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Trybulski R, Muracki J, Podleśny M, Vovkanych A, Kużdżał A. Effectiveness of Kinesiotherapy in the Treatment of Achilles Tendinopathy-A Narrative Review. Sports (Basel) 2024; 12:202. [PMID: 39195578 PMCID: PMC11360343 DOI: 10.3390/sports12080202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/29/2024] Open
Abstract
This narrative review of kinesiotherapy methods in the treatment of Achilles tendinopathy (AT) encompassed a diverse range of studies, including athletes and untrained people, healthy or injured, undergoing kinesiotherapy treatments. Most experimental studies (86%) reported results related to pain perception, 27% to the range of motion, and 27% to biomechanical assessment. However, the studies showed notable heterogeneity in the outcomes associated with the interventions, and, in this review of kinesiotherapy protocols for AT, a prominent observation emerged regarding their efficacy, suggesting a more favorable impact on pain and tendon stiffness management when comparing the measured parameters between the trained and untrained groups. The importance of tailoring the treatment approach based on the individual's athletic background and conditioning status is underscored. There is a need for personalized rehabilitation strategies in athletic populations. The average duration of kinesiotherapy in the treatment of tendinopathy was 15.3 weeks. This observation underscores the potential of kinesiotherapy interventions as a viable treatment option for individuals with Achilles tendon issues. These findings underscore the urgent need for further research to provide stakeholders with more comprehensive directions for future studies. The results may be helpful for doctors, physiotherapists, trainers, and researchers interested in this topic.
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Affiliation(s)
- Robert Trybulski
- Provita Żory Medical Center, 44-240 Żory, Poland;
- Medical Department Wojciech Korfanty, Upper Silesian Academy in Katowice, 40-659 Katowice, Poland
| | - Jarosław Muracki
- Institute of Physical Culture Sciences, Department of Physical Culture and Health, University of Szczecin, 70-453 Szczecin, Poland
| | | | - Andriy Vovkanych
- Department of Physical Therapy and Ergotherapy, Ivan Boberkyj Lviv State University of Physical Culture, 79007 Lviv, Ukraine
| | - Adrian Kużdżał
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-310 Rzeszów, Poland
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Ito N, Sigurðsson HB, Cortes DH, Snyder-Mackler L, Silbernagel KG. Regional healing trajectory of the patellar tendon after bone-patellar tendon-bone autograft harvest for anterior cruciate ligament reconstruction. J Orthop Res 2024; 42:1399-1408. [PMID: 38376078 PMCID: PMC11161334 DOI: 10.1002/jor.25807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024]
Abstract
Graft site morbidities after bone-patellar tendon-bone (BPTB) autograft harvest for anterior cruciate ligament reconstruction (ACLR) negatively impacts rehabilitation. The purpose of this study was to establish tendon structural properties 1-month after BPTB autograft harvest compared to the uninvolved patellar tendon, and subsequently to quantify the healing trajectory of the patellar tendon over the course of rehabilitation. Patellar tendon morphology (ultrasound) and mechanical properties (continuous shear wave elastography) from 3 regions of the tendon (medial, lateral, central) were measured in 34 participants at 1 month, 3-4 months, and 6-9 months after ACLR. Mixed models were used to compare tendon structure between limbs at 1 month, and quantify healing over 3 timepoints. The involved patellar tendon had increased cross-sectional area and thickness in all regions 1-month after ACLR. Thickness reduced uniformly over time. Possible tendon elongation was observed and remained stable over time. Tendon viscosity was uniform across the three regions in the involved limb while the medial region had higher viscosity in the uninvolved limb, and shear modulus was elevated in all three regions at 1 month. Viscosity and shear modulus in only the central region reduced over time. Statement of Clinical Significance: The entire patellar tendon, and not just the central third, is altered after graft harvest. Tendon structure starts to normalize over time, but alterations remain especially in the central third at the time athletes are returning to sport. Early rehabilitation consisting of tendon loading protocols may be necessary to optimize biologic healing at the graft site tendon.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | | | - Daniel H. Cortes
- Department of Mechanical Engineering, Penn State University, State College, PA, USA
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Wu CX, Xiong CY, Bai L, Chen SM, Yan YX, Wang L, Zhang XT. Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study. Chin J Traumatol 2023; 26:323-328. [PMID: 37940448 PMCID: PMC10755773 DOI: 10.1016/j.cjtee.2023.10.002] [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: 08/31/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Previous studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function. METHODS In this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference. RESULTS AOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = -17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = -8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period. CONCLUSION Achilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.
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Affiliation(s)
- Chen-Xi Wu
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Chang-Yue Xiong
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Lu Bai
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China.
| | - Su-Meng Chen
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Yu-Xin Yan
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Lu Wang
- Department of Statistics and Mathematical Sciences, Southern University of Science and Technology, Shenzhen, 518055, Guangdong province, China
| | - Xin-Tao Zhang
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
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Ito N, Silva RS, Sigurðsson HB, Cortes DH, Silbernagel KG. Challenging the assumption of uniformity in patellar tendon structure: Regional patellar tendon morphology and mechanical properties in vivo. J Orthop Res 2023; 41:2232-2237. [PMID: 36970753 PMCID: PMC10522788 DOI: 10.1002/jor.25563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/31/2023] [Accepted: 03/24/2023] [Indexed: 04/10/2023]
Abstract
Patellar tendons are assumed to be uniform in morphology and mechanical properties despite a higher prevalence of tendinopathies observed in the medial region. The purpose of this study was to compare the thickness, length, viscosity, and shear modulus of the medial, central, and lateral regions of healthy patellar tendons of young males and females in vivo. B-mode ultrasound and continuous shear wave elastography were performed on 35 patellar tendons (17 females, 18 males) over three regions of interest. A linear mixed-effects model (α = 0.05) was used to determine differences between the three regions and sexes followed by pairwise comparisons for significant findings. The lateral region (mean [95% confidence interval] = 0.34 [0.31-0.37] cm) was thinner compared with the medial (0.41 [0.39-0.44] cm, p < 0.001), and central (0.41 [0.39-0.44] cm, p < 0.001) regions regardless of sex. Viscosity was lower in the lateral (19.8 [16.9-22.7] Pa-s) versus medial region (27.4 [24.7-30.2] Pa-s, p = 0.001). Length had a region-by-sex interaction (p = 0.003) characterized by a longer lateral (4.83 [4.54-5.13] cm) versus medial (4.42 [4.12-4.72] cm) region in males (p < 0.001), but not females (p = 0.992). Shear modulus was uniform between regions and sexes. The thinner, and less viscous lateral patellar tendon may reflect the lower load the tendon experiences explaining the differences in regional prevalence of developing tendon pathology. Statement of Clinical Significance: Healthy patellar tendons are not uniform in morphology or mechanical properties. Considering regional tendon properties may help guide targeted interventions for patellar tendon pathologies.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Rodrigo Scattone Silva
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Postgraduate Program in Rehabilitation Sciences, Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
| | | | - Daniel H. Cortes
- Department of Mechanical Engineering, Penn State University, State College, PA, USA
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Escriche-Escuder A, Nijs J, Silbernagel KG, van Wilgen CP, Plinsinga ML, Casaña J, Cuesta-Vargas AI. Pain neuroscience education in persistent painful tendinopathies: A scoping review from the Tendon PNE Network. Phys Ther Sport 2023; 63:38-49. [PMID: 37499463 DOI: 10.1016/j.ptsp.2023.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE to conduct and report a scoping review of the available evidence of the effects and content of pain neuroscience education for patients with persistent painful tendinopathies. METHODS PubMed, Embase, Web of Science, CINAHL, SPORTDiscus, and grey literature databases were searched from database inception to May 2022. Randomised and non-randomised controlled trials, non-controlled clinical trials, cohort studies, case series, case studies including people with persistent painful tendinopathy aged ≥18 years, a pain education intervention, and in English were included. Studies were excluded if they were cross-sectional studies, reviews, editorials, abstracts, or full-text not available or if included heterogeneous study cohorts, patients with tendon rupture, or patients with systemic diseases. RESULTS five studies (n = 164) were included. Pain neuroscience education entailed face-to-face discussion sessions or educational materials including videos, brochures, paper drawings, and review questions. All studies used pain neuroscience education in conjunction with other interventions, obtaining significant benefits in outcomes related to pain, physical performance, or self-reported function, among others. CONCLUSIONS The application of pain neuroscience education in conjunction with other interventions seemed to improve several outcomes. However, considering the current knowledge about tendon pain and the scarcity of well-designed trials studying pain neuroscience education in tendinopathy, additional research is needed.
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Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - C Paul van Wilgen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Transcare Transdisciplinary Pain Management Center, Groningen, the Netherlands
| | - Melanie L Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
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Ito N, Sigurðsson HB, Pohlig RT, Cortes DH, Grävare Silbernagel K, Sprague AL. Reliability of Continuous Shear Wave Elastography in the Pathological Patellar Tendon. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1047-1055. [PMID: 36301665 PMCID: PMC10101861 DOI: 10.1002/jum.16115] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 10/09/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Patellar tendon injuries occur via various mechanisms such as overuse, or due to surgical graft harvest for anterior cruciate ligament reconstruction (ACLR). Quantified patellar tendon stiffness after injury may help guide clinical care. Continuous shear wave elastography (cSWE) allows for the assessment of viscosity and shear modulus in tendons. The reliability of the measure, however, has not been established in the patellar tendon. The purpose of this study was to investigate the interrater reliability, intrarater reliability, and between-day stability of cSWE in both healthy and pathological patellar tendons. METHODS Participants with patellar tendinopathy (n = 13), history of ACLR using bone-patellar tendon-bone autograft (n = 9), and with no history of patellar tendon injury (n = 13) were recruited. cSWE was performed 4 times by multiple raters over 2 days. Intraclass correlations (ICC) and minimum detectable change (MDC95% ) were calculated. RESULTS Good to excellent between-day stability were found for viscosity (ICC = 0.905, MDC95% = 8.3 Pa seconds) and shear modulus (ICC = 0.805, MDC95% = 27.4 kPa). The interrater reliability measures, however, were not as reliable (ICC = 0.591 and 0.532). CONCLUSIONS cSWE is a reliable assessment tool for quantifying patellar tendon viscoelastic properties over time. It is recommended, however, that a single rater performs the measure as the interrater reliability was less than ideal.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Haraldur B Sigurðsson
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ryan T Pohlig
- Biostatistic Core Facility, College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Daniel H Cortes
- Department of Mechanical and Nuclear Engineering, Penn State University, State College, Pennsylvania, USA
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Andrew L Sprague
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Mifsud T, Gatt A, Micallef-Stafrace K, Chockalingam N, Padhiar N. Elastography in the assessment of the Achilles tendon: a systematic review of measurement properties. J Foot Ankle Res 2023; 16:23. [PMID: 37101290 PMCID: PMC10134611 DOI: 10.1186/s13047-023-00623-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/16/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Managing and rehabilitating Achilles tendinopathy can be difficult, and the results are often unsatisfactory. Currently, clinicians use ultrasonography to diagnose the condition and predict symptom development. However, relying on subjective qualitative findings using ultrasound images alone, which are heavily influenced by the operator, may make it difficult to identify changes within the tendon. New technologies, such as elastography, offer opportunities to quantitatively investigate the mechanical and material properties of the tendon. This review aims to evaluate and synthesise the current literature on the measurement properties of elastography, which can be used to assess tendon pathologies. METHODS A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, PubMed, Cochrane, Scopus, MEDLINE Complete, and Academic Search Ultimate were searched. Studies assessing the measurement properties concerning reliability, measurement error, validity, and responsiveness of the instruments identified in healthy and patients with Achilles tendinopathy were included. Two independent reviewers assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology. RESULTS Out of the 1644 articles identified, 21 were included for the qualitative analysis investigating four different modalities of elastography: axial strain elastography, shear wave elastography, continuous shear wave elastography, and 3D elastography. Axial strain elastography obtained a moderate level of evidence for both validity and reliability. Although shear wave velocity was graded as moderate to high for validity, reliability obtained a very low to moderate grading. Continuous shear wave elastography was graded as having a low level of evidence for reliability and very low for validity. Insufficient data is available to grade three-dimensional shear wave elastography. Evidence on measurement error was indeterminate so evidence could not be graded. CONCLUSIONS A limited number of studies explored quantitative elastography on Achilles tendinopathy as most evidence was conducted on a healthy population. Based on the identified evidence on the measurement properties of elastography, none of the different types showed superiority for its use in clinical practice. Further high-quality studies with longitudinal design are needed to investigate responsiveness.
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Affiliation(s)
- Tiziana Mifsud
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Kirill Micallef-Stafrace
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Department of Orthopaedics, Trauma and Sports Medicine, Mater Dei Hospital, L-Imsida, Malta
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke On Trent, Staffordshire, UK
| | - Nat Padhiar
- Centre for Sports &Exercise Medicine, St Bartholomew's & The London School of Medicine & Dentistry, William Harvey Research Institute, Queen Mary University of London, London, UK.
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Sancho I, Willy RW, Morrissey D, Malliaras P, Lascurain-Aguirrebeña I. Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study. Phys Ther Sport 2023; 60:26-33. [PMID: 36640640 DOI: 10.1016/j.ptsp.2023.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To estimate Achilles tendon forces and their relationship with self-reported pain in runners with Achilles tendinopathy (AT) during common rehabilitation exercises. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS 24 recreational male runners (45.92 (8.24) years old; 78.20 (8.01) kg; 177.17 (6.69) cm) with symptomatic AT. MAIN OUTCOME MEASURES Kinematic and kinetic data were collected to estimate Achilles tendon forces during 12 commonly prescribed exercises. Achilles tendon forces were estimated from biomechanical data and normalised to the participant's bodyweight. The secondary aim was to investigate the relationship between Achilles tendon forces and pain during these exercises. RESULTS Two exercise clusters were identified based on Achilles tendon forces. Cluster1 included various exercises including double heel raises, single heel raises, and walking (range: 1.10-2.76 BWs). Cluster2 included running, jumping and hopping exercises (range: 5.13-6.35 BWs). Correlation between tendon forces and pain was at best low for each exercise (range: -0.43 - 0.20). Higher force exercises lead to more tendon load for a given amount of pain (R2 = 0.7505; y = 0.2367x + 0.6191). CONCLUSION This study proposes a hierarchical exercise progression based on Achilles tendon forces to guide treatment of runners with AT. Achilles tendon forces and pain are not correlated in runners with AT.
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Affiliation(s)
- Igor Sancho
- Sports and Exercise Medicine, William Harvey Research Institute. Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Physiotherapy Department, University of Deusto, San Sebastian, Spain.
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT, USA.
| | - Dylan Morrissey
- Sports and Exercise Medicine, William Harvey Research Institute. Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK; Physiotherapy Department, Barts Health NHS Trust, London, UK.
| | - Peter Malliaras
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Australia.
| | - Ion Lascurain-Aguirrebeña
- Faculty of Medicine & Nursing, Physiotherapy, Department of Physiology, University of the Basque Country UPV/EHU, Leioa, Spain.
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Romer C, Czupajllo J, Zessin E, Fischer T, Wolfarth B, Lerchbaumer MH. Stiffness of Muscles and Tendons of the Lower Limb of Professional and Semiprofessional Athletes Using Shear Wave Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:3061-3068. [PMID: 35900250 DOI: 10.1002/jum.16062] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Shear wave elastography (SWE) allows assessment of muscle and tendon stiffness and can be used to diagnose soft tissue pathologies such as tendinopathies. In sports medicine, SWE may have the potential to uncover structural changes early on before they lead to functional impairment. To systematically analyze possible differences in tendon and muscle stiffness of the lower limb between professional (PG) and semiprofessional female athletes (SG) using SWE and to compile reference values for developing preventive medicine approaches for professional athletes. METHODS Standardized SWE of both lower limb tendons and muscles (Achilles tendon [AT], soleus muscle insertion [SM], patellar tendon [PT], quadriceps tendon [QT], vastus medialis muscle [VM]) in the longitudinal plane was performed with the tendons in relaxed position in 24 healthy professional female athletes (PG) in comparison with 24 healthy semiprofessional female athletes (SG). RESULTS Median tendon and muscle stiffness was significantly higher in professional athletes (AT:PG, 11.12 m/s vs SG, 7.33 m/s, P < .001; SM: 1.77 m/s vs 1.14 m/s, P < .001; VM: 1.63 m/s vs 0.87 m/s, P < .001; QT: 3.31 m/s vs 2.61 m/s, P < .05). There was no significant difference in patellar tendon stiffness between PG and SG (PT: 2.57 m/s vs 3.21, P = .25). CONCLUSION Professional female athletes have higher stiffness values than semiprofessional female athletes in lower limb muscles and tendons, except for the patellar tendon. Knowledge of such differences is necessary for diagnosing tendinopathy and injuries. Musculoskeletal SWE could offer great benefits in sports medicine as well as in rehabilitation and preventive medicine.
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Affiliation(s)
- Claudia Romer
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Enrico Zessin
- Department of Sports Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernd Wolfarth
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus H Lerchbaumer
- Department of Radiology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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10
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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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11
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Corrigan P, Hornsby S, Pohlig RT, Willy RW, Cortes DH, Silbernagel KG. Tendon loading in runners with Achilles tendinopathy: Relations to pain, structure, and function during return-to-sport. Scand J Med Sci Sports 2022; 32:1201-1212. [PMID: 35488734 PMCID: PMC9972464 DOI: 10.1111/sms.14178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 12/27/2022]
Abstract
We aimed to (1) compare pain, tendon structure, lower limb function, and Achilles tendon loads while running between limbs in runners with Achilles tendinopathy, and (2) explore the relations of pain, tendon structure, and lower limb function to Achilles tendon loads while running. Twenty runners with Achilles tendinopathy participated in this pilot study. Pain was assessed with questionnaires, quantitative sensory testing, and functional testing. Tendon morphology and mechanical properties were evaluated with ultrasound imaging, continuous shear wave elastography, and ultrasound imaging combined with dynamometry. Lower limb function was assessed with an established test battery. Achilles tendon loads were estimated from biomechanical data acquired during running. Compared to the least symptomatic limb, the most symptomatic limb had lower scores on the Victorian Institute of Sports Assessment - Achilles questionnaire and worse pain during drop countermovement jumping, hopping, and running. Tendon thickness and cross-sectional area were greater, and Young's modulus, drop countermovement jump height, and plyometric quotient during hopping were lower on the most symptomatic limb. Side-to-side differences in drop countermovement jump height were significantly associated with side-to-side differences in Achilles tendon peak forces and average loading rates during running. Various measures of pain, structure, and function differ between limbs in runners with Achilles tendinopathy during return-to-sport. Tendon forces, however, do not differ between limbs during comfortable running. In addition to measures that differ between limbs, measures of performance during drop countermovement jumping may aid in clinical decision-making during return-to-sport because they are associated with tendon forces while running.
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Affiliation(s)
- Patrick Corrigan
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, Missouri, USA,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Samantha Hornsby
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Ryan T. Pohlig
- College of Health Sciences Biostatistics Core Facility, University of Delaware, Burlington, Vermont, USA
| | - Richard W. Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Daniel H. Cortes
- Department of Mechanical Engineering, Penn State University, State College, Pennsylvania, USA
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12
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Grävare Silbernagel K, Malliaras P, de Vos RJ, Hanlon S, Molenaar M, Alfredson H, van den Akker-Scheek I, Antflick J, van Ark M, Färnqvist K, Haleem Z, Kaux JF, Kirwan P, Kumar B, Lewis T, Mallows A, Masci L, Morrissey D, Murphy M, Newsham-West R, Norris R, O'Neill S, Peers K, Sancho I, Seymore K, Vallance P, van der Vlist A, Vicenzino B. ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy. Sports Med 2022; 52:613-641. [PMID: 34797533 PMCID: PMC8891092 DOI: 10.1007/s40279-021-01588-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. OBJECTIVE To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. DESIGN Systematic review. DATA SOURCES Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. RESULTS 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. CONCLUSION 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. PROSPERO REGISTRATION CRD42020156763.
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Affiliation(s)
- Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA.
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Shawn Hanlon
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Mitchel Molenaar
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jarrod Antflick
- Department of Bioengineering, School of Engineering, Imperial College, London, UK
| | - Mathijs van Ark
- Department of Physiotherapy, School of Health Care Studies, Hanze University of Applied Sciences and Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands
| | | | - Zubair Haleem
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Arsenal Football Club, London, UK
| | - Jean-Francois Kaux
- Department of Physical and Rehabilitation Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium
| | - Paul Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bhavesh Kumar
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Trevor Lewis
- Aintree University Hospital, Liverpool Foundation Trust, Liverpool, UK
| | - Adrian Mallows
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Lorenzo Masci
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Myles Murphy
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Richard Newsham-West
- School of Allied Health, Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
| | - Richard Norris
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Seth O'Neill
- School of Allied Health, University of Leicester, Leicester, UK
| | - Koen Peers
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Igor Sancho
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, University of Deusto, San Sebastian, Spain
| | - Kayla Seymore
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Patrick Vallance
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, VIC, Australia
| | - Arco van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
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13
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Scattone Silva R, Smitheman HP, Smith AK, Silbernagel KG. Are static foot posture and ankle dorsiflexion range of motion associated with Achilles tendinopathy? A cross-sectional study. Braz J Phys Ther 2022; 26:100466. [PMID: 36470091 PMCID: PMC9720357 DOI: 10.1016/j.bjpt.2022.100466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 10/03/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Subtalar hyperpronation and ankle dorsiflexion restriction have been theoretically associated with Achilles tendinopathy (AT). However, evidence to support these associations is lacking. OBJECTIVES To compare foot alignment and ankle dorsiflexion range of motion (ROM) between the symptomatic and non-symptomatic limbs of individuals with unilateral AT. And to verify whether differences exist between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain, structure, and symptom severity. METHODS Sixty-three participants with unilateral AT underwent a bilateral evaluation of pain during tendon palpation, symptom severity, tendon thickening, tendon neovascularization, ankle dorsiflexion ROM, and foot posture alignment [foot posture index (FPI), navicular drop, navicular drift, and longitudinal arch angle (LAA)]. Side and group comparisons were made using t-tests and correlations were evaluated using the Pearson test. RESULTS There were no differences between the symptomatic and non-symptomatic limbs regarding foot posture alignment. Specifically, non-significant negligible differences were observed between limbs regarding FPI [mean difference (MD)=-0.23; 95% confidence interval (CI)=-0.70, 0.25), navicular drop (MD=0.58 mm; 95%CI=-0.25, 1.43), navicular drift (MD=0.16 mm; 95%CI=-0.77, 1.09), and LAA (MD=0.30º; 95%CI=-1.74, 2.34). There was no difference between limbs regarding ankle dorsiflexion ROM. However, lower ankle dorsiflexion was associated with worse symptom severity (r = 0.223). Finally, no difference was observed between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain or structure. CONCLUSIONS Static foot alignment measures do not seem to be clinically relevant in patients with AT. Smaller ankle dorsiflexion ROM, however, was associated with greater symptom severity in this population.
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Affiliation(s)
- Rodrigo Scattone Silva
- Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States,Postgraduate Program in Rehabilitation Sciences and Postgraduate Program in Physical Therapy, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Hayley Powell Smitheman
- Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Andy K. Smith
- Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Karin Grävare Silbernagel
- Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States,Corresponding author at: University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE 19713, United States.
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14
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Human Achilles tendon mechanical behavior is more strongly related to collagen disorganization than advanced glycation end-products content. Sci Rep 2021; 11:24147. [PMID: 34921194 PMCID: PMC8683434 DOI: 10.1038/s41598-021-03574-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/03/2021] [Indexed: 12/25/2022] Open
Abstract
Diabetes is associated with impaired tendon homeostasis and subsequent tendon dysfunction, but the mechanisms underlying these associations is unclear. Advanced glycation end-products (AGEs) accumulate with diabetes and have been suggested to alter tendon function. In vivo imaging in humans has suggested collagen disorganization is more frequent in individuals with diabetes, which could also impair tendon mechanical function. The purpose of this study was to examine relationships between tendon tensile mechanics in human Achilles tendon with accumulation of advanced glycation end-products and collagen disorganization. Achilles tendon specimens (n = 16) were collected from individuals undergoing lower extremity amputation or from autopsy. Tendons were tensile tested with simultaneous quantitative polarized light imaging to assess collagen organization, after which AGEs content was assessed using a fluorescence assay. Moderate to strong relationships were observed between measures of collagen organization and tendon tensile mechanics (range of correlation coefficients: 0.570-0.727), whereas no statistically significant relationships were observed between AGEs content and mechanical parameters (range of correlation coefficients: 0.020-0.210). Results suggest that the relationship between AGEs content and tendon tensile mechanics may be masked by multifactorial collagen disorganization at larger length scales (i.e., the fascicle level).
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15
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Beyond the Diagnosis: Using Patient Characteristics and Domains of Tendon Health to Identify Latent Subgroups of Achilles Tendinopathy. J Orthop Sports Phys Ther 2021; 51:440-448. [PMID: 34074130 PMCID: PMC8410667 DOI: 10.2519/jospt.2021.10271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify latent subgroups among patients with Achilles tendinopathy, describe patient characteristics and clinical attributes that defined each subgroup, and develop a clinical classification model for subgroup membership. DESIGN Cross-sectional study. METHODS One hundred forty-five participants (men, n = 73; mean ± SD age, 51 ± 14 years) with clinically diagnosed Achilles tendinopathy completed a baseline evaluation, including demographics and medical history, patient-reported outcome measures, a clinical exam, tendon structure measures via ultrasound imaging and continuous shear-wave elastography, and a functional test battery. Subgroups were identified using mixture modeling. We compared the subgroups using a 1-way analysis-of-variance or chi-square test and the Tukey post hoc test to identify defining attributes. We developed a clinical classification model using logistic regression and receiver operating characteristic curves. RESULTS Three latent subgroups were identified and named by their distinctive patient characteristics and clinical attributes. The activity-dominant subgroup (n = 67), on average, had the highest physical activity level, function, and quality of life; reported mild symptoms; and was the youngest. The psychosocial-dominant subgroup (n = 56), on average, had the worst symptoms, impaired function, heightened psychological factors, the poorest quality of life, minimal tendon structural alterations, and was obese and predominantly female. The structure-dominant subgroup (n = 22), on average, had the most tendon structural alterations, severe functional deficits, moderate symptoms and psychological factors, reduced quality of life, and was the oldest, obese, and predominantly male. The clinical classification model correctly classified 85% (123/145) of participants. CONCLUSION Three Achilles tendinopathy subgroups (activity dominant, psychosocial dominant, and structure dominant) differed in patient characteristics and clinical attributes. J Orthop Sports Phys Ther 2021;51(9):440-448. Epub 1 Jun 2021. doi:10.2519/jospt.2021.10271.
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16
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Lalumiere M, Perrino S, Nadeau MJ, Larivière C, Lamontagne M, Desmeules F, H. Gagnon D. To What Extent Do Musculoskeletal Ultrasound Biomarkers Relate to Pain, Flexibility, Strength, and Function in Individuals With Chronic Symptomatic Achilles Tendinopathy? FRONTIERS IN REHABILITATION SCIENCES 2021; 2:726313. [PMID: 36188777 PMCID: PMC9397971 DOI: 10.3389/fresc.2021.726313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/08/2021] [Indexed: 12/12/2022]
Abstract
Introduction: Achilles tendinopathy (AT) is a chronic musculoskeletal pathology best evaluated by ultrasound imaging. This cross-sectional study aimed at better understanding the relationship between musculoskeletal ultrasound biomarkers (MUBs) of Achilles tendon and localized pain, ankle flexibility, ankle strength, and functional abilities. Method: Forty-one participants with unilateral midportion chronic AT had their tendon images analyzed bilaterally in the longitudinal and transverse planes. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and Lower Extremity Functional Scale (LEFS) assessed pain and function, respectively, during standing and walking-related activities. Ankle flexibility was evaluated by weight-bearing lunge tests, while ankle isometric peak strength was measured using an instrumented dynamometer. Achilles tendon ultrasonographic images were analyzed using geometric (thickness), composition (echogenicity), and texture (homogeneity) MUBs. Discriminative validity was evaluated using paired Student's t-tests to compare MUBs between symptomatic and asymptomatic sides. Predictive validity was evaluated by computing the Pearson product-moment correlations coefficient between MUBs and pain, ankle flexibility, ankle strength, and function. Results: Significant differences were found in MUBs between the symptomatic and asymptomatic sides, confirming the discriminative validity of the selected MUBs. On the symptomatic side, thickness was found 29.9% higher (p < 0.001), echogenicity 9.6% lower (p < 0.001), and homogeneity 3.8% higher (p = 0.001) when compared with the asymptomatic side. However, predictive validity was scarcely confirmed, as most of the correlation coefficients were found negligible for the associations investigated between MUBs with localized pain, ankle flexibility, strength, and function. Only 14 statistically significant low to moderate associations were found, with negative and positive correlations ranging between −0.31 and −0.55 and between 0.34 and 0.54, respectively. Discussion: Musculoskeletal ultrasound biomarkers have a clinical utility in visualizing in vivo tendon integrity and diagnosing AT. MUBs should be valued as part of a comprehensive neuro-musculoskeletal assessment as they complement pain, flexibility, strength, and function measures. Altogether, they may inform the development and monitoring of a personalized rehabilitation treatment plan.
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Affiliation(s)
- Mathieu Lalumiere
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Sarah Perrino
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Christian Larivière
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, QC, Canada
| | | | - François Desmeules
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, QC, Canada
| | - Dany H. Gagnon
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- *Correspondence: Dany H. Gagnon orcid.org/0000-0003-3464-4667
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17
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Goh SL, Jaafar Z, Gan YN, Choong A, Kaur J, Kundakci B, Abdul Karim S, Jaffar MR, A. Hamid MS. Efficacy of prolotherapy in comparison to other therapies for chronic soft tissue injuries: A systematic review and network meta-analysis. PLoS One 2021; 16:e0252204. [PMID: 34038486 PMCID: PMC8153441 DOI: 10.1371/journal.pone.0252204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/11/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Prolotherapy and other injections, primarily acting on pathways associated with maladaptive tissue repair, are recommended for recalcitrant chronic soft tissue injuries (CSTI). However, selection of injection is challenging due to mixed results. This network meta-analysis (NMA) aimed to compare prolotherapy with other therapies, particularly injections, for CSTI and establish robustness of the results. Methodology Pubmed, Medline, SPORTDiscus and Google scholar were searched from inception to 4th January 2021 for randomised controlled trials (RCTs) involving injection therapies (e.g. blood derivatives, corticosteroid, hyaluronic acid, botulinum toxin) for CSTI. The primary and secondary outcomes were pain and function, respectively, at (or nearest to) 6 months. Effect size (ES) was presented as standardised mean difference with 95% confidence interval (CI). Frequentist random effect NMA was used to generate the overall estimates, subgroup estimates (by region and measurement time point) and sensitivity analyses. Results A total of 91 articles (87 RCTs; 5859 participants) involving upper limb (74%), lower limb (23%) and truncal/hip (3%) injuries were included. At all time points, prolotherapy had no statistically significant pain benefits over other therapies. This observation remained unchanged when tested under various assumptions and with exclusion of studies with high risk of bias. Although prolotherapy did not offer statistically significant functional improvement compared to most therapies, its ES was consistently better than non-injections and corticosteroid injection for both outcomes. At selected time points and for selected injuries, prolotherapy demonstrated potentially better pain improvement over placebo (<4 months: shoulder [ES 0.65; 95% CI 0.00 to 1.30]; 4–8 months: elbow [ES 0.91; 95% CI 0.12 to 1.70]; >8 months: shoulder [ES 2.08; 95% CI 1.49, to 2.68]). Injections generally produced greater ES when combined with non-injection therapy. Conclusion While clinical outcomes were generally comparable across types of injection therapy, prolotherapy may be used preferentially for selected conditions at selected times.
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Affiliation(s)
- Siew-Li Goh
- Sports and Exercise Medicine Research and Education Group, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Zulkarnain Jaafar
- Sports and Exercise Medicine Research and Education Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Yan-Nee Gan
- Malaysian Health Technology Assessment Section (MaHTAS), Ministry of Health, Kuala Lumpur, Malaysia
| | - Alston Choong
- Sports and Exercise Medicine Research and Education Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Jaspreet Kaur
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, United Kingdom
| | - Burak Kundakci
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, United Kingdom
| | - Samihah Abdul Karim
- Sports and Exercise Medicine Research and Education Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Rahmani Jaffar
- Sports and Exercise Medicine Research and Education Group, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Shariff A. Hamid
- Sports and Exercise Medicine Research and Education Group, University of Malaya, Kuala Lumpur, Malaysia
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Färnqvist K. Treating tendinopathies – are we searching for a needle in a haystack, when we should include the whole haystack? EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2020.1773921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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