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Devran S, Gözübüyük ÖB, Dinçer Ş, Günver MG, Bayraktar B. Diagnostic value of shear-wave elastography for patellar tendinopathy in female volleyball and basketball athletes: a cross sectional case control study. PHYSICIAN SPORTSMED 2024:1-8. [PMID: 38243396 DOI: 10.1080/00913847.2024.2308507] [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: 10/18/2023] [Accepted: 01/18/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVES We aim to investigate the accuracy of shear-wave elastography (SWE) in diagnosing patellar tendinopathy in female volleyball and basketball players. In addition, we compared different parts of the patellar tendon and investigated the effects of different knee angles on elastography measurements. METHODS This cross-sectional case-control study evaluated 63 female athletes from professional basketball and volleyball teams (NCT06199583). Patellar tendinopathy diagnoses were made using clinical and ultrasonographic criteria. SWE measurements were taken at 30-degree knee flexion and extension. Rectangular regions of interest boxes were placed in three different parts of the tendon (proximal, middle, distal). The global SWE value was calculated by taking the mean of measurements in the three parts. Receiver operating characteristic (ROC) curves were used to identify significant cutoff points for SWE, and 2 × 2 tables were generated to determine sensitivity and specificity. RESULTS Thirteen (20.6%) of the 63 athletes were diagnosed with patellar tendinopathy. The ROC curves have identified different cutoff scores for SWE measurements. The SWE score of 130.75 from the proximal part showed the highest sensitivity of 89% and specificity of 80% (p < 0.001) with a 4.45 likelihood ratio at the 30-degree knee flexion. The likelihood ratio is 1.5 at a 30-degree angle and 1.65 at a 0-degree angle when measuring the entire tendon, whereas other portions indicate a ratio ranging from 1.12 to 1.73. CONCLUSIONS Shear-wave elastography is a reliable evaluation method for diagnosing patellar tendinopathy. It has more accuracy when applied to the proximal part and at 30-degree knee flexion compared to measurements taken at knee extension and other parts of the tendon.
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Affiliation(s)
- Sergen Devran
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
| | | | - Şensu Dinçer
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
| | - Mehmet Güven Günver
- Faculty of Medicine, Biostatistics Department, Istanbul University, Istanbul, Turkey
| | - Bülent Bayraktar
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
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2
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Pringels L, Stouthandel M, Van Hoof T, Martens M, Chevalier A, Burssens A, Wezenbeek E, Vanden Bossche L. Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion. Scand J Med Sci Sports 2023; 33:2230-2238. [PMID: 37608446 DOI: 10.1111/sms.14467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023]
Abstract
Torsion of the Achilles tendon (AT) enhances tensile strength, but a high degree of torsion might also be a risk factor for Achilles tendinopathy, due to greater internal compression exerted during tensile loading. However, evidence supporting the grounds for this assumption is lacking. Hence, we aimed to investigate the impact of AT torsion type on intratendinous pressure. Eighteen human fresh frozen cadaveric legs were mounted in a testing rig and a miniature pressure catheter was placed through ultrasound-guided insertion in the midportion region of the AT. Intratendinous pressure was measured during a simulated straight-knee calf stretch and eccentric heel drop. The AT was then carefully dissected and classified into Type I (least), Type II (moderate), and Type III (extreme) torsion. Of the ATs examined, nine were found to have Type I torsion (50%), nine Type II (50%), and none Type III. It was found that the intratendinous pressure of the AT increased exponentially with ankle dorsiflexion during both exercises (p < 0.001) and that this increase was greater in ATs with Type II torsion than Type I torsion (p < 0.05). This study provides the first biomechanical data to support the hypothesis that in athletes with a high degree of torsion in the AT, the midportion area will experience more internal compression during exercise, for example, calf stretching and eccentric heel drops. Whether this phenomenon is also associated with an elevated risk for Achilles tendinopathy needs further prospective investigation.
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Affiliation(s)
- Lauren Pringels
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Tom Van Hoof
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Manuel Martens
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Amelie Chevalier
- Department of Electromechanics, University of Antwerp, Antwerp, Belgium
| | - Arne Burssens
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Evi Wezenbeek
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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3
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Merza EY, Pearson SJ, Lichtwark GA, Malliaras P. The acute effects of higher versus lower load duration and intensity on morphological and mechanical properties of the healthy Achilles tendon: a randomized crossover trial. J Exp Biol 2022; 225:275126. [PMID: 35470387 PMCID: PMC9167578 DOI: 10.1242/jeb.243741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/19/2022] [Indexed: 11/20/2022]
Abstract
The Achilles tendon (AT) exhibits volume changes related to fluid flow under acute load which may be linked to changes in stiffness. Fluid flow provides a mechanical signal for cellular activity and may be one mechanism that facilitates tendon adaptation. This study aimed to investigate whether isometric intervention involving a high level of load duration and intensity could maximize the immediate reduction in AT volume and stiffness compared with interventions involving a lower level of load duration and intensity. Sixteen healthy participants (12 males, 4 females; age 24.4±9.4 years, body mass 70.9±16.1 kg, height 1.7±0.1 m) performed three isometric interventions of varying levels of load duration (2 s and 8 s) and intensity (35% and 75% maximal voluntary isometric contraction) over a 3 week period. Freehand 3D ultrasound was used to measure free AT volume (at rest) and length (at 35%, 55% and 75% of maximum plantarflexion force) pre- and post-interventions. The slope of the force–elongation curve over these force levels represented individual stiffness (N mm−1). Large reductions in free AT volume and stiffness resulted in response to long-duration high-intensity loading whilst less reduction was produced with a lower load intensity. In contrast, no change in free AT volume and a small increase in AT stiffness occurred with lower load duration. These findings suggest that the applied load on the AT must be heavy and sustained for a long duration to maximize immediate volume reduction, which might be an acute response that enables optimal long-term tendon adaptation via mechanotransduction pathways. Summary: High levels of load duration and intensity have the greatest acute effect on the free Achilles tendon volume and stiffness.
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Affiliation(s)
- Eman Y Merza
- Department of physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston Vic 3199, Melbourne, Australia
| | - Stephen J Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Greater Manchester, M5 4WT, UK
| | - Glen A Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD 4072, Brisbane, Australia
| | - Peter Malliaras
- Department of physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston Vic 3199, Melbourne, Australia
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4
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Drakonaki EE, Gataa KG, Szaro P. The anatomical variant of high soleus muscle may predispose to tendinopathy: a preliminary MR study. Surg Radiol Anat 2021; 43:1681-1689. [PMID: 34032901 PMCID: PMC8455493 DOI: 10.1007/s00276-021-02768-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to examine the anatomic variations at the level of the distal soleus musculotendinous junction and the possible association between the length of the free tendon and the development of symptomatic Achilles tendinopathy. METHODS We retrospectively assessed 72 ankle MRI studies with findings of Achilles tendinopathy (study group, 26 females/46 males, mean age 52.6 ± 10.5 years, 30 right/42 left) and 72 ankle MRI studies with normal Achilles tendon (control group, 32 females/40 males, mean age 35.7 ± 13.7 years, 42 right/30 left side). We measured the distance from the lowest outline of the soleus myotendinous junction to the proximal outline of the Achilles tendon insertion (length of the free tendon, diameter a) and to the distal outline of the insertion (distance B). We also measured the maximum thickness of the free tendon (diameter c) and the distance between the levels of maximum thickness to the proximal outline of the Achilles tendon insertion (distance D). All measurements were assessed twice. Statistical analysis was performed using independent t test. RESULTS Distances A and B were significantly larger in tendinopathic tendons (59.7 and 83.4 mm, respectively) than normal Achilles tendons (38.5 and 60.8 mm, respectively) (p = 0.001). Mean distance C was larger in tendinopathic than normal tendons (11.2 versus 4.9 mm). Distances C and D were significantly larger in males than females. There was no significant difference in the measurements between sides. CONCLUSION There is wide anatomical variation in the length of the free Achilles tendon. Tendinopathy may be associated with the thicker free part of the Achilles tendon. The anatomical variant of the high soleus musculotendinous junction resulting in a longer free Achilles tendon may be a predisposing factor to the development of tendinopathy.
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Affiliation(s)
| | - Khaldun Ghali Gataa
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.
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5
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Szaro P, Ghali Gataa K. The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging. Sci Rep 2021; 11:6131. [PMID: 33731785 PMCID: PMC7969943 DOI: 10.1038/s41598-021-85604-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
This comparative study aimed to investigate how tendinopathy-related lesions change correlations in the dimensions of the Achilles tendon. Our experimental group included 74 patients. The mean age was 52.9 ± 10.4 years. The control group included 81 patients with a mean age was 35.2 ± 13.6 years, p < .001. The most significant difference in correlation was the thickness of the tendon and the midportion's width, which was more significant in the tendinopathy (r = .49 vs. r = .01, p < .001). The correlation was positive between width and length of the insertion but negative in normal tendons (r = .21 vs. r = − .23, p < .001). The correlation was between the midportions width in tendinopathy and the tendon's length but negative in the normal tendon (r = .16 vs. r = − .23, p < .001). The average thickness of the midportion in tendinopathy was 11.2 ± 3.3 mm, and 4.9 ± 0.5 mm in the control group, p < .001. The average width of the midportion and insertion was more extensive in the experimental group, 17.2 ± 3.1 mm vs. 14.7 ± 1.8 mm for the midportion and 31.0 ± 3.9 mm vs. 25.7 ± 3.0 mm for insertion, respectively, p < .001. The tendon's average length was longer in tendinopathy (83.5 ± 19.3 mm vs. 61.5 ± 14.4 mm, p < .001). The dimensions correlations in normal Achilles tendon and tendinopathic tendon differ significantly.
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Affiliation(s)
- Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden. .,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland.
| | - Khaldun Ghali Gataa
- Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Merza E, Pearson S, Lichtwark G, Ollason M, Malliaras P. Immediate and long-term effects of mechanical loading on Achilles tendon volume: A systematic review and meta-analysis. J Biomech 2021; 118:110289. [PMID: 33556887 DOI: 10.1016/j.jbiomech.2021.110289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 01/07/2023]
Abstract
The Achilles tendon (AT) may experience changes in dimensions related to fluid flow under load. The extent to which fluid flow involves redistribution within or flow out of the tendon is not known and could be determined by investigating volume changes. This study aimed to synthesize data on immediate and long-term effects of loading on tendon volume among people with a healthy AT and midportion Achilles tendinopathy (MAT). A secondary aim was to synthesise data from the included studies investigating parallel change in cross-sectional area and length. Systematic electronic search was performed in MEDLINE, EMBASE, CINAHL, AMED, and Scopus from inception until May 2020. Standardized mean differences (SMDs) were calculated for intervention-induced changes from baseline for all outcomes. Methodological quality was assessed using modified version of Newcastle Ottawa Scale (NOS). Twelve studies were included in meta-analysis. For healthy AT, there were negligible to small changes in volume following cross-country running (-0.33 [95% CI = -1.11 to 0.45] (P = 0.41)) and isometric exercise (0.01 [95% CI = -0.54 to 0.55] (P = 0.98)) and a large increase at the short-term with 12-week isometric protocol (0.88 [95% CI = -0.10 to1.86] (P = 0.08)). For MAT, there was an immediate large reduction in volume with isometric exercise (-1.24 [95% CI = -1.93 to -0.55] (P = 0.0004)), small increase with eccentric exercise (0.41 [95% CI = -0.18 to 1.01](P = 0.18)) and small reduction at the short-term with long-term interventions (-0.46 [95% CI = -0.87 to -0.05] (P = 0.03)). This meta-analysis suggests that healthy AT remain isovolumetric with acute interventions while MAT exhibit immediate and short-term volume reductions in response to different interventions.
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Affiliation(s)
- Eman Merza
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Vic 3199, Melbourne, Australia.
| | - Stephen Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Greater Manchester M5 4WT, United Kingdom.
| | - Glen Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD 4072, Brisbane, Australia.
| | - Meg Ollason
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Vic 3800, Melbourne, Australia.
| | - Peter Malliaras
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Vic 3199, Melbourne, Australia.
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7
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Techniques for In Vivo Measurement of Ligament and Tendon Strain: A Review. Ann Biomed Eng 2020; 49:7-28. [PMID: 33025317 PMCID: PMC7773624 DOI: 10.1007/s10439-020-02635-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
The critical clinical and scientific insights achieved through knowledge of in vivo musculoskeletal soft tissue strains has motivated the development of relevant measurement techniques. This review provides a comprehensive summary of the key findings, limitations, and clinical impacts of these techniques to quantify musculoskeletal soft tissue strains during dynamic movements. Current technologies generally leverage three techniques to quantify in vivo strain patterns, including implantable strain sensors, virtual fibre elongation, and ultrasound. (1) Implantable strain sensors enable direct measurements of tissue strains with high accuracy and minimal artefact, but are highly invasive and current designs are not clinically viable. (2) The virtual fibre elongation method tracks the relative displacement of tissue attachments to measure strains in both deep and superficial tissues. However, the associated imaging techniques often require exposure to radiation, limit the activities that can be performed, and only quantify bone-to-bone tissue strains. (3) Ultrasound methods enable safe and non-invasive imaging of soft tissue deformation. However, ultrasound can only image superficial tissues, and measurements are confounded by out-of-plane tissue motion. Finally, all in vivo strain measurement methods are limited in their ability to establish the slack length of musculoskeletal soft tissue structures. Despite the many challenges and limitations of these measurement techniques, knowledge of in vivo soft tissue strain has led to improved clinical treatments for many musculoskeletal pathologies including anterior cruciate ligament reconstruction, Achilles tendon repair, and total knee replacement. This review provides a comprehensive understanding of these measurement techniques and identifies the key features of in vivo strain measurement that can facilitate innovative personalized sports medicine treatment.
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8
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Devaprakash D, Obst SJ, Lloyd DG, Barrett RS, Kennedy B, Ball I, Adams KL, Collings TJ, Davico G, Hunter A, Vlahovich N, Pease DL, Pizzolato C. The Free Achilles Tendon Is Shorter, Stiffer, Has Larger Cross-Sectional Area and Longer T2 * Relaxation Time in Trained Middle-Distance Runners Compared to Healthy Controls. Front Physiol 2020; 11:965. [PMID: 32973544 PMCID: PMC7482361 DOI: 10.3389/fphys.2020.00965] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/15/2020] [Indexed: 12/14/2022] Open
Abstract
Tendon geometry and tissue properties are important determinants of tendon function and injury risk and are altered in response to ageing, disease, and physical activity levels. The purpose of this study was to compare free Achilles tendon geometry and mechanical properties between trained elite/sub-elite middle-distance runners and a healthy control group. Magnetic resonance imaging (MRI) was used to measure free Achilles tendon volume, length, average cross-sectional area (CSA), regional CSA, moment arm, and T2* relaxation time at rest, while freehand three-dimensional ultrasound (3DUS) was used to quantify free Achilles tendon mechanical stiffness, Young’s modulus, and length normalised mechanical stiffness. The free Achilles tendon in trained runners was significantly shorter and the average and regional CSA (distal end) were significantly larger compared to the control group. Mechanical stiffness of the free Achilles tendon was also significantly higher in trained runners compared to controls, which was explained by the group differences in tendon CSA and length. T2* relaxation time was significantly longer in trained middle-distance runners when compared to healthy controls. There was no relationship between T2* relaxation time and Young’s modulus. The longer T2* relaxation time in trained runners may be indicative of accumulated damage, disorganised collagen, and increased water content in the free Achilles tendon. A short free Achilles tendon with large CSA and higher mechanical stiffness may enable trained runners to rapidly transfer high muscle forces and possibly reduce the risk of tendon damage from mechanical fatigue.
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Affiliation(s)
- Daniel Devaprakash
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Steven J Obst
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,School of Health, Medical, and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia
| | - David G Lloyd
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Rod S Barrett
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Ben Kennedy
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,QSCAN Radiology Clinics, Gold Coast, QLD, Australia
| | - Iain Ball
- Philips Healthcare, Australia and New Zealand, Sydney, NSW, Australia
| | | | - Tyler J Collings
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Giorgio Davico
- Department of Industrial Engineering, Alma Mater Studiorum-University of Bologna, Bologna, Italy.,Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Adam Hunter
- Australian Institute of Sport, Canberra, ACT, Australia
| | | | - David L Pease
- Australian Institute of Sport, Canberra, ACT, Australia
| | - Claudio Pizzolato
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Griffith Centre for Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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9
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Pizzolato C, Shim VB, Lloyd DG, Devaprakash D, Obst SJ, Newsham-West R, Graham DF, Besier TF, Zheng MH, Barrett RS. Targeted Achilles Tendon Training and Rehabilitation Using Personalized and Real-Time Multiscale Models of the Neuromusculoskeletal System. Front Bioeng Biotechnol 2020; 8:878. [PMID: 32903393 PMCID: PMC7434842 DOI: 10.3389/fbioe.2020.00878] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022] Open
Abstract
Musculoskeletal tissues, including tendons, are sensitive to their mechanical environment, with both excessive and insufficient loading resulting in reduced tissue strength. Tendons appear to be particularly sensitive to mechanical strain magnitude, and there appears to be an optimal range of tendon strain that results in the greatest positive tendon adaptation. At present, there are no tools that allow localized tendon strain to be measured or estimated in training or a clinical environment. In this paper, we first review the current literature regarding Achilles tendon adaptation, providing an overview of the individual technologies that so far have been used in isolation to understand in vivo Achilles tendon mechanics, including 3D tendon imaging, motion capture, personalized neuromusculoskeletal rigid body models, and finite element models. We then describe how these technologies can be integrated in a novel framework to provide real-time feedback of localized Achilles tendon strain during dynamic motor tasks. In a proof of concept application, Achilles tendon localized strains were calculated in real-time for a single subject during walking, single leg hopping, and eccentric heel drop. Data was processed at 250 Hz and streamed on a smartphone for visualization. Achilles tendon peak localized strains ranged from ∼3 to ∼11% for walking, ∼5 to ∼15% during single leg hop, and ∼2 to ∼9% during single eccentric leg heel drop, overall showing large strain variation within the tendon. Our integrated framework connects, across size scales, knowledge from isolated tendons and whole-body biomechanics, and offers a new approach to Achilles tendon rehabilitation and training. A key feature is personalization of model components, such as tendon geometry, material properties, muscle geometry, muscle-tendon paths, moment arms, muscle activation, and movement patterns, all of which have the potential to affect tendon strain estimates. Model personalization is important because tendon strain can differ substantially between individuals performing the same exercise due to inter-individual differences in these model components.
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Affiliation(s)
- Claudio Pizzolato
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Vickie B Shim
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - David G Lloyd
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Daniel Devaprakash
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Steven J Obst
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia
| | - Richard Newsham-West
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - David F Graham
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Thor F Besier
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Ming Hao Zheng
- Centre for Orthopaedic Translational Research, School of Surgery, The University of Western Australia, Nedlands, WA, Australia
| | - Rod S Barrett
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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10
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Hayes A, Easton K, Devanaboyina PT, Wu JP, Kirk TB, Lloyd D. A review of methods to measure tendon dimensions. J Orthop Surg Res 2019; 14:18. [PMID: 30636623 PMCID: PMC6330756 DOI: 10.1186/s13018-018-1056-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/27/2018] [Indexed: 12/16/2022] Open
Abstract
Tendons are soft tissues of the musculoskeletal system that are designed to facilitate joint movement. Tendons exhibit a wide range of mechanical properties matched to their functions and, as a result, have been of interest to researchers for many decades. Dimensions are an important aspect of tendon properties. Change in the dimensions of tissues is often seen as a sign of injury and degeneration, as it may suggest inflammation or general disorder of the tissue. Dimensions are also important for determining the mechanical properties and behaviours of materials, particularly the stress, strain, and elastic modulus. This makes the dimensions significant in the context of a mechanical study of degenerated tendons. Additionally, tendon dimensions are useful in planning harvesting for tendon transfer and joint reconstruction purposes. Historically, many methods have been used in an attempt to accurately measure the dimensions of soft tissue, since improper measurement can lead to large errors in the calculated properties. These methods can be categorised as destructive (by approximation), contact, and non-contact and can be considered in terms of in vivo and ex vivo.
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Affiliation(s)
- Alex Hayes
- Department of Mechanical Engineering, Curtin University of Technology, Perth, Western Australia, Australia. .,Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, Australia.
| | | | - Pavan Teja Devanaboyina
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Jian-Ping Wu
- Academy of Advanced Interdisciplinary Studies and the Department of Biomedical Engineering of Southern University of Science and Technology, No 1088, Xueyaun Rd, Xili, Nanshan District, Shenzhen City, 518055, Guangdong Province, China
| | - Thomas Brett Kirk
- Department of Mechanical Engineering, Curtin University of Technology, Perth, Western Australia, Australia.,Faculty of Science and Engineering, Curtin University of Technology, Perth, Western Australia, Australia
| | - David Lloyd
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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11
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Shim VB, Hansen W, Newsham-West R, Nuri L, Obst S, Pizzolato C, Lloyd DG, Barrett RS. Influence of altered geometry and material properties on tissue stress distribution under load in tendinopathic Achilles tendons – A subject-specific finite element analysis. J Biomech 2019; 82:142-148. [DOI: 10.1016/j.jbiomech.2018.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/17/2018] [Accepted: 10/20/2018] [Indexed: 12/19/2022]
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12
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Obst SJ, Heales LJ, Schrader BL, Davis SA, Dodd KA, Holzberger CJ, Beavis LB, Barrett RS. Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Review with Meta-analysis. Sports Med 2018; 48:2179-2198. [DOI: 10.1007/s40279-018-0956-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Nuri L, Obst SJ, Newsham-West R, Barrett RS. Recovery of human Achilles tendon three-dimensional deformation following conditioning. J Sci Med Sport 2018; 21:473-478. [DOI: 10.1016/j.jsams.2017.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/21/2017] [Accepted: 09/20/2017] [Indexed: 02/01/2023]
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Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther 2018; 48:A1-A38. [PMID: 29712543 DOI: 10.2519/jospt.2018.0302] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.
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Nuri L, Obst SJ, Newsham-West R, Barrett RS. Three-dimensional morphology and volume of the free Achilles tendon at rest and under load in people with unilateral mid-portion Achilles tendinopathy. Exp Physiol 2018; 103:358-369. [DOI: 10.1113/ep086673] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Leila Nuri
- School of Allied Health Sciences, Menzies Health Institute Queensland; Griffith University; Gold Coast QLD 4222 Australia
| | - Steven J. Obst
- School of Health, Medical and Applied Sciences; Central Queensland University; Bundaberg QLD 4670 Australia
| | - Richard Newsham-West
- School of Allied Health Sciences, Menzies Health Institute Queensland; Griffith University; Gold Coast QLD 4222 Australia
| | - Rod S. Barrett
- School of Allied Health Sciences, Menzies Health Institute Queensland; Griffith University; Gold Coast QLD 4222 Australia
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Pizzolato C, Lloyd DG, Barrett RS, Cook JL, Zheng MH, Besier TF, Saxby DJ. Bioinspired Technologies to Connect Musculoskeletal Mechanobiology to the Person for Training and Rehabilitation. Front Comput Neurosci 2017; 11:96. [PMID: 29093676 PMCID: PMC5651250 DOI: 10.3389/fncom.2017.00096] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 10/04/2017] [Indexed: 12/20/2022] Open
Abstract
Musculoskeletal tissues respond to optimal mechanical signals (e.g., strains) through anabolic adaptations, while mechanical signals above and below optimal levels cause tissue catabolism. If an individual's physical behavior could be altered to generate optimal mechanical signaling to musculoskeletal tissues, then targeted strengthening and/or repair would be possible. We propose new bioinspired technologies to provide real-time biofeedback of relevant mechanical signals to guide training and rehabilitation. In this review we provide a description of how wearable devices may be used in conjunction with computational rigid-body and continuum models of musculoskeletal tissues to produce real-time estimates of localized tissue stresses and strains. It is proposed that these bioinspired technologies will facilitate a new approach to physical training that promotes tissue strengthening and/or repair through optimal tissue loading.
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Affiliation(s)
- Claudio Pizzolato
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
- Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - David G. Lloyd
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
- Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Rod S. Barrett
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
- Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Jill L. Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Ming H. Zheng
- Centre for Orthopaedic Translational Research, School of Surgery, University of Western Australia, Nedlands, WA, Australia
| | - Thor F. Besier
- Auckland Bioengineering Institute and Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - David J. Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
- Gold Coast Orthopaedic Research and Education Alliance, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
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