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Fontenelle A, Mannarino P, Oliveira LFD, Menegaldo LL, Souza SALD, Fontenelle CRDC. Evaluation of the Mechanical Behavior of the Patellar and Semitendinosus Tendons Using Supersonic Shear-wave Imaging (SSI) Elastography and Tensile Tests. Rev Bras Ortop 2024; 59:e556-e563. [PMID: 39239578 PMCID: PMC11374394 DOI: 10.1055/s-0044-1788290] [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: 11/20/2023] [Accepted: 03/18/2024] [Indexed: 09/07/2024] Open
Abstract
Objective To analyze the mechanical properties of the patellar (PT) and semitendinosus (ST) tendons from fresh-frozen human cadavers from a tissue bank using supersonic shear-wave imaging (SSI) elastography and tensile tests. Methods We tested seven PT and five ST samples on a traction machine and performed their simultaneous assessment through SSI. The measurements enabled the comparison of the mechanical behavior of the tendons using the stress x strain curve and shear modulus (μ) at rest. In addition, we analyzed the stress x μ relationship under tension and tested the relationship between these parameters. The statistical analysis of the results used unpaired t -tests with Welch correction, the Pearson correlation, and linear regression for the Young modulus (E) estimation. Results The μ values for the PT and ST at rest were of 58.86 ± 5.226 kPa and 124.3 ± 7.231 kPa respectively, and this difference was statistically significant. The correlation coefficient between stress and μ for the PT and ST was very strong. The calculated E for the PT and ST was of 19.97 kPa and 124.8 kPa respectively, with a statistically significant difference. Conclusion The ST was stiffer than the PT in the traction tests and SSI evaluations. The μ value was directly related to the stress imposed on the tendon. Clinical relevance The present is an evaluation of the mechanical properties of the tendons most used as grafts in knee ligament reconstruction surgeries.
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Affiliation(s)
- André Fontenelle
- Serviço de Traumato-Ortopedia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Pietro Mannarino
- Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Liliam Fernandes de Oliveira
- Programa de Engenharia Biomédica, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Luciano Luporini Menegaldo
- Programa de Engenharia Biomédica, Instituto Alberto Luiz Coimbra de Pós-Graduação e Pesquisa de Engenharia (Coppe), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Sérgio Augusto Lopes de Souza
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - César Rubens da Costa Fontenelle
- Serviço de Traumato-Ortopedia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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van Dam L, Terink R, van den Akker-Scheek I, Zwerver J. Intra- and inter-operator reliability of measuring compressive stiffness of the patellar tendon in volleyball players using a handheld digital palpation device. PLoS One 2024; 19:e0304743. [PMID: 38917106 PMCID: PMC11198853 DOI: 10.1371/journal.pone.0304743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
This observational study aimed to evaluate the intra- and inter-operator reliability of a digital palpation device in measuring compressive stiffness of the patellar tendon at different knee angles in talent and elite volleyball players. Second aim was to examine differences in reliability when measuring at different knee angles, between dominant and non-dominant knees, between sexes, and with age. Two operators measured stiffness at the midpoint of the patellar tendon in 45 Dutch volleyball players at 0°, 45° and 90° knee flexion, on both the dominant and non-dominant side. We found excellent intra-operator reliability (ICC>0.979). For inter-operator reliability, significant differences were found in stiffness measured between operators (p<0.007). The coefficient of variance significantly decreased with increasing knee flexion (2.27% at 0°, 1.65% at 45° and 1.20% at 90°, p<0.001). In conclusion, the device appeared to be reliable when measuring compressive stiffness of the patellar tendon in elite volleyball players, especially at 90° knee flexion. Inter-operator reliability appeared to be questionable. More standardized positioning and measurement protocols seem necessary.
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Affiliation(s)
- Lotte van Dam
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
- Department of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rieneke Terink
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes Zwerver
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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Dickson DM, Smith SL, Hendry GJ. Association between quadriceps tendon elasticity and neuromuscular control in individuals with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2024; 111:106159. [PMID: 38101187 DOI: 10.1016/j.clinbiomech.2023.106159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Knee osteoarthritis is a complex condition with established risk factors such as female sex, increasing age and body mass index, reduced quadriceps muscle strength and knee injury. Despite known associated risks, the role and behaviour of knee tendons in knee osteoarthritis remains unclear. This study explores the association between quadriceps tendon elasticity, muscle strength, neuromuscular control, proprioception and patient reported outcome measures in individuals with knee osteoarthritis. METHODS Adults with doctor-diagnosed knee osteoarthritis were recruited from rheumatology clinics and general practitioner practices. Quadriceps tendon elasticity was estimated using sonoelastography. Neuromuscular control data including electromyography, electromechanical delay and proprioception measures were included. Participants completed the Knee Injury and Osteoarthritis Outcome Score. Associations between elasticity values, physical and neuromuscular data and patient reported outcomes scores were evaluated using Spearman's correlations. FINDINGS Thirty-nine adults with knee osteoarthritis were eligible for inclusion. Increased tendon stiffness was negatively associated with rate of force development, time to half peak force and passive positioning sense in individuals with knee osteoarthritis. Similarly, patient reported symptoms were found to be associated with sonoelastography findings with moderate-strong associations observed between activities of daily living sport and recreation, pain and symptoms and between neuromuscular control measures and muscle strength. INTERPRETATION Stiffer tendon identified within the knee osteoarthritis group was associated with reduced neuromuscular control and knee joint proprioception. Stiffer quadriceps tendon may contribute to the poorer reported symptoms by knee osteoarthritis individuals. These findings may impact disease symptoms and progression which could lead to further joint impairment.
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Affiliation(s)
- Diane M Dickson
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK.
| | - Stephanie L Smith
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK; Pain Centre Versus Arthritis, Academic Rheumatology, Injury Recovery and Inflammation Sciences, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham NG5 1PB, UK
| | - Gordon J Hendry
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK
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Aguilar-Nuñez D, Cervera-Garvi P, Aguilar-Garcia M, Cuevas-Cervera M, Gonzalez-Muñoz A, Navarro-Ledesma S. Ultrasound Strain Elastography Reliability in the Assessment of the Plantar Fascia and Its Relationship with the Plantar Thickness in Healthy Adults: An Intra and Interobserver Reliability Study in Novice Evaluators. Biomedicines 2023; 11:2040. [PMID: 37509678 PMCID: PMC10377694 DOI: 10.3390/biomedicines11072040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
PURPOSE This study was aimed at verifying both the intraobserver and interobserver reliability of measuring plantar fascia stiffness for a given image in healthy active adults. METHODOLOGY This study is reported following the Guidelines of Reporting Reliability and Agreement Studies. A total of 20 plantar fascia from healthy volunteers were analyzed. The thickness of the plantar fascia was measured vertically from the anterior edge of the inferior calcaneal border to the inferior border of the plantar fascia and the ultrasound elastography measurement was taken at the calcaneal insertion of the plantar fascia with the region of interest one centimeter away from the insertion. RESULTS The ultrasound strain elastography measurements: the right intraobserver 1 showed an ICC value of 0.9 and the left intraobserver 1 showed an ICC value of 0.78, while the right intraobserver 2 showed an ICC value of 0.91 and the left intraobserver 2 showed an ICC value of 0.83. Interobserver measurements showed excellent reliability with a right ICC value of 0.8 and a left ICC value of 0.9 for the plantar fascia thickness measurements. DISCUSSION The results of this study showed a strong correlation between left and right plantar fascia thickness. The intraobserver reliability was excellent for both plantar fascia ultrasound strain elastography and thickness measurements, with interobserver measurements showing excellent reliability.
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Affiliation(s)
- Daniel Aguilar-Nuñez
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
| | - Pablo Cervera-Garvi
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Penalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain
| | - Maria Aguilar-Garcia
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
| | - Maria Cuevas-Cervera
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
| | - Ana Gonzalez-Muñoz
- Clinica Ana Gonzalez, Avenida Hernan Nuñez de Toledo 6, 29018 Malaga, Spain
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
| | - Santiago Navarro-Ledesma
- Department of Physiotherapy, Faculty of Health Sciences, Campus of Melilla, University of Granada, Querol Street, 5, 52004 Melilla, Spain
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Comparative Study of Muscle Hardness during Water-Walking and Land-Walking Using Ultrasound Real-Time Tissue Elastography in Healthy Young People. J Clin Med 2023; 12:jcm12041660. [PMID: 36836194 PMCID: PMC9959738 DOI: 10.3390/jcm12041660] [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: 02/01/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Compared with land-walking, water-walking is considered to be beneficial as a whole-body exercise because of the characteristics of water (buoyancy, viscosity, hydrostatic pressure, and water temperature). However, there are few reports on the effects of exercise in water on muscles, and there is no standard qualitative assessment method for muscle flexibility. Therefore, we used ultrasound real-time tissue elastography (RTE) to compare muscle hardness after water-walking and land-walking. Participants were 15 healthy young adult males (24.8 ± 2.3 years). The method consisted of land-walking and water-walking for 20 min on separate days. The strain ratio of the rectus femoris (RF) and medial head of gastrocnemius (MHGM) muscles were measured before and immediately after walking using RTE to evaluate muscle hardness. In water-walking, the strain ratio significantly decreased immediately after water-walking, with p < 0.01 for RF and p < 0.05 for MHGM, indicating a significant decrease in muscle hardness after water-walking. On the other hand, land-walking did not produce significant differences in RF and MHGM. Muscle hardness after aerobic exercise, as assessed by RTE, was not changed by land walking but was significantly decreased by water walking. The decrease in muscle hardness induced by water-walking was thought to be caused by the edema reduction effect produced by buoyancy and hydrostatic pressure.
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Bravo-Sánchez A, Abián P, Sánchez-Infante J, Ramírez-delaCruz M, Esteban-García P, Jiménez F, Abián-Vicén J. Five-Compressions Protocol as a Valid Myotonometric Method to Assess the Stiffness of the Lower Limbs: A Brief Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14425. [PMID: 36361308 PMCID: PMC9654301 DOI: 10.3390/ijerph192114425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
The objective of this study was to evaluate the validity of a short assessment MyotonPRO protocol to measure the stiffness of the superficial muscles and tendons of the lower limbs. The stiffness of the dominant lower limb vastus lateralis (VL), rectus femoris (RF) and patellar tendon (PT) was evaluated in 52 healthy participants (26.9 ± 3.4 years) with two MyotonPRO protocols: the standard protocol (10 mechanical taps) and the short protocol (five mechanical taps). The myotonometry was performed at the midpoint of the length from the upper pole of the patella to the greater trochanter for the VL, and to the anterior superior iliac spine for the RF. The PT was evaluated 1 cm caudal from the inferior pole of the patella. Pearson's correlation coefficients were calculated to determine the relationships between protocols. The validity of the short protocol was evaluated with Student's t-test. High positive correlations were observed between the short and standard protocols in the stiffness of the VL (r = 0.959; p < 0.001), the RF (r = 0.967; p < 0.001) and the PT (r = 0.953; p < 0.001) and no differences were found between both protocols in the stiffness assessment of the VL, RF and PT (p > 0.05). Therefore, the five-compressions protocol is a valid protocol for the assessment of lower limb mechanical properties.
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Affiliation(s)
- Alfredo Bravo-Sánchez
- Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, C. Alberto Aguilera 23, 28049 Madrid, Spain
| | | | - María Ramírez-delaCruz
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
| | - Paula Esteban-García
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
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Römer C, Czupajllo J, Zessin E, Fischer T, Wolfarth B, Lerchbaumer MH. Muscle and Tendon Stiffness of the Lower Limb of Professional Adolescent Soccer Athletes Measured Using Shear Wave Elastography. Diagnostics (Basel) 2022; 12:diagnostics12102453. [PMID: 36292143 PMCID: PMC9601169 DOI: 10.3390/diagnostics12102453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/14/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While adolescents have specific risk factors for acute and chronic injury, there is a lack of preventive medicine algorithms for this vulnerable group. Shear wave elastography (SWE) is currently mainly used for assessing muscle and tendon stiffness in adult athletes and can diagnose tissue pathologies such as tendinopathy. The aim was to investigate differences in quadriceps tendon and muscle stiffness between adolescent and adult professional soccer players using SWE and identify lateral imbalances in order to improve the knowledge of preventive medicine algorithms for professional adolescent athletes. METHODS Standardized SWE examinations of both lower limb tendons and muscles (the quadriceps tendon (QT) and the vastus medialis (VM) muscle) in the longitudinal plane and relaxed tendon position were performed in 13 healthy adolescent soccer athletes (13-17 years), and a control group of 19 healthy adult professional soccer athletes (18-29 years). RESULTS Adolescent soccer players had lower stiffness values for both the quadriceps tendon (3.11 m/s vs. 3.25 m/s) and the vastus medialis muscle (1.67 m/s vs. 1.71 m/s) than adult athletes. Moreover, QT stiffness in adolescent soccer players was significantly lower on the right side (QT: adult 3.50 m/s (2.73-4.56) vs. adolescent 2.90 m/s (2.61-3.12); p = 0.031). Analysis of the lateral differences revealed softer QT and VM tissue on the right side in over two-thirds of adolescent soccer athletes. Over two-thirds of adults had stiffer QT and VM tissue on the right side. CONCLUSION In adolescent soccer players, the stiffness of the QT and VM muscle measured by SWE is lower in the right leg. SWE of the musculoskeletal system may thus become a relevant diagnostic tool to detect early lateral imbalances as a main risk factor for injury and may thus contribute to the prevention of acute and chronic injury prevention in adolescent athletes.
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Affiliation(s)
- Claudia Römer
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Enrico Zessin
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Markus Herbert Lerchbaumer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450657084
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Dickson DM, Smith SL, Hendry GJ. Strain sonoelastography in asymptomatic individuals and individuals with knee osteoarthritis: an evaluation of quadriceps and patellar tendon. Rheumatol Int 2022; 42:2241-2251. [PMID: 35974116 PMCID: PMC9548467 DOI: 10.1007/s00296-022-05184-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
An advanced ultrasound imaging technique, sonoelastography (SE) is used to evaluate tissue elasticity. To determine SE potential to detect pathological-related changes, and characteristics related to tendon pathology we aimed to (1) compare quadriceps and patellar tendon findings in individuals with knee osteoarthritis (KOA) and asymptomatic older adults (AC), and (2) explore associations between SE, participant characteristics (age, BMI, and leg circumference) and KOA status. 84 participants (47; KOA and 37; asymptomatic older adults) underwent SE examination of quadriceps (distal) and patellar (distal, proximal) tendon in a supine position with the knee bent at 30°. Colour score (CS) and Elasticity Ratio (ER) analysis were performed by a blinded experienced operator using Esaote Mylab 70 XVG Ultrasound equipment. Significantly reduced elasticity in the distal quadriceps (median (IQR) 2(2), 3(1), p = 0.033 for KOA and AC, respectively) and proximal patellar (3(1), 3(0), p = 0.001) tendons and more elastic distal patellar (1.50 (0.55), 1.87 (0.72), p = 0.034) tendons were observed in the KOA group. Significant associations) were identified between SE and participant BMI (Rs = − 0.249–0.750, p < 0.05) and leg circumference (Rs = − 0.260–0.903, p < 0.05). Age, BMI and KOA status, were independent explanatory variables of SE CS findings at the distal quadriceps tendon patellar tendon, proximal patellar tendon and distal patellar tendon, explaining 66%, 81% and 64% of variance, respectively. Age, BMI and KOA status were independent explanatory variables of SE ER findings at the distal patellar tendon explaining 19% of variance. Potentially clinically relevant altered tendon stiffness were observed between individuals with KOA and asymptomatic controls. Key KOA risk factors and participant characteristics explained variance in tendon stiffness. Findings provide context for future studies to investigate the potential for targeted SE detected early clinical management based on associated participant characteristics.
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Affiliation(s)
- Diane M Dickson
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Stephanie L Smith
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK.,Pain Centre Versus Arthritis, Academic Rheumatology, Injury Recover and Inflammation Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham, NG5 1PB, UK
| | - Gordon J Hendry
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK
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Henriksen P, Brage K, Junge T, Juul-Kristensen B, Bojsen-Møller J, Thorlund JB. Concurrent validity and intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness. ULTRASOUND 2022; 30:18-27. [PMID: 35173775 PMCID: PMC8841948 DOI: 10.1177/1742271x21994609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022]
Abstract
Introduction Assessment of tendon stiffness in vivo traditionally involves maximal muscle contractions, which can be challenging in pain populations. Alternative methods are suggested, although the clinimetric properties are sparse. This study investigated the concurrent validity and the intrarater reliability of two ultrasound-based methods for assessing patellar tendon stiffness. Methods Patellar tendon stiffness was assessed in 17 healthy adults with (a) the dynamometer and B-mode ultrasonography method (DBUS) and (b) the strain elastography method. Correlations between the two methods were analysed using Kendall’s Tau-b. The relative reliability of both methods was evaluated using intraclass correlation coefficient (ICC). The absolute reliability was presented by Bland–Altman plots, standard error of measurement (SEM) and minimum detectable change (MDC). Results No correlation was found between the two methods, irrespective of reference tissue in strain elastography (Kendall’s Tau-b Hoffa = –0.01 (p = 1.00), Kendall’s Tau-b subcutis = 0.04 (p = 0.87)). Tracking of the tendon elongation in the DBUS method had good to excellent relative reliability (ICC = 0.95 (95% confidence interval – CI: 0.85–0.98)) and high absolute reliability (SEM = 0.04 mm (1%), MDC = 0.11 mm (3%)). The strain elastography method had good to excellent relative reliability, regardless of reference tissue (ICC Hoffa = 0.95 (95% CI: 0.86–0.98), ICC subcutis = 0.94 (95% CI: 0.82–0.98)), but low absolute reliability (SEM Hoffa = 0.06 (20%), MDC Hoffa = 0.18 (60%), SEM subcutis = 0.12 (41%), MDC subcutis = 0.32 (110%)). Conclusions No concurrent validity existed for DBUS and strain elastography, suggesting that the two methods measure different tendon properties. The overall reliability for the DBUS method was high, but the absolute reliability was low for strain elastography stiffness ratios. Therefore, the strain elastography method may not be recommended for tracking differences in patellar tendon stiffness in healthy adults.
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Affiliation(s)
- P Henriksen
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - K Brage
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - T Junge
- Health Sciences Research Centre, UCL University College, Odense, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - B Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - J Bojsen-Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Institute for Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - JB Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Bravo-Sánchez A, Abián P, Sánchez-Infante J, Jiménez F, Abián-Vicén J. Reply to Chang and Wu: Comment on "The Influence of Bias in the Assessment of Patellar Tendon Stiffness: A Systematic Review and Meta-analysis". ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2776-2778. [PMID: 34238617 DOI: 10.1016/j.ultrasmedbio.2021.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Alfredo Bravo-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain.
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, Madrid, Spain
| | - Jorge Sánchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
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Martínez F, Abián P, Jiménez F, Abián-Vicén J. Effects of Cross-Education After 6 Weeks of Eccentric Single-Leg Decline Squats Performed With Different Execution Times: A Randomized Controlled Trial. Sports Health 2021; 13:594-605. [PMID: 34075821 DOI: 10.1177/19417381211016353] [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] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cross-education of strength refers to the strength gain that is transferred to the contralateral limb after a unilateral training program. HYPOTHESIS Unilateral eccentric training using different muscle contraction times would improve the structural and functional properties of the untrained contralateral limb. STUDY DESIGN Randomized controlled trial. LEVEL OF EVIDENCE Level 2. METHODS Thirty-six participants were randomized into a control group, experimental group 1 (EG6s; eccentric contraction runtime = 6 seconds) and experimental group 2 (EG3s; eccentric contraction runtime = 3 seconds). The thickness and elastographic index of the patellar tendon (PT), lean mass and fat percentage of the thigh, contractile properties of the vastus lateralis (VL), as well as isometric, concentric, and eccentric knee extensor peak torques, and eccentric single-leg decline squat (SLDSe) 1 repetition maximum (1-RM) were measured after 6 weeks of SLDSe training (3 times per week, 80% of 1-RM) and after 6 weeks of detraining in the untrained contralateral limb. RESULTS After training, there was an increase in lean thigh mass of the untrained limb in both groups: EG6s (0.17 ± 0.29 kg;P = 0.03; effect size [ES] = 0.15) and EG3s (0.15 ± 0.23 kg; P = 0.04; ES = 0.19). Likewise, both EG6s (62.30 ± 19.09 kg; P < 0.001; ES = 4.23) and EG3s (68.09 ± 27.49 kg; P < 0.001; ES = 3.40) increased their 1-RM, isometric (EG6s: 48.64 ± 44.82 N·m, P < 0.001, ES = 0.63; EG3s: 34.81 ± 47.30 N·m, P = 0.004, ES = 0.38), concentric at 60 deg/s and 180 deg/s and eccentric at 60 deg/s and 180 deg/s knee extensor peak torques (P < 0.05) in the untrained limb. However, no differences were found in the contractile properties of the VL or in the thickness of the PT after eccentric training in either of the 2 experimental groups. CONCLUSION Regardless of the runtime of the contraction, 6 weeks of SLSDe was effective for inducing structural and strength adaptations in the contralateral untrained limb. However, most of these adaptations were lost after 6 weeks of detraining. CLINICAL RELEVANCE Our study suggests that cross-education training can be of great importance for clinical application and musculoskeletal and neuromuscular rehabilitative processes after unilateral injury.
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Affiliation(s)
- Fernando Martínez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, Madrid, Spain
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
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Bravo-Sánchez A, Abián P, Sánchez-Infante J, Esteban-Gacía P, Jiménez F, Abián-Vicén J. Objective Assessment of Regional Stiffness in Vastus Lateralis with Different Measurement Methods: A Reliability Study. SENSORS 2021; 21:s21093213. [PMID: 34066343 PMCID: PMC8125613 DOI: 10.3390/s21093213] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/16/2022]
Abstract
The objective of this study was to evaluate the reliability of four methods of assessing vastus lateralis (VL) stiffness, and to describe the influence of structural characteristics on them. The stiffness of the dominant lower-limb’s VL was evaluated in 53 healthy participants (28.4 ± 9.1 years) with shear wave elastography (SWE), strain elastography (SE), myotonometry and tensiomyography (TMG). The SWE, SE and myotonometry were performed at 50%, and TMG was assessed at 30%, of the length from the upper pole of the patella to the greater trochanter. The thickness of the VL, adipose tissue and superficial connective tissue was also measured with ultrasound. Three repeated measurements were acquired to assess reliability, using intraclass correlation coefficients (ICC). Pearson’s correlation coefficients were calculated to determine the relationships between methodologic assessments and between structural characteristics and stiffness assessments of the VL. Myotonometry (ICC = 0.93; 95%-CI = 0.89,0.96) and TMG (ICC = 0.89; 95%-CI = 0.82,0.94) showed excellent inter-day reliability whereas with SWE (ICC = 0.62; 95%-CI = 0.41,0.77) and SE (ICC = 0.71; 95%-CI = 0.57,0.81) reliability was moderate. Significant correlations were found between myotonometry and VL thickness (r = 0.361; p = 0.008), adipose tissue thickness (r = −0.459; p = 0.001) and superficial connective tissue thickness (r = 0.340; p = 0.013). Myotonometry and TMG showed the best reliability values, although myotonometry stiffness values were influenced by the structural variables of the supra-adjacent tissue.
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Affiliation(s)
- Alfredo Bravo-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (A.B.-S.); (J.S.-I.); (P.E.-G.); (F.J.)
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, 28049 Madrid, Spain;
| | - Jorge Sánchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (A.B.-S.); (J.S.-I.); (P.E.-G.); (F.J.)
| | - Paula Esteban-Gacía
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (A.B.-S.); (J.S.-I.); (P.E.-G.); (F.J.)
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (A.B.-S.); (J.S.-I.); (P.E.-G.); (F.J.)
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (A.B.-S.); (J.S.-I.); (P.E.-G.); (F.J.)
- Correspondence: ; Tel.: +34-925268800 (ext. 5522)
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Schneebeli A, Folli A, Falla D, Barbero M. Reliability of Sonoelastography Measurements of Lower Limb Tendon Properties: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1131-1150. [PMID: 33516588 DOI: 10.1016/j.ultrasmedbio.2020.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
This study investigated the reliability of sonoelastography techniques in quantifying lower limb tendon elasticity. A literature search was conducted using PubMed, Web of Science and CINAHL. The quality of the selected papers was evaluated using the Guidelines for Reporting Reliability and Agreement Studies and the Quality Appraisal Tool for Studies of Diagnostic Reliability checklist. Reliability values were extracted and synthesized. Twenty-four studies were included and were divided by the two main technologies used: strain and shear-wave elastography. The overall methodological quality was questionable; all studies were at risk of bias. Highly variable results ranging from poor to excellent reliability were found for both technologies and for all tendons considered. Intra-rater reliability of strain elastography on the Achilles tendon and shear-wave elastography on the patellar and quadriceps tendon was adequate. Inter-rater, inter-session and inter-machine reliability was insufficient. Caution should be used when interpreting results from sonoelastography studies measuring lower limb tendon elasticity.
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Affiliation(s)
- Alessandro Schneebeli
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland.
| | - Anna Folli
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
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Bravo-Sánchez A, Abián P, Sánchez-Infante J, Jimenez F, Abián-Vicén J. Influence of Bias in the Assessment of Patellar Tendon Stiffness: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1151-1162. [PMID: 33589353 DOI: 10.1016/j.ultrasmedbio.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
The aim of the present study was to provide a systematic review and meta-analysis of the main biases in practical applications of the different types of elastography in assessment of the stiffness of healthy patellar tendons. A literature search on four databases (Scopus, Web of Science, Pubmed and SportDiscus) was conducted on March 25, 2020. After analysis of 1,052 resultant articles, studies were included if they met two inclusion criteria: (1) studies were observational or randomized controlled trials; (2) studies included outcomes of patellar tendon stiffness. Twenty-one studies met the inclusion criteria and were included in this meta-analysis. Four meta-analyses were performed with respect to assessment procedure and participant characteristics. This meta-analysis found a low effect of examined portion of patellar tendon (standardized mean difference [SMD] = 0.27, 95% confidence interval [CI]: 0.01-0.54, n = 379, Z = 2.01, p = 0.04) and a high effect of knee flexion angle during assessment (SMD = -2.12; 95% CI: -2.67 to -1.58, n = 97, Z = 7.68, p < 0.01) in stiffness outcomes. The risk of bias was generally low, but the heterogenicity of the results downgraded the level of evidence. There is evidence in the elastography assessment of patellar tendon suggesting that the knee position and patellar tendon portion evaluated influence stiffness outcomes for patellar tendon in healthy volunteers.
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Affiliation(s)
- Alfredo Bravo-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, Madrid, Spain
| | - Jorge Sánchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Fernando Jimenez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain.
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Yang SJ, Zhang MZ, Li J, Xue Y, Chen G. A Reliable, Ultrasound-Based Method for the Diagnosis of Discoid Lateral Meniscus. Arthroscopy 2021; 37:882-890. [PMID: 32998041 DOI: 10.1016/j.arthro.2020.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/09/2020] [Accepted: 09/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To explore the feasibility and validity of ultrasound in the diagnosis of discoid lateral meniscus (DLM) by comparing quantitatively the morphologic difference between DLM and normal lateral meniscus. METHODS This study was designed to develop and validate the ultrasound diagnostic criterion for DLM. In the development stage (July 2018 to June 2019), data from 180 subjects were used to derive the ultrasound diagnostic criterion, including 90 patients diagnosed as DLM by magnetic resonance imaging (DLM group) and 90 matched controls diagnosed as normal lateral meniscus diagnosed by magnetic resonance imaging (control group). Twelve distinct parameters of meniscus thickness, width, 0.5∗thickness/width, and angle were obtained through anterior, lateral, and posterior views with the probe oriented perpendicular to the lateral tibiofemoral joint line. In the validation stage (July 2019 to December 2019), data from 324 additional participants were used to validate the criterion derived from the development stage. Differences of the continuous variables and categorical variables between the 2 groups were analyzed by an independent t test and χ2 test, respectively. The diagnostic value of parameters was analyzed by the receiver operating characteristic curve. RESULTS In the development stage, significant differences were found in the above 12 parameters between the 2 groups (P < .05 for all). Cut-off values of anterior meniscus angle, meniscus body angle, and posterior meniscus angle were 28.45°, 27.85°, and 29.15°, respectively. The area under the curve, sensitivity, and specificity of anterior meniscus angle (0.953, 95.6%, 91.1%), meniscus body angle (0.980, 95.6%, 95.6%), and posterior meniscus angle (0.942, 80.0%, 97.8%) were greater than other parameters. In the validation stage, the sensitivity, specificity, and accuracy of anterior meniscus angle, meniscus body angle, and posterior meniscus angle in diagnosing DLM were as high as 91.3%, 88.6%, and 89.2%; 94.2%, 93.3%, and 93.5%; and 76.8%, 95.7%, and 91.7%. CONCLUSIONS DLM can be reliably diagnosed by ultrasound measurements of anterior meniscus angle, meniscal body angle, and posterior meniscus angle. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Shun-Jie Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Zhi Zhang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Xue
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Chen
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China; Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.
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Dickson DM, Smith SL, Hendry GJ. Can patient characteristics explain variance in ultrasound strain elastography measures of the quadratus femoris and patellar tendons? Knee 2021; 28:282-293. [PMID: 33460994 DOI: 10.1016/j.knee.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/18/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the associations between participant characteristics and magnitudes of difference in paired elastography measures of knee tendon from different ultrasound systems, and to compare strain elastography pattern description. MATERIALS AND METHODS Quadriceps and patellar tendons of 20 healthy volunteers (40 tendons) were examined by an experienced operator employing two ultrasound systems (GE S8 and Esaote MyLab 70XVG). Pearson/Spearman correlations explored the influence of participant characteristics (BMI, body fat %, leg circumference, activity level) on the magnitude of differences between measures. Paired-sample t test or Wilcoxon signed rank test were performed to compare repeated measures of individual ultrasound systems. RESULTS The quadriceps tendon was characteristically stiffer than the patellar tendon. Participant characteristics were associated with within machine differences of the distal quadriceps tendon (BMI; r = 0.49, p = 0.028-0.03 and body fat %; r = 0.43, p = 0.05-0.056) ER measures. CONCLUSIONS Anthropometric and body composition parameters were associated with within machine differences for elasticity measures, where high BMI and body fat % contribute to paired measurement variance at the distal quadriceps tendon. Strain elastography protocols should be standardised, repeated ER measures performed using the same US system and patient characteristics considered for future clinical applications.
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Affiliation(s)
- Diane M Dickson
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK.
| | - Stephanie L Smith
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK; University of Nottingham, University Park, Nottingham, UK
| | - Gordon J Hendry
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK
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Dickson DM, Fawole HO, Hendry GJ, Smith SL. Intermachine Variation of Ultrasound Strain Elastographic Measures of the Quadriceps and Patellar Tendons in Healthy Participants: Implications for Clinical Practice. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1343-1353. [PMID: 31981428 DOI: 10.1002/jum.15228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate intermachine variation and compare intraoperator and interoperator agreement and repeatability characteristics of 2 ultrasound (US) systems for measurements of quadriceps and patellar tendons by strain elastography (SE). METHODS Forty tendons from 20 healthy participants were investigated by operators with different experience (operator 1, 12 years of US experience and >50 SE examinations; operator 2, no US experience and 1 day of SE training). Repeated measures were performed on GE Healthcare (Waukesha, WI) and Esaote (Genoa, Italy) US systems. The percentage of agreement, Cohen κ, intraclass correlation coefficient, and correlation tests assessed agreement, repeatability, and associations of SE measures. A paired t test and Wilcoxon signed rank test assessed differences in SE measures. RESULTS The study participants included 5 male and 15 female volunteers (mean [range] age, 29.3 [21-39] years). Better agreement and repeatability characteristics were observed for the patellar compared to the quadriceps tendon and the color score (CS) method over the elasticity ratio (ER). Intraoperator agreement was better for the experienced operator. Intraoperator repeatability was achieved in 55% of ER (intraclass correlation coefficient, 0.40-0.91; P < .05) and 77% to 85% (κ = -0.25-1) of CS measures. Interoperator repeatability was achieved in 35% (t/z, -2.93-7.94; P < .001-.048) of all ER measures. No significant differences in proximal (z, -0.13- -0.78) and distal patellar (z, -1.52-2.26; P > .5) patellar ER measures were observed. Seventy-four percent to 75% mean agreement (κ = 0-0.5) for CS measures comparable across both US systems was observed. Intermachine ER associations were poor (r = -0.39-0.13; P > .05), whereas greater than 70% agreement (κ = -0.87-0.53) for the CS was achieved. CONCLUSIONS The reproducibility of knee tendon SE measurements is influenced by the operator experience, US system, and tendon site.
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Affiliation(s)
- Diane M Dickson
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
| | - Henrietta O Fawole
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
- Physiotherapy Department, University of Benin, School of Basic Medical Sciences, Benin City, Nigeria
| | - Gordon J Hendry
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
| | - Stephanie L Smith
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
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