinoyi
- Department of Anatomical Sciences, School of Medicine, All Saints University, Roseau, Dominica
| | - Francis Adelade Fakoya
- Department of Anatomical Sciences, St. George's International School of Medicine, Drill Hall, Northumbria University, Newcastle, England, UK
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17
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Martin KD, Wake J, Dawson L, Van Buren JP. Cross-sectional Area of the Achilles Tendon in a Cohort of Elite Military Warriors Using Standard Ultrasound Techniques. Mil Med 2018; 183:e744-e747. [PMID: 29548031 DOI: 10.1093/milmed/usy019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kevin D Martin
- Evans Army Community Hospital, 1650 Cochran Circle, Ft Carson, CO
| | - Jeffrey Wake
- Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Road, Parker, CO
| | - Laura Dawson
- Keller Army Community Hospital, Building 900, Washington Road, West Point, NY
| | - J Preston Van Buren
- Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Road, Parker, CO
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18
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Bhatia DN, Kandhari V, DasGupta B. Cadaveric Study of Insertional Anatomy of Distal Biceps Tendon and its Relationship to the Dynamic Proximal Radioulnar Space. J Hand Surg Am 2017; 42:e15-e23. [PMID: 28052833 DOI: 10.1016/j.jhsa.2016.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/08/2016] [Accepted: 11/02/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify and assess the relationship between the insertional dimensions of the distal biceps tendon (DBT) and radioulnar space (RUS) in 3 rotational positions. We hypothesized that in all positions RUS would be adequate for the DBT and would remain adequate even after an incremental increase (1 to 3 mm) in tendon thickness. METHODS Eleven fresh-frozen cadaveric elbows were dissected; DBT dimensions and bicipital tuberosity measurements were performed and insertional footprints were quantified using a distal biceps footprint index. The RUS was measured at 3 levels of the bicipital tuberosity and in 3 positions of forearm rotation. We performed statistical analysis to analyze differences in RUS (positional and inter-level). In addition, significant differences between DBT thickness (native and incremental) and RUS were analyzed to identify potential sites of radioulnar impingement. RESULTS The DBT had a mean length of 92 mm; thickness ranged from 2.9 to 6.1 mm. Three variations in DBT insertional footprint were observed and quantified. The RUS linear distance reduced significantly from a supinated to a pronated position at each of 3 bicipital tuberosity levels; the reduction was statistically significant at the lower tuberosity level (45%). Pronation RUS distance was adequate for native DBT thickness and was significantly less when DBT thickness increased by 2 and 3 mm. CONCLUSIONS Radioulnar space reduces significantly from the supinated to the pronated position and is most evident in the lower aspect of the tuberosity. In addition, the RUS in pronation is inadequate for incremental increases in DBT thickness. CLINICAL RELEVANCE Postoperative DBT impingement in the RUS may be prevented by avoiding techniques that increase the thickness of the tendon and by using a reattachment site at the proximal aspect of the tuberosity.
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Affiliation(s)
- Deepak N Bhatia
- Department of Orthopaedic Surgery, Seth GS Medical College and King Edward VII Memorial Hospital, Mumbai, India.
| | - Vikram Kandhari
- Department of Orthopaedic Surgery, Seth GS Medical College and King Edward VII Memorial Hospital, Mumbai, India
| | - Bibhas DasGupta
- Department of Orthopaedic Surgery, Seth GS Medical College and King Edward VII Memorial Hospital, Mumbai, India
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Kruse A, Stafilidis S, Tilp M. Ultrasound and magnetic resonance imaging are not interchangeable to assess the Achilles tendon cross-sectional-area. Eur J Appl Physiol 2016; 117:73-82. [PMID: 27838848 PMCID: PMC5306331 DOI: 10.1007/s00421-016-3500-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/03/2016] [Indexed: 11/21/2022]
Abstract
Purpose The major aim of this study was to compare ultrasound (US) and magnetic resonance imaging (MRI) measurements of the Achilles tendon cross-sectional area (CSA). Further aims were to conduct reliability analyses and to assess the influence of transducer pressure on the tendon properties in US measurements. Methods The Achilles tendon CSA of 15 participants was assessed at two positions with US and MRI by use of a standardized protocol. Method comparison was performed by two-way analysis of variance (ANOVA) and paired t test. Reliability was assessed by coefficients of variation (CV), intraclass correlation (ICC2,2), standard error of measurement (SEM), and minimal detectable change (MDC95). A paired t test was performed to investigate the effect of probe pressure on tendon CSA and thickness. Results Mean US measurements provided a ~5.5% smaller CSA compared to MRI measurements. Intra-rater reliability analyses of US demonstrated CV values of 1.5–4.9%, ICC of 0.89–0.97, SEM and MDC95 values of 0.22–0.77 mm2 and 0.61–2.16 mm2 for both raters, whereby CV values for intra-rater reliability of MRI ranged from 1.0 to 3.7%. Inter-rater reliability was lower for both modalities. Pressure applied on the transducer altered Achilles tendon CSA and thickness significantly (p < 0.05). Conclusions Our findings show that US and MRI cannot be used interchangeably for Achilles tendon CSA assessments, however, each imaging modality separately is reliable to assess this property. Pressure applied on the transducer during US measurements causes alterations of the tendon’s morphology and should be avoided.
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Affiliation(s)
- Annika Kruse
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Savvas Stafilidis
- Centre of Sport Science, University of Vienna, Auf der Schmelz 6a, 1150, Vienna, Austria.
| | - Markus Tilp
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
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Bohm S, Mersmann F, Schroll A, Mäkitalo N, Arampatzis A. Insufficient accuracy of the ultrasound-based determination of Achilles tendon cross-sectional area. J Biomech 2016; 49:2932-2937. [DOI: 10.1016/j.jbiomech.2016.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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Schreiber T, Allenspach P, Seifert B, Schweizer A. Connective tissue adaptations in the fingers of performance sport climbers. Eur J Sport Sci 2015; 15:696-702. [DOI: 10.1080/17461391.2015.1048747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bohm S, Mersmann F, Arampatzis A. Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults. SPORTS MEDICINE-OPEN 2015; 1:7. [PMID: 27747846 PMCID: PMC4532714 DOI: 10.1186/s40798-015-0009-9] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/29/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present article systematically reviews recent literature on the in vivo adaptation of asymptomatic human tendons following increased chronic mechanical loading, and meta-analyzes the loading conditions, intervention outcomes, as well as methodological aspects. METHODS The search was performed in the databases PubMed, Web of Knowledge, and Scopus as well as in the reference lists of the eligible articles. A study was included if it conducted (a) a longitudinal exercise intervention (≥8 weeks) on (b) healthy humans (18 to 50 years), (c) investigating the effects on mechanical (i.e., stiffness), material (i.e., Young's modulus) and/or morphological properties (i.e., cross-sectional area (CSA)) of tendons in vivo, and was reported (d) in English language. Weighted average effect sizes (SMD, random-effects) and heterogeneity (Q and I 2 statistics) of the intervention-induced changes of tendon stiffness, Young's modulus, and CSA were calculated. A subgroup analysis was conducted regarding the applied loading intensity, muscle contraction type, and intervention duration. Further, the methodological study quality and the risk of bias were assessed. RESULTS The review process yielded 27 studies with 37 separate interventions on either the Achilles or patellar tendon (264 participants). SMD was 0.70 (confidence interval: 0.51, 0.88) for tendon stiffness (N=37), 0.69 (0.36, 1.03) for Young's modulus (N=17), and 0.24 (0.07, 0.42) for CSA (N=33), with significant overall intervention effects (p<0.05). The heterogeneity analysis (stiffness: I 2 =30%; Young's modulus: I 2 =57%; CSA: I 2 =21%) indicated that differences in the loading conditions may affect the adaptive responses. The subgroup analysis confirmed that stiffness adaptation significantly (p<0.05) depends on loading intensity (I 2 =0%), but not on muscle contraction type. Although not significantly different, SMD was higher for interventions with longer duration (≥12 weeks). The average score of 71±9% in methodological quality assessment indicated an appropriate quality of most studies. CONCLUSIONS The present meta-analysis provides elaborate statistical evidence that tendons are highly responsive to diverse loading regimens. However, the data strongly suggests that loading magnitude in particular plays a key role for tendon adaptation in contrast to muscle contraction type. Furthermore, intervention-induced changes in tendon stiffness seem to be more attributed to adaptations of the material rather than morphological properties.
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Affiliation(s)
- Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, Berlin, Germany.
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