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Larsson E, Nilsson N, Walstern J, Brorsson A, Helander KN. Females present larger deficit in heel-rise height at 3 months following an Achilles tendon rupture compared with males. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38651585 DOI: 10.1002/ksa.12208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/28/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE There is a lack of knowledge concerning differences between females and males in the early stages after an acute Achilles tendon rupture. This article aims to explore the different factors affecting early function after an Achilles tendon rupture with a validated test battery that includes functional tests, clinical measurements and patient-reported outcome at a 3-month follow-up analysis of a larger prospective study. METHODS This study was part of the DUSTAR-study (Diagnostic UltraSonography for the choice of Treatment of acute Achilles tendon Rupture) where the main aim was to evaluate if an acute ultrasonography could determine which patients, with an Achilles tendon rupture, should be treated surgically or nonsurgically. At the 3-month follow-up, the results between males and females were compared. RESULTS One hundred and twenty-seven patients were included at the 3-month follow-up; of these, 102 (80%) were males and 25 (20%) were females. Amongst the females, 11 (44%) were able to perform a single leg heel-rise compared to 48 (47%) of the males; however, the difference was not statistically significant. There was no difference between the sexes in the frequency of completing a single-leg heel-rise at 3 months after injury; however, there were statistically significant differences between the groups when comparing Limb Symmetry Index (LSI) of heel-rise height and heel-rise work. The females had a median heel-rise height LSI/median heel-rise work LSI of 45%/14% compared to males who reached a level of 57%/23% (p = 0.006/p = 0.010). At the 3-month follow-up, the median (range) Achilles tendon Total Rupture Score (ATRS) reported by females was 28.5 (8-51), which had a nonsignificant difference compared to males who reported a median (range) ATRS of 30 (1-86). CONCLUSION The risk of reduced heel-rise height and worse heel-rise work 3 months after an acute Achilles tendon rupture increases by being a female. Through this knowledge, we highlighted the importance of an individualised treatment for acute Achilles tendon ruptures with better outcome for both males and females. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Elin Larsson
- Department of Orthopaedics, Institute of Clinical Science at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden
| | - Niklas Nilsson
- Department of Orthopaedics, Institute of Clinical Science at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Julia Walstern
- Department of Orthopaedics, Institute of Clinical Science at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Science at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- IFK Kliniken Rehab, Gothenburg, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Institute of Clinical Science at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden
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Campbell TM, Godbout C, Trudel G. Achilles tendons change shape after 21 days of bedrest: A crossover study. Ann Phys Rehabil Med 2024; 67:101818. [PMID: 38479113 DOI: 10.1016/j.rehab.2024.101818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 04/13/2024]
Affiliation(s)
- T Mark Campbell
- Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Bone and Joint Research Laboratory, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Charles Godbout
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Guy Trudel
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Bone and Joint Research Laboratory, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada
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Gianakos AL, Hartman H, Kerkhoffs GMMJ, Calder J, Kennedy JG. Sex differences in biomechanical properties of the Achilles tendon may predispose men to higher risk of injury: A systematic review. J ISAKOS 2024; 9:184-191. [PMID: 37967617 DOI: 10.1016/j.jisako.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023]
Abstract
IMPORTANCE Men have a higher risk of Achilles tendon (AT) injury, and the impact of morphological and mechanical sex differences may play a role. AIM The aim of this study is to systematically review the literature to determine whether there are sex-specific differences in AT morphological and mechanical properties and analyze how these differences may impact AT injury in both men and women. EVIDENCE REVIEW A systematic literature search of articles published between 2001 and 2021, in the MEDLINE, EMBASE, and Cochrane databases was performed during May 2022 according to PRISMA. The primary outcome measures included sex-related differences in the mechanical and morphological properties of the Achilles tendon. Secondary outcomes included impact of sex on Achilles tendon properties and adaptation. FINDINGS Nineteen studies with a total of 1,143 participants (613 men and 530 women) were included in this systematic review. Men had increased measurements when compared with women in the following: AT length, thickness, cross-sectional area (CSA), stiffness, peak force, loading rate, and voluntary muscle contraction. Women had an increase in CSA deformation, strain, and compliance. CONCLUSIONS AND RELEVANCE Our study demonstrates that men have an increased AT length, thickness, and CSA, indicating that men may be subjected biomechanically to higher loads in their day-to-day activities. In addition, men have lower deformation and compliance properties, along with increased AT stiffness, reducing their capacity to adapt during loading, potentially increasing their risk of injury. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Arianna L Gianakos
- Department of Orthopaedic Surgery, Yale Medicine Orthopaedics and Rehabilitation, New Haven, CT, 06519, USA
| | - Hayden Hartman
- Lincoln Memorial University, DeBusk College of Osteopathic Medicine, Knoxville, TN, 37932, USA.
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Academic Center for Evidence-Based Sports Medicine, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - John G Kennedy
- Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, 10002, USA
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Domroes T, Weidlich K, Bohm S, Arampatzis A, Mersmann F. Effect of sex on muscle-tendon imbalances and tendon micromorphology in adolescent athletes-A longitudinal consideration. Scand J Med Sci Sports 2023; 33:2561-2572. [PMID: 37697699 DOI: 10.1111/sms.14483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/03/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
Imbalances between muscle strength and tendon stiffness may cause high-level tendon strain during maximum effort muscle contractions and lead to tendon structural impairments and an increased risk for tendinopathy in adolescent athletes. However, it remains unclear whether the development of musculotendinous imbalances is influenced by sex. At four measurement time points during a competitive season, we measured quadriceps femoris muscle strength and patellar tendon mechanical properties in 15 female (14.3 ± 0.7 years) and 13 male (16.0 ± 0.6 years) elite handball players of similar maturity using dynamometry and ultrasonography. To estimate the tendon's structural integrity, the peak spatial frequency (PSF) of proximal tendon ultrasound scans was determined. Females demonstrated significantly lower muscle strength (p < 0.001) and patellar tendon stiffness (p < 0.001) than males with no significant changes over time (p > 0.05). Tendon strain during isometric maximum voluntary contractions and PSF neither differed between sexes nor changed significantly over time (p > 0.05). We found lower fluctuations in muscle strength (p < 0.001) in females during the season but no differences in the fluctuations of tendon strain, stiffness, and PSF (p > 0.05). Descriptively, there was a similar frequency (~40%) of athletes with high-level tendon strain (>9%) in both sexes. These findings suggest that the lower strength capacity of female athletes is paralleled by lower tendon stiffness. Thereby, muscle-tendon imbalances occur to a similar extent in both sexes leading to increased strain levels during the season, which indicates the need for specific tendon training.
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Affiliation(s)
- Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kolja Weidlich
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Adam NC, Smith CR, Herzog W, Amis AA, Arampatzis A, Taylor WR. In Vivo Strain Patterns in the Achilles Tendon During Dynamic Activities: A Comprehensive Survey of the Literature. SPORTS MEDICINE - OPEN 2023; 9:60. [PMID: 37466866 DOI: 10.1186/s40798-023-00604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
Achilles' tendon (AT) injuries such as ruptures and tendinopathies have experienced a dramatic rise in the mid- to older-aged population. Given that the AT plays a key role at all stages of locomotion, unsuccessful rehabilitation after injury often leads to long-term, deleterious health consequences. Understanding healthy in vivo strains as well as the complex muscle-tendon unit interactions will improve access to the underlying aetiology of injuries and how their functionality can be effectively restored post-injury. The goals of this survey of the literature with a systematic search were to provide a benchmark of healthy AT strains measured in vivo during functional activities and identify the sources of variability observed in the results. Two databases were searched, and all articles that provided measured in vivo peak strains or the change in strain with respect to time were included. In total, 107 articles that reported subjects over the age of 18 years with no prior AT injury and measured while performing functional activities such as voluntary contractions, walking, running, jumping, or jump landing were included in this review. In general, unclear anatomical definitions of the sub-tendon and aponeurosis structures have led to considerable confusion in the literature. MRI, ultrasound, and motion capture were the predominant approaches, sometimes coupled with modelling. The measured peak strains increased from 4% to over 10% from contractions, to walking, running, and jumping, in that order. Importantly, measured AT strains were heavily dependent on measurement location, measurement method, measurement protocol, individual AT geometry, and mechanical properties, as well as instantaneous kinematics and kinetics of the studied activity. Through a comprehensive review of approaches and results, this survey of the literature therefore converges to a united terminology of the structures and their common underlying characteristics and presents the state-of-knowledge on their functional strain patterns.
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Affiliation(s)
- Naomi C Adam
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Colin R Smith
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, The University of Calgary, Calgary, Canada
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, and Berlin School of Movement Science, Berlin, Germany
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
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Holzer D, Millard M, Hahn D, Siebert T, Schwirtz A, Seiberl W. Tendon compliance and preload must be considered when determining the in vivo force-velocity relationship from the torque-angular velocity relation. Sci Rep 2023; 13:6588. [PMID: 37085664 PMCID: PMC10121672 DOI: 10.1038/s41598-023-33643-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
In vivo, the force-velocity relation (F-v-r) is typically derived from the torque-angular velocity relation (T-ω-r), which is subject to two factors that may influence resulting measurements: tendon compliance and preload prior to contraction. The in vivo plantar flexors' T-ω-r was determined during preloaded maximum voluntary shortening contractions at 0-200°/s. Additionally, we used a two factor block simulation study design to independently analyze the effects of preload and tendon compliance on the resulting T-ω-r. Therefore, we replicated the in vivo experiment using a Hill-type muscle model of the gastrocnemius medialis. The simulation results matched a key pattern observed in our recorded in vivo experimental data: during preloaded contractions, torque output of the muscle was increased when compared with non-preloaded contractions from literature. This effect increased with increasing contraction velocity and can be explained by a rapidly recoiling tendon, allowing the contractile element to contract more slowly, thus developing higher forces compared with non-preloaded contractions. Our simulation results also indicate that a more compliant tendon results in increased ankle joint torques. The simulation and the experimental data clearly show that the deduction of the in vivo F-v-r from the T-ω-r is compromised due to the two factors preloading and tendon compliance.
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Affiliation(s)
- Denis Holzer
- Biomechanics in Sports, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
| | - Matthew Millard
- Institute of Engineering and Computational Mechanics, University of Stuttgart, Stuttgart, Germany
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Daniel Hahn
- Human Movement Science, Faculty of Sport Science, Ruhr University Bochum, Bochum, Germany
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
| | - Tobias Siebert
- Department of Motion and Exercise Science, University of Stuttgart, Stuttgart, Germany
| | - Ansgar Schwirtz
- Biomechanics in Sports, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Wolfgang Seiberl
- Biomechanics in Sports, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
- Institute of Sport Science, Department of Human Sciences, Universität der Bundeswehr München, Neubiberg, Germany
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Ashton DM, Blaker CL, Hartnell N, Haubruck P, Hefferan SA, Little CB, Clarke EC. Challenging the Perceptions of Human Tendon Allografts: Influence of Donor Age, Sex, Height, and Tendon on Biomechanical Properties. Am J Sports Med 2023; 51:768-778. [PMID: 36594505 DOI: 10.1177/03635465221143385] [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] [Indexed: 01/04/2023]
Abstract
BACKGROUND The use of allograft tendons has increased for primary and revision anterior cruciate ligament reconstruction, but allograft supply is currently limited to a narrow range of tendons and donors up to the age of 65 years. Expanding the range of donors and tendons could help offset an increasing clinical demand. PURPOSE To investigate the effects of donor age, sex, height, and specific tendon on the mechanical properties of a range of human lower leg tendons. STUDY DESIGN Descriptive laboratory study. METHODS Nine tendons were retrieved from 39 fresh-frozen human cadaveric lower legs (35 donors [13 female, 22 male]; age, 49-99 years; height, 57-85 inches [145-216 cm]) including: Achilles tendon, tibialis posterior and anterior, fibularis longus and brevis, flexor and extensor hallucis longus, plantaris, and flexor digitorum longus. Tendons underwent tensile loading to failure measuring cross-sectional area (CSA), maximum load, strain at failure, ultimate tensile strength, and elastic modulus. Results from 332 tendons were analyzed using mixed-effects linear regression, accounting for donor age, sex, height, and weight. RESULTS Mechanical properties were significantly different among tendons and were substantially greater than the effects of donor characteristics. Significant effects of donor sex, age, and height were limited to specific tendons: Achilles tendon, tibialis posterior, and tibialis anterior. All other tendons were unaffected. The Achilles tendon was most influenced by donor variables: greater CSA in men (β = 15.45 mm2; Šidák adjusted P < .0001), decreased maximum load with each year of increased age (β = -17.20 N per year; adjusted P = .0253), and increased CSA (β = 1.92 mm2 per inch; adjusted P < .0001) and maximum load (β = 86.40 N per inch; adjusted P < .0001) with each inch of increased height. CONCLUSION Mechanical properties vary significantly across different human tendons. The effects of donor age, sex, and height are relatively small, are limited to specific tendons, and affect different tendons uniquely. The findings indicate that age negatively affected only the Achilles tendon (maximum load) and challenge the exclusion of donors aged >65 years across all tendon grafts. CLINICAL RELEVANCE The findings support including a broader range of tendons for use as allografts for anterior cruciate ligament reconstruction and reviewing the current exclusion criterion of donors aged >65 years.
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Affiliation(s)
- Dylan M Ashton
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute; Northern Sydney Local Health District; Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St Leonards, Australia
| | - Carina L Blaker
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute; Northern Sydney Local Health District; Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St Leonards, Australia
| | | | - Patrick Haubruck
- Heidelberg Trauma Research Group, Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute; Northern Sydney Local Health District; Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St Leonards, Australia
| | - Samantha A Hefferan
- Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research, Kolling Institute; Northern Sydney Local Health District; Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St Leonards, Australia
| | - Christopher B Little
- Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research, Kolling Institute; Northern Sydney Local Health District; Sydney Musculoskeletal Health, Faculty of Medicine and Health, University of Sydney, St Leonards, Australia
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Nozaki S, Kinugasa R, Yaeshima K, Hashimoto T, Jinzaki M, Ogihara N. Quantification of the in vivo stiffness and natural length of the human plantar aponeurosis during quiet standing using ultrasound elastography. Sci Rep 2022; 12:15707. [PMID: 36127445 PMCID: PMC9489693 DOI: 10.1038/s41598-022-20211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/09/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to identify the stiffness and natural length of the human plantar aponeurosis (PA) during quiet standing using ultrasound shear wave elastography. The shear wave velocity (SWV) of the PA in young healthy males and females (10 participants each) was measured by placing a probe in a hole in the floor plate. The change in the SWV with the passive dorsiflexion of the metatarsophalangeal (MP) joint was measured. The Young's modulus of the PA was estimated to be 64.7 ± 9.4 kPa, which exponentially increased with MP joint dorsiflexion. The PA was estimated to have the natural length when the MP joint was plantarflexed by 13.8°, indicating that the PA is stretched by arch compression during standing. However, the present study demonstrated that the estimated stiffness for the natural length in quiet standing was significantly larger than that in the unloaded condition, revealing that the PA during standing is stiffened by elongation and through the possible activation of intrinsic muscles. Such quantitative information possibly contributes to the detailed biomechanical modeling of the human foot, facilitating an improved understanding of the mechanical functions and pathogenetic mechanisms of the PA during movements.
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Affiliation(s)
- Shuhei Nozaki
- Laboratory of Human Evolutionary Biomechanics, Department of Biological Sciences, Graduate School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.
| | - Ryuta Kinugasa
- Department of Human Sciences, Kanagawa University, Kanagawa, 221-8686, Japan
| | - Katsutoshi Yaeshima
- Department of Human Sciences, Kanagawa University, Kanagawa, 221-8686, Japan
| | - Takeshi Hashimoto
- Sports Medicine Research Center, Keio University, Kanagawa, 223-8521, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, 160-8582, Japan
| | - Naomichi Ogihara
- Laboratory of Human Evolutionary Biomechanics, Department of Biological Sciences, Graduate School of Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan.
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Wu AC, Rauh MJ, DeLuca S, Lewis M, Ackerman KE, Barrack MT, Heiderscheit B, Krabak BJ, Roberts WO, Tenforde AS. Running-related injuries in middle school cross-country runners: Prevalence and characteristics of common injuries. PM R 2022; 14:793-801. [PMID: 34053194 DOI: 10.1002/pmrj.12649] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Understanding the prevalence and factors associated with running-related injuries in middle school runners may guide injury prevention. OBJECTIVE To determine the prevalence of running-related injuries and describe factors related to a history of injury. DESIGN Retrospective cross-sectional study. SETTING Survey distributed online to middle school runners. METHODS Participants completed a web-based survey regarding prior running-related injuries, training, sleep, diet, and sport participation. MAIN OUTCOME MEASUREMENTS Prevalence and characteristics differentiating girls and boys with and without running-related injury history adjusted for age. PARTICIPANTS Youth runners (total: 2113, average age, 13.2 years; boys: n = 1255, girls: n = 858). RESULTS Running-related injuries were more prevalent in girls (56% vs. 50%, p = .01). Ankle sprain was the most common injury (girls: 22.5%, boys: 21.6%), followed by patellofemoral pain (20.4% vs. 7.8%) and shin splints (13.6% vs. 5.9%); both were more prevalent in girls (p < .001). Boys more frequently reported plantar fasciitis (5.6% vs. 3.3%, p = .01), iliotibial band syndrome (4.1% vs. 1.4%, p = .001) and Osgood-Schlatter disease (3.8% vs. 1.2%, p = .001). Runners with history of running-related injuries were older, ran greater average weekly mileage, ran faster, had fewer average hours of sleep on weekends, skipped more meals, missed breakfast, and consumed less milk (all p < .05). Girls with history of running-related injuries reported higher dietary restraint scores, later age of menarche, more menstrual cycle disturbances, and higher likelihood of following vegetarian diets and an eating disorder diagnosis (all p < .05). Runners with no history of running-related injuries were more likely to have participated in ≥2 years of soccer or basketball (p < .001). CONCLUSIONS Most middle school runners reported a history of running-related injuries and certain injuries differing by gender. Modifiable factors with the greatest association with running-related injuries included training volume, dietary restraint, skipping meals, and less sleep. Sport sampling, including participation in ball sports, may reduce running-related injury risk in this population.
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Affiliation(s)
- Alexander C Wu
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell J Rauh
- Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Stephanie DeLuca
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Margo Lewis
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn E Ackerman
- Sports Medicine, Boston Children's Hospital; Neuroendocrine Unit, Massachusetts General Hospital; and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Bryan Heiderscheit
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, Wisconsin, USA
| | - Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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Exercise Effects on the Biomechanical Properties of the Achilles Tendon—A Narrative Review. BIOLOGY 2022; 11:biology11020172. [PMID: 35205039 PMCID: PMC8869522 DOI: 10.3390/biology11020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/01/2022] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
Simple Summary The Achilles tendon influences the running economy because of its ability to store and release strain energy, and it remains one of the most vulnerable tendons among athletes and recreational runners. Exercised-related mechanical loading appears to induce changes in the Achilles tendon morphology and mechanical material properties. Both acute and relatively long-term exercise induces tendon adaptation, although biomechanical changes, e.g., cross-sectional area, plantarflexion moment, Young’s modulus, and stiffness, in response to exercise duration, type, and loading-regimes differ widely. Furthermore, a strong Achilles tendon can be developed by chronic exposure to habitual mechanical loading from daily exercise, which is associated with greater energy storage, release and overall health. Abstract The morphological and mechanical properties (e.g., stiffness, stress, and force) of the Achilles tendon (AT) are generally associated with its tendinosis and ruptures, particularly amongst runners. Interest in potential approaches to reduce or prevent the risk of AT injuries has grown exponentially as tendon mechanics have been efficiently improving. The following review aims to discuss the effect of different types of exercise on the AT properties. In this review article, we review literature showing the possibility to influence the mechanical properties of the AT from the perspective of acute exercise and long-term training interventions, and we discuss the reasons for inconsistent results. Finally, we review the role of the habitual state in the AT properties. The findings of the included studies suggest that physical exercise could efficiently improve the AT mechanical properties. In particular, relatively long-term and low-intensity eccentric training may be a useful adjunct to enhance the mechanical loading of the AT.
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11
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Smart RR, O'Connor B, Jakobi JM. Resting Tendon Cross-Sectional Area Underestimates Biceps Brachii Tendon Stress: Importance of Measuring During a Contraction. Front Physiol 2021; 12:654231. [PMID: 34646145 PMCID: PMC8502959 DOI: 10.3389/fphys.2021.654231] [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: 01/15/2021] [Accepted: 08/09/2021] [Indexed: 11/25/2022] Open
Abstract
Force produced by the muscle during contraction is applied to the tendon and distributed through the cross-sectional area (CSA) of the tendon. This ratio of force to the tendon CSA is quantified as the tendon mechanical property of stress. Stress is traditionally calculated using the resting tendon CSA; however, this does not take into account the reductions in the CSA resulting from tendon elongation during the contraction. It is unknown if calculating the tendon stress using instantaneous CSA during a contraction significantly increases the values of in vivo distal biceps brachii (BB) tendon stress in humans compared to stress calculated with the resting CSA. Nine young (22 ± 1 years) and nine old (76 ± 4 years) males, and eight young females (21 ± 1 years) performed submaximal isometric elbow flexion tracking tasks at force levels ranging from 2.5 to 80% maximal voluntary contraction (MVC). The distal BB tendon CSA was recorded on ultrasound at rest and during the submaximal tracking tasks (instantaneous). Tendon stress was calculated as the ratio of tendon force during contraction to CSA using the resting and instantaneous measures of CSA, and statistically evaluated with multi-level modeling (MLM) and Johnson–Neyman regions of significance tests to determine the specific force levels above which the differences between calculation methods and groups became statistically significant. The tendon CSA was greatest at rest and decreased as the force level increased (p < 0.001), and was largest in young males (23.0 ± 2.90 mm2) followed by old males (20.87 ± 2.0 mm2) and young females (17.08 ± 1.54 mm2) (p < 0.001) at rest and across the submaximal force levels. Tendon stress was greater in the instantaneous compared with the resting CSA condition, and young males had the greatest difference in the values of tendon stress between the two conditions (20 ± 4%), followed by old males (19 ± 5%), and young females (17 ± 5%). The specific force at which the difference between the instantaneous and resting CSA stress values became statistically significant was 2.6, 6.6, and 10% MVC for old males, young females, and young males, respectively. The influence of using the instantaneous compared to resting CSA for tendon stress is sex-specific in young adults, and age-specific in the context of males. The instantaneous CSA should be used to provide a more accurate measure of in vivo tendon stress in humans.
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Affiliation(s)
- Rowan R Smart
- Healthy Exercise and Aging Laboratory, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Brian O'Connor
- Department of Psychology, Faculty of Arts and Social Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Jennifer M Jakobi
- Healthy Exercise and Aging Laboratory, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
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Zhang X, Deng L, Xiao S, Li L, Fu W. Sex Differences in the Morphological and Mechanical Properties of the Achilles Tendon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178974. [PMID: 34501564 PMCID: PMC8430544 DOI: 10.3390/ijerph18178974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
Background: Patients with Achilles tendon (AT) injuries are often engaged in sedentary work because of decreasing tendon vascularisation. Furthermore, men are more likely to be exposed to AT tendinosis or ruptures. These conditions are related to the morphological and mechanical properties of AT, but the mechanism remains unclear. This study aimed to investigate the effects of sex on the morphological and mechanical properties of the AT in inactive individuals. Methods: In total, 30 inactive healthy participants (15 male participants and 15 female participants) were recruited. The AT morphological properties (cross-sectional area, thickness, and length) were captured by using an ultrasound device. The AT force–elongation characteristics were determined during isometric plantarflexion with the ultrasonic videos. The AT stiffness was determined at 50%–100% maximum voluntary contraction force. The AT strain, stress, and hysteresis were calculated. Results: Male participants had 15% longer AT length, 31% larger AT cross-sectional area and 21% thicker AT than female participants (p < 0.05). The plantarflexion torque, peak AT force, peak AT stress, and AT stiffness were significantly greater in male participants than in female participants (p < 0.05). However, no significant sex-specific differences were observed in peak AT strain and hysteresis (p > 0.05). Conclusions: In physically inactive adults, the morphological properties of AT were superior in men but were exposed to higher stress conditions. Moreover, no significant sex-specific differences were observed in peak AT strain and hysteresis, indicating that the AT of males did not store and return elastic energy more efficiently than that of females. Thus, the mechanical properties of the AT should be maintained and/or improved through physical exercise.
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Affiliation(s)
- Xini Zhang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (L.D.); (S.X.)
| | - Liqin Deng
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (L.D.); (S.X.)
| | - Songlin Xiao
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (L.D.); (S.X.)
| | - Lu Li
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (L.D.); (S.X.)
- Institute of Sport and Sport Science, University of Freiburg, 79098 Freiburg, Germany
- Correspondence: (L.L.); (W.F.)
| | - Weijie Fu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai 200438, China; (X.Z.); (L.D.); (S.X.)
- Correspondence: (L.L.); (W.F.)
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13
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Pletcher ER, Dekker TJ, Lephart SM, Sell TC. Sex and Age Comparisons in Neuromuscular And Biomechanical Characteristics of the Knee in Young Athletes. Int J Sports Phys Ther 2021; 16:438-449. [PMID: 33842039 PMCID: PMC8016419 DOI: 10.26603/001c.21358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/10/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The identification of risk factors for injury is a key step for musculoskeletal injury prevention in youth sports. Not identifying and correcting for injury risk factors may result in lost opportunity for athletic development. Physical maturation and sex affect these characteristics, which may indicate the need for both age and sex-based injury prevention programs. HYPOTHESIS/PURPOSE This study examined age and sex differences in knee strength, static balance, jump height, and lower extremity landing biomechanics in school- and high school-age athletes. STUDY DESIGN Cross-sectional. METHODS Forty healthy school aged (10.8±0.8 yrs) and forty high school (16.8±0.8 yrs) athletes completed isokinetic knee flexion and extension strength tests, single-leg static balance and single-leg vertical stop jump tasks. RESULTS High school athletes were significantly stronger (~67% and 35% stronger for males and females, respectively) and jumped higher (regardless of sex) compared to school age athletes. High school males had worse balance (~28%) compared to their younger counterparts. High school females had lower strength (~23%) compared to males but had better balance (~46%). Conclusion: Maturation had different effects on the variables analyzed and sex differences were mainly observed after maturation. These differences may be minimized through appropriate age and sex specific training programs. LEVELS OF EVIDENCE 3a. CLINICAL RELEVANCE Neuromuscular and biomechanical differences between sex and age groups should be accounted for in injury prevention and rehabilitation. Inadequate training may be a primary factor contributing to injuries in a young athletic population. When designing training programs for long term athlete development, programs should be dependent on decrements seen at specific time points throughout maturation.What is known about the subject: Generally, both males and females get stronger and jump higher as they get older but the results comparing balance and biomechanics between genders or across age groups have been mixed.What this study adds to existing knowledge: The current study looks at multiple neuromuscular and biomechanical variables in male and female participants at different maturation statuses. The current data supports the significant changes observed in strength and jump height, as both genders age, but the data also demonstrates significant differences in balance between age groups in males and between genders in balance and knee flexion angles.
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14
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Hilton EN, Lundberg TR. Transgender Women in the Female Category of Sport: Perspectives on Testosterone Suppression and Performance Advantage. Sports Med 2021; 51:199-214. [PMID: 33289906 PMCID: PMC7846503 DOI: 10.1007/s40279-020-01389-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Males enjoy physical performance advantages over females within competitive sport. The sex-based segregation into male and female sporting categories does not account for transgender persons who experience incongruence between their biological sex and their experienced gender identity. Accordingly, the International Olympic Committee (IOC) determined criteria by which a transgender woman may be eligible to compete in the female category, requiring total serum testosterone levels to be suppressed below 10 nmol/L for at least 12 months prior to and during competition. Whether this regulation removes the male performance advantage has not been scrutinized. Here, we review how differences in biological characteristics between biological males and females affect sporting performance and assess whether evidence exists to support the assumption that testosterone suppression in transgender women removes the male performance advantage and thus delivers fair and safe competition. We report that the performance gap between males and females becomes significant at puberty and often amounts to 10-50% depending on sport. The performance gap is more pronounced in sporting activities relying on muscle mass and explosive strength, particularly in the upper body. Longitudinal studies examining the effects of testosterone suppression on muscle mass and strength in transgender women consistently show very modest changes, where the loss of lean body mass, muscle area and strength typically amounts to approximately 5% after 12 months of treatment. Thus, the muscular advantage enjoyed by transgender women is only minimally reduced when testosterone is suppressed. Sports organizations should consider this evidence when reassessing current policies regarding participation of transgender women in the female category of sport.
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Affiliation(s)
- Emma N Hilton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tommy R Lundberg
- Department of Laboratory Medicine/ANA Futura, Division of Clinical Physiology, Karolinska Institutet, Alfred Nobles Allé 8B, Huddinge, 141 52, Stockholm, Sweden.
- Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
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15
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Sorushanova A, Skoufos I, Tzora A, Mullen AM, Zeugolis DI. The influence of animal species, gender and tissue on the structural, biophysical, biochemical and biological properties of collagen sponges. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:12. [PMID: 33475864 PMCID: PMC7819930 DOI: 10.1007/s10856-020-06485-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/18/2020] [Indexed: 05/03/2023]
Abstract
Although collagen type I is extensively used in biomedicine, no study to-date has assessed how the properties of the produced scaffolds are affected as a function of species, gender and tissue from which the collagen was extracted. Herein, we extracted and characterised collagen from porcine and bovine, male and female and skin and tendon tissues and we subsequently fabricated and assessed the structural, biophysical, biochemical and biological properties of collagen sponges. All collagen preparations were of similar purity and free-amine content (p > 0.05). In general, the porcine groups yielded more collagen; had higher (p < 0.05) denaturation temperature and resistance to enzymatic degradation; and lower (p < 0.05) swelling ratio and compression stress and modulus than the bovine groups of the same gender and tissue. All collagen preparations supported growth of human dermal fibroblasts and exhibited similar biological response to human THP-1 monocytes. These results further illustrate the need for standardisation of collagen preparations for the development of reproducible collagen-based devices. Assessment of the physicochemical and biological properties of collagen sponges as a function of animal species (bovine versus porcine), gender (male versus female) and tissue (skin versus tendon).
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Affiliation(s)
- Anna Sorushanova
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
| | - Ioannis Skoufos
- Laboratory of Animal Science, Nutrition and Biotechnology, School of Agriculture, University of Ioannina, Arta, Greece
| | - Athina Tzora
- Laboratory of Animal Science, Nutrition and Biotechnology, School of Agriculture, University of Ioannina, Arta, Greece
| | | | - Dimitrios I Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland.
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland.
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.
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16
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Healthy women confined to 60 days of bed rest showed no change in Achilles tendon dimensions but reduced calcaneal bone density. Ann Phys Rehabil Med 2020; 64:101412. [PMID: 32619632 DOI: 10.1016/j.rehab.2020.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/19/2020] [Accepted: 05/24/2020] [Indexed: 11/22/2022]
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17
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Szczesny SE, Aeppli C, David A, Mauck RL. Fatigue loading of tendon results in collagen kinking and denaturation but does not change local tissue mechanics. J Biomech 2018. [PMID: 29519673 DOI: 10.1016/j.jbiomech.2018.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fatigue loading is a primary cause of tendon degeneration, which is characterized by the disruption of collagen fibers and the appearance of abnormal (e.g., cartilaginous, fatty, calcified) tissue deposits. The formation of such abnormal deposits, which further weakens the tissue, suggests that resident tendon cells acquire an aberrant phenotype in response to fatigue damage and the resulting altered mechanical microenvironment. While fatigue loading produces clear changes in collagen organization and molecular denaturation, no data exist regarding the effect of fatigue on the local tissue mechanical properties. Therefore, the objective of this study was to identify changes in the local tissue stiffness of tendons after fatigue loading. We hypothesized that fatigue damage would reduce local tissue stiffness, particularly in areas with significant structural damage (e.g., collagen denaturation). We tested this hypothesis by identifying regions of local fatigue damage (i.e., collagen fiber kinking and molecular denaturation) via histologic imaging and by measuring the local tissue modulus within these regions via atomic force microscopy (AFM). Counter to our initial hypothesis, we found no change in the local tissue modulus as a consequence of fatigue loading, despite widespread fiber kinking and collagen denaturation. These data suggest that immediate changes in topography and tissue structure - but not local tissue mechanics - initiate the early changes in tendon cell phenotype as a consequence of fatigue loading that ultimately culminate in tendon degeneration.
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Affiliation(s)
- Spencer E Szczesny
- Department of Orthopaedic Surgery, University of Pennsylvania, 110 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA 19104, United States; Department of Biomedical Engineering, Department of Orthopaedics and Rehabilitation, Pennsylvania State University, 205 Hallowell Building, University Park, PA 16802, United States.
| | - Céline Aeppli
- Eidgenössische Technische Hochschule, Rämistrasse 101, 8092 Zürich, Switzerland
| | - Alexander David
- Department of Bioengineering, 240 Skirkanich Hall, 210 South 33rd Street, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Robert L Mauck
- Department of Orthopaedic Surgery, University of Pennsylvania, 110 Stemmler Hall, 36th Street & Hamilton Walk, Philadelphia, PA 19104, United States; Department of Bioengineering, 240 Skirkanich Hall, 210 South 33rd Street, University of Pennsylvania, Philadelphia, PA 19104, United States; Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, United States
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