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Sahinis C, Kellis E. Distal hamstrings tendons mechanical properties at rest and contraction using free-hand 3-D ultrasonography. Scand J Med Sci Sports 2024; 34:e14621. [PMID: 38597348 DOI: 10.1111/sms.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/10/2024] [Accepted: 03/17/2024] [Indexed: 04/11/2024]
Abstract
Tendon properties impact human locomotion, influencing sports performance, and injury prevention. Hamstrings play a crucial role in sprinting, particularly the biceps femoris long head (BFlh), which is prone to frequent injuries. It remains uncertain if BFlh exhibits distinct mechanical properties compared to other hamstring muscles. This study utilized free-hand three-dimensional ultrasound to assess morphological and mechanical properties of distal hamstrings tendons in 15 men. Scans were taken in prone position, with hip and knee extended, at rest and during 20%, 40%, 60%, and 80% of maximal voluntary isometric contraction of the knee flexors. Tendon length, volume, cross-sectional area (CSA), and anteroposterior (AP) and mediolateral (ML) widths were quantified at three locations. Longitudinal and transverse deformations, stiffness, strain, and stress were estimated. The ST had the greatest tendon strain and the lowest stiffness as well as the highest CSA and AP and ML width strain compared to other tendons. Biceps femoris short head (BFsh) exhibited the least strain, AP and ML deformation. Further, BFlh displayed the highest stiffness and stress, and BFsh had the lowest stress. Additionally, deformation varied by region, with the proximal site showing generally the lowest CSA strain. Distal tendon mechanical properties differed among the hamstring muscles during isometric knee flexions. In contrast to other bi-articular hamstrings, the BFlh high stiffness and stress may result in greater energy absorption by its muscle fascicles, rather than the distal tendon, during late swing in sprinting. This could partly account for the increased incidence of hamstring injuries in this muscle.
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Affiliation(s)
- Chrysostomos Sahinis
- Department of Physical Education and Sport Sciences at Serres, Laboratory of Neuromechanics, Aristotle University of Thessaloniki, Serres, Greece
| | - Eleftherios Kellis
- Department of Physical Education and Sport Sciences at Serres, Laboratory of Neuromechanics, Aristotle University of Thessaloniki, Serres, Greece
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Alabau-Dasi R, Dominguez-Maldonado G, Gijon-Nogueron G, Ortega-Avila AB, Delacroix S. How susceptible are our Achilles Tendons? Sonoanatomical assessment. A cross-sectional study. J Tissue Viability 2023; 32:572-576. [PMID: 37722941 DOI: 10.1016/j.jtv.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE the aim of this study is to observe whether there are ultrasound changes between men and women in the Achilles tendon at rest, at maximum passive force is applied and during walking. MATERIAL AND METHODS it was a cross-sectional study involving 27 healthy young participants recruited as volunteers between April to July 2022. A variety of data was recorded: (age, Body Mass Index, sex, smoking, current injury status, allergies, medications, previous surgeries, type of sport, and number of weekly workouts) and ultrasound measurements at rest and at passive force (Cross Sectional Area Achilles Tendon length, tendon thickness, Cross Sectional Area and pennation angle of the soleus muscle to the Achilles Tendon). RESULTS women demonstrated a statistically significant lower proximal and median thickness both at rest (4.5 vs 5.1 mm with p < 0.001 for proximal thickness; 4.4 vs 5.3 mm with p < 0.001 for median thickness) as well as during maximum eccentric contraction (4.3 vs 4.8 mm with p=<0.001 for proximal thickness; 4.1 vs 4.8 mm with p < 0.001 for median thickness). CONCLUSION there are significant sonoanatomical differences in vivo Achilles tendon between men and women.
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Affiliation(s)
- Raquel Alabau-Dasi
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain.
| | - Gabriel Dominguez-Maldonado
- Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Universidad de Sevilla, Departamento de Podología, Spain.
| | - Gabriel Gijon-Nogueron
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain; Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA platform BIONAND, Malaga, Spain.
| | - Ana Belen Ortega-Avila
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain; Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA platform BIONAND, Malaga, Spain.
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Diniz P, Quental C, Violindo P, Veiga Gomes J, Pereira H, Kerkhoffs GMMJ, Ferreira FC, Folgado J. Design and validation of a finite element model of the aponeurotic and free Achilles tendon. J Orthop Res 2023; 41:534-545. [PMID: 35780388 DOI: 10.1002/jor.25408] [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: 11/09/2021] [Revised: 05/02/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023]
Abstract
The Achilles tendon (AT) is a common injury site. Ruptures are usually located in the free tendon but may cross the myotendinous junction into the aponeurotic region. Considering the possibility of aponeurotic region involvement in AT ruptures, a novel three dimensional (3D) finite element (FE) model that includes both the aponeurotic and free AT regions and features subtendon twisting and sliding was developed. It was hypothesized that the model would be able to predict in vivo data collected from the literature, thus being considered valid, and that model outputs would be most sensitive to subtendon twist configurations. The 3D model was constructed using magnetic resonance images. The model was divided into soleus and gastrocnemius subtendons. In addition to a frictionless contact condition, the interaction between subtendons was modeled using two contact formulations: sliding with anisotropic friction and no sliding. Loads were applied on the tendon's most proximal cross-section and anterior surface, with magnitudes estimated from in vivo studies. Model outputs were compared with experimental data regarding 3D deformation, transverse plane rotation, and nodal displacements in the free tendon. The FE model adequately simulated the free tendon behavior regarding longitudinal strain, cross-section area variation, transverse plane rotation, and sagittal nodal displacements, provided that subtendon sliding was allowed. The frictionless model exhibited noticeable medial transverse sliding of the soleus subtendon, which was present to a much lesser degree in the anisotropic friction model. Model outputs were most sensitive to variations in subtendon twist and dispersion of the collagen fiber orientations. Clinical Significance: This Achilles tendon finite element model, validated using in vivo experimental data, may be used to study its mechanical behavior, injury mechanisms, and rupture risk factors.
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Affiliation(s)
- Pedro Diniz
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal.,Department of Bioengineering and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,Associate Laboratory i4HB - Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,Fisiogaspar, Lisboa, Lisboa, Portugal
| | - Carlos Quental
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Violindo
- Department of Radiology, Hospital de Sant'Ana, Parede, Portugal
| | | | - Hélder Pereira
- Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.,Ripoll y De Prado Sports Clinic: FIFA Medical Centre of Excellence, Murcia, Spain.,University of Minho ICVS/3 B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Frederico Castelo Ferreira
- Department of Bioengineering and iBB - Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.,Associate Laboratory i4HB - Institute for Health and Bioeconomy, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - João Folgado
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Shorter heels are linked with greater elastic energy storage in the Achilles tendon. Sci Rep 2021; 11:9360. [PMID: 33931686 PMCID: PMC8087768 DOI: 10.1038/s41598-021-88774-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/16/2021] [Indexed: 11/25/2022] Open
Abstract
Previous research suggests that the moment arm of the m. triceps surae tendon (i.e., Achilles tendon), is positively correlated with the energetic cost of running. This relationship is derived from a model which predicts that shorter ankle moment arms place larger loads on the Achilles tendon, which should result in a greater amount of elastic energy storage and return. However, previous research has not empirically tested this assumed relationship. We test this hypothesis using an inverse dynamics approach in human subjects (n = 24) at speeds ranging from walking to sprinting. The spring function of the Achilles tendon was evaluated using specific net work, a metric of mechanical energy production versus absorption at a limb joint. We also combined kinematic and morphological data to directly estimate tendon stress and elastic energy storage. We find that moment arm length significantly determines the spring-like behavior of the Achilles tendon, as well as estimates of mass-specific tendon stress and elastic energy storage at running and sprinting speeds. Our results provide support for the relationship between short Achilles tendon moment arms and increased elastic energy storage, providing an empirical mechanical rationale for previous studies demonstrating a relationship between calcaneal length and running economy. We also demonstrate that speed and kinematics moderate tendon performance, suggesting a complex relationship between lower limb geometry and foot strike pattern.
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Chen J, Sheng D, Ying T, Zhao H, Zhang J, Li Y, Xu H, Chen S. MOFs-Based Nitric Oxide Therapy for Tendon Regeneration. NANO-MICRO LETTERS 2020; 13:23. [PMID: 34138189 PMCID: PMC8187533 DOI: 10.1007/s40820-020-00542-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/29/2020] [Indexed: 05/06/2023]
Abstract
Tendon regeneration is still a great challenge due to its avascular structure and low self-renewal capability. The nitric oxide (NO) therapy emerges as a promising treatment for inducing the regeneration of injured tendon by angiogenesis. Here, in this study, a system that NO-loaded metal-organic frameworks (MOFs) encapsulated in polycaprolactone (PCL)/gelatin (Gel) aligned coaxial scaffolds (NMPGA) is designed and prepared for tendon repair. In this system, NO is able to be released in vitro at a slow and stable average speed of 1.67 nM h-1 as long as 15 d without a burst release stage in the initial 48 h. Furthermore, NMPGA can not only improve the tubular formation capability of endothelial cells in vitro but also obviously increase the blood perfusion near the injured tendon in vivo, leading to accelerating the maturity of collagen and recovery of biomechanical strength of the regenerated tendon tissue. As a NO-loaded MOFs therapeutic system, NMPGA can promote tendon regeneration in a shorter healing period with better biomechanical properties in comparison with control group by angiogenesis. Therefore, this study not only provides a promising scaffold for tendon regeneration, but also paves a new way to develop a NO-based therapy for biomedical application in the future.
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Affiliation(s)
- Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Ting Ying
- College of Chemistry and Materials Science, Shanghai Normal University, Shanghai, 200234, People's Republic of China
| | - Haojun Zhao
- Department of Ultrasound, Jing'an District Center Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Jian Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - He Xu
- College of Chemistry and Materials Science, Shanghai Normal University, Shanghai, 200234, People's Republic of China.
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.
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Chang TT, Feng YN, Zhu Y, Liu CL, Wang XQ, Zhang ZJ. Objective Assessment of Regional Stiffness in Achilles Tendon in Different Ankle Joint Positions Using the MyotonPRO. Med Sci Monit 2020; 26:e926407. [PMID: 33071278 PMCID: PMC7583434 DOI: 10.12659/msm.926407] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Achilles tendinopathy commonly occurs in specific regions of the tendon, and Achilles tendon stiffness can be related to local pathological changes in the tendon. The MyotonPRO is a new handheld device that conveniently assesses stiffness of muscles and tendons. This study aimed to 1) evaluate the intra- and inter-rater reliability of stiffness measurements of the Achilles tendon at different ankle positions, 2) investigate the modulation of stiffness at different ankle joint angles, and 3) examine the differences between 2 regions of Achilles tendon stiffness. MATERIAL AND METHODS Thirty healthy young adults (15 men and 15 women) participated in this study. The regional Achilles tendon stiffness at 0 cm (AT-0) and 6 cm (AT-6) above the tendon insertion were evaluated by the MyotonPRO in the neutral position and 10° dorsiflexion of the ankle joint. Measurements of stiffness were taken by 2 raters on the first day and 5 days later. The stiffness data were compared by repeated measures analysis of variance (ANOVA). RESULTS The intra- and inter-rater reliability of stiffness measurements at AT-0 and AT-6 for each ankle position were good (all intraclass correlation coefficients >0.84). A significant modulation of Achilles tendon stiffness was obtained at different ankle joint angles (P<0.05). Stiffness at AT-0 was higher than at AT-6 (P<0.05) in both positions. CONCLUSIONS These results suggest the MyotonPRO reliably assessed Achilles tendon stiffness and monitors its modulation, and tendon stiffness increased with ankle dorsiflexion. Stiffness was also nonuniform along the length of the tendon.
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Affiliation(s)
- Tian-Tian Chang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Ya-Nan Feng
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China (mainland)
| | - Yi Zhu
- Department of Musculoskeletal Pain Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Chun-Long Liu
- Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China (mainland)
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China (mainland)
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China (mainland)
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Monte A, Nardello F, Pavei G, Moro S, Festa L, Tarperi C, Schena F, Zamparo P. Mechanical determinants of the energy cost of running at the half-marathon pace. J Sports Med Phys Fitness 2020; 60:198-205. [PMID: 31957999 DOI: 10.23736/s0022-4707.19.09999-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to determine the influence of spring mass model characteristics (e.g. stiffness) and Achilles tendon properties in determining the energy cost of running in half marathon runners. METHODS Achilles tendon characteristics (i.e. cross-sectional area -ATCSA- and resting length -ATL-) were measured on 32 males by means of an ultrasound apparatus the day before a half marathon race. After these measurements the energy cost of running (C) was determined while the subjects run on a treadmill at the speed (vT) they were expected to maintain during the race (vR); the vertical (kvert) and leg (kleg) stiffness were calculated based on kinematic data. RESULTS No differences were observed between vT and vR. Higher values of vT were associated with larger values of kleg and kvert. The faster runners (with larger vT) were the ones with the lower C (r=-0.43, P<0.05) and the larger ATCSA (r=0.46, P<0.01). No relationship was found between C and ATCSA but C was lower in runners with longer ATL (r=-0.52, P<0.001). Finally, no relationship was found between kleg or kvert and C, but runners with larger kvert were also those with the larger ATCSA (r=0.45, P<0.01). CONCLUSIONS These findings underline the correlation between spring-mass model parameters and Achilles tendon characteristics in half-marathon runners; they further show how these parameters influence the half marathon pace and the energy cost of running at this pace.
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Affiliation(s)
- Andrea Monte
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy -
| | - Francesca Nardello
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gaspare Pavei
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Sofia Moro
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Luca Festa
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cantor Tarperi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Schena
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Paola Zamparo
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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T1- and T2*-Mapping for Assessment of Tendon Tissue Biophysical Properties: A Phantom MRI Study. Invest Radiol 2019; 54:212-220. [PMID: 30444794 DOI: 10.1097/rli.0000000000000532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to quantitatively assess changes in collagen structure using MR T1- and T2*-mapping in a novel controlled ex vivo tendon model setup. MATERIALS AND METHODS Twenty-four cadaveric bovine flexor tendons underwent MRI at 3 T before and after chemical modifications, representing mechanical degeneration and augmentation. Collagen degradation (COL), augmenting collagen fiber cross-linking (CXL), and a control (phosphate-buffered saline [PBS]) were examined in experimental groups, using histopathology as standard of reference. Variable echo-time and variable-flip angle gradient-echo sequences were used for T2*- and T1-mapping, respectively. Standard T1- and T2-weighted spin-echo sequences were acquired for visual assessment of tendon texture. Tendons were assessed subsequently for their biomechanical properties and compared with quantitative MRI analysis. RESULTS T1- and T2*-mapping was feasible and repeatable for untreated (mean, 545 milliseconds, 2.0 milliseconds) and treated tendons. Mean T1 and T2* values of COL, CXL, and PBS tendons were 1459, 934, and 1017 milliseconds, and 5.5, 3.6, and 2.5 milliseconds, respectively. T2* values were significantly different between enzymatically degraded tendons, cross-linked tendons, and controls, and were significantly correlated with mechanical tendon properties (r = -0.74, P < 0.01). T1 values and visual assessment could not differentiate CXL from PBS tendons. Photo-spectroscopy showed increased autofluorescence of cross-linked tendons, whereas histopathology verified degenerative lesions of enzymatically degraded tendons. CONCLUSIONS T2*-mapping has the potential to detect and quantify subtle changes in tendon collagen structure not visible on conventional clinical MRI. Tendon T2* values might serve as a biomarker for biochemical alterations associated with tendon pathology.
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Dias CP, Freire B, Goulart NBA, Dias De Castro C, Lemos FDA, Becker J, Arndt A, Vaz MA. Impaired mechanical properties of Achilles tendon in spastic stroke survivors: an observational study. Top Stroke Rehabil 2019; 26:261-266. [PMID: 30890042 DOI: 10.1080/10749357.2019.1591688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The spasticity could lead to decreased functional capacity and changes in musculoskeletal tissue. OBJECTIVE To compare the Achilles tendon properties between the affected and contralateral limbs of participants with spasticity due to stroke and the healthy subjects. METHODS Fifteen individuals with ankle spasticity due to stroke and 15 healthy subjects were recruited. Maximal isometric ankle joint torque was obtained with an isokinetic dynamometer, and an ultrasound was used to determine tendon length, tendon cross-sectional area, and the medial gastrocnemius myotendinous junction displacement. The Achilles tendon strength, displacement, stress, strain, stiffness, and Young's modulus were obtained during a maximum voluntary isometric plantarflexion contraction. RESULTS There were no differences between Achilles tendon length among participants. Both limbs of participants with stroke showed reduced tendon cross-sectional area (~18%) compared to healthy limb. The affected limb showed decreased tendon strength (686 ± 293.3 N), displacement (10.6 ± 1.7 mm), Young's modulus values (849 ± 235.6 MPa), and lower stiffness (196.6 ± 67.6 N/mm) compared to the contralateral limb (strength, 1357.1 ± 294.8 N; displacement, 15.2 ± 5.5 mm; Young's modulus, 1431.8 ± 301.9 MPa; stiffness, 337.5 ± 98.1 N/mm) and to the healthy limb. The contralateral limb also showed decreased tendon strength (~26.2%) and stiffness (~21.5%) compared to the healthy group. CONCLUSION There is a decrement in Achilles tendon morphological and mechanical properties of the affected limb in individuals with spasticity due to stroke. The contralateral limb had a thinner tendon more compliant likely to physical activity reduction.
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Affiliation(s)
- Caroline Pieta Dias
- a School of Physical Education, Physiotherapy and Dance , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Bruno Freire
- b Human Movement Sciences, Motor Control Laboratory , University of State of Santa Catarina , Florianópolis , Brazil
| | | | - Camila Dias De Castro
- a School of Physical Education, Physiotherapy and Dance , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Fernando De Aguiar Lemos
- a School of Physical Education, Physiotherapy and Dance , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Jefferson Becker
- c Neurology Service, São Lucas Hospital , Pontifical Catholic University of Rio Grande do Sul , Porto Alegre , Brazil
| | - Anton Arndt
- d GIH , The Swedish School of Sport and Health Sciences , Stockholm , Sweden.,e Karolinska Institute , Stockholm , Sweden
| | - Marco Aurélio Vaz
- a School of Physical Education, Physiotherapy and Dance , Federal University of Rio Grande do Sul , Porto Alegre , Brazil
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Romero-Morales C, Javier Martín-Llantino P, Calvo-Lobo C, Palomo-López P, López-López D, Fernández-Carnero J, Rodríguez-Sanz D. Ultrasonography effectiveness of the vibration vs cryotherapy added to an eccentric exercise protocol in patients with chronic mid-portion Achilles tendinopathy: A randomised clinical trial. Int Wound J 2019; 16:542-549. [PMID: 30790440 DOI: 10.1111/iwj.13074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 12/20/2022] Open
Abstract
Tendinopathy is a very common disease in the general population as well as in athletes. The aim of the present study was to examine the tendon thickness and cross-sectional area (CSA) in subjects with chronic mid-portion Achilles tendinopathy (AT) who engaged in either an eccentric exercise (EE) programme with vibration training or an EE programme combined with cryotherapy. A sample of 61 patients with chronic mid-portion AT were recruited and divided into two groups: EE programme vibration training (n = 30) and EE programme combined with cryotherapy (n = 31). Three ultrasound assessments were performed: pre-intervention and at 4, and at 12 weeks. The comparison of thickness and CSA measures at baseline, 4, and 12 weeks showed a significant (P < 0.05) increase at 0, 2, 4, and 6 cm in maximal isometric contraction and at rest in subjects with chronic mid-portion AT. The EE vibration training resulted in a statistically significant CSA increase compared with the cryotherapy group in patients with chronic mid-portion AT.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | | | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Insitute of Biomedicine (IBIOMED), Universidad de León, Ponferrada, Spain
| | | | - Daniel López-López
- Research, Health and Podiatry Unit. Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - David Rodríguez-Sanz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.,School of Nursing, Physiotherapy and Podiatry. Universidad Complutense de Madrid, Spain
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Sartori J, Köhring S, Witte H, Fischer MS, Löffler M. Three-dimensional imaging of the fibrous microstructure of Achilles tendon entheses in Mus musculus. J Anat 2018; 233:370-380. [PMID: 29920671 PMCID: PMC6081500 DOI: 10.1111/joa.12837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 12/20/2022] Open
Abstract
The whole-organ, three-dimensional microstructure of murine Achilles tendon entheses was visualized with micro-computed tomography (microCT). Contrast-enhancement was achieved either by staining with phosphotungstic acid (PTA) or by a combination of cell-maceration, demineralization and critical-point drying with low tube voltages and propagation-based phase-contrast (fibrous structure scan). By PTA-staining, X-ray absorption of the enthesial soft tissues became sufficiently high to segment the tendon and measure cross-sectional areas along its course. With the fibrous structure scans, three-dimensional visualizations of the collagen fiber networks of complete entheses were obtained. The characteristic tissues of entheses were identified in the volume data. The tendon proper was marked as a segment manually. The fibers within the tendon were marked by thresholding. Tendon and fiber cross-sectional areas were measured. The measurements were compared between individuals and protocols for contrast-enhancement, using a spatial reference system within the three-dimensional enthesis. The usefulness of the method for investigations of the fibrous structure of collagenous tissues is demonstrated.
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Affiliation(s)
- Julian Sartori
- Institut für Zoologie und EvolutionsforschungFriedrich‐Schiller‐Universität JenaJenaGermany
| | - Sebastian Köhring
- Fachgebiet BiomechatronikFakultät für Maschinenbau / IMN MacroNano®Technische Universität IlmenauIlmenauGermany
| | - Hartmut Witte
- Fachgebiet BiomechatronikFakultät für Maschinenbau / IMN MacroNano®Technische Universität IlmenauIlmenauGermany
| | - Martin S. Fischer
- Institut für Zoologie und EvolutionsforschungFriedrich‐Schiller‐Universität JenaJenaGermany
| | - Markus Löffler
- Dresden Center for Nanoanalysis (DCN)Center for Advancing Electronics Dresden (cfaed)Technische Universität DresdenDresdenGermany
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12
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Massey GJ, Balshaw TG, Maden-Wilkinson TM, Folland JP. Tendinous tissue properties after short- and long-term functional overload: Differences between controls, 12 weeks and 4 years of resistance training. Acta Physiol (Oxf) 2018; 222:e13019. [PMID: 29253326 DOI: 10.1111/apha.13019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/27/2017] [Accepted: 12/08/2017] [Indexed: 01/20/2023]
Abstract
AIM The potential for tendinous tissues to adapt to functional overload, especially after several years of exposure to heavy-resistance training, is largely unexplored. This study compared the morphological and mechanical characteristics of the patellar tendon and knee extensor tendon-aponeurosis complex between young men exposed to long-term (4 years; n = 16), short-term (12 weeks; n = 15) and no (untrained controls; n = 39) functional overload in the form of heavy-resistance training. METHODS Patellar tendon cross-sectional area, vastus lateralis aponeurosis area and quadriceps femoris volume, plus patellar tendon stiffness and Young's modulus, and tendon-aponeurosis complex stiffness, were quantified with MRI, dynamometry and ultrasonography. RESULTS As expected, long-term trained had greater muscle strength and volume (+58% and +56% vs untrained, both P < .001), as well as a greater aponeurosis area (+17% vs untrained, P < .01), but tendon cross-sectional area (mean and regional) was not different between groups. Only long-term trained had reduced patellar tendon elongation/strain over the whole force/stress range, whilst both short-term and long-term overload groups had similarly greater stiffness/Young's modulus at high force/stress (short-term +25/22%, and long-term +17/23% vs untrained; all P < .05). Tendon-aponeurosis complex stiffness was not different between groups (ANOVA, P = .149). CONCLUSION Despite large differences in muscle strength and size, years of resistance training did not induce tendon hypertrophy. Both short-term and long-term overload demonstrated similar increases in high-force mechanical and material stiffness, but reduced elongation/strain over the whole force/stress range occurred only after years of overload, indicating a force/strain specific time-course to these adaptations.
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Affiliation(s)
- G. J. Massey
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis; Loughborough University; Leicestershire UK
- School of Sport, Exercise, and Health Sciences; Loughborough University; Leicestershire UK
| | - T. G. Balshaw
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis; Loughborough University; Leicestershire UK
- School of Sport, Exercise, and Health Sciences; Loughborough University; Leicestershire UK
| | - T. M. Maden-Wilkinson
- School of Sport, Exercise, and Health Sciences; Loughborough University; Leicestershire UK
- Faculty of Health and Wellbeing; Sheffield Hallam University; Sheffield UK
| | - J. P. Folland
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis; Loughborough University; Leicestershire UK
- School of Sport, Exercise, and Health Sciences; Loughborough University; Leicestershire UK
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Nuri L, Obst SJ, Newsham-West R, Barrett RS. The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound. J Exp Biol 2017; 220:3053-3061. [DOI: 10.1242/jeb.159764] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/12/2017] [Indexed: 12/22/2022]
Abstract
Mid-portion Achilles tendinopathy (MAT) alters the normal three-dimensional (3D) morphology of the Achilles tendon (AT) at rest and under a single tensile load. However, how MAT changes the 3D morphology of AT during repeated loading remains unclear. This study compared the AT longitudinal, transverse and volume strains during repeated loading in MAT with those of the contralateral tendon in people with unilateral MAT. Ten adults with unilateral MAT performed 10 successive 25 second submaximal (50%) voluntary isometric plantarflexion contractions with both legs. Freehand 3D ultrasound scans were recorded and used to measure whole AT, free AT, and proximal AT longitudinal strains and free AT cross-sectional area (CSA) and volume strains. The free AT experienced higher longitudinal and CSA strain and reached steady state following a greater number of contractions (5 contractions) in MAT compared to the contralateral tendon (3 contractions). Further, free tendon CSA and volume strained more in MAT than contralateral tendon from the first contraction, whereas free AT longitudinal strain was not greater than the contralateral tendon until the fourth contraction. Volume loss from the tendon core therefore preceded the greater longitudinal strain in MAT. Overall, these findings suggest that the tendinopathic free AT experiences an exaggerated longitudinal and transverse strain response under repeated loading that is underpinned by an altered interaction between solid and fluid tendon matrix components. These alterations are indicative of accentuated poroelasticity and an altered local stress-strain environment within the tendinopathic free tendon matrix, which could affect tendon remodelling via mechanobiological pathways.
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Affiliation(s)
- Leila Nuri
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Steven J. Obst
- School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia
| | - Richard Newsham-West
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rod S. Barrett
- School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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