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Zellers JA, Edalati M, Eekhoff JD, McNish R, Tang SY, Lake SP, Mueller MJ, Hastings MK, Zheng J. Quantative MRI predicts tendon mechanical behavior, collagen composition, and organization. J Orthop Res 2023; 41:2329-2338. [PMID: 36324161 PMCID: PMC10151441 DOI: 10.1002/jor.25471] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/06/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
Quantitative magnetic resonance imaging (qMRI) measures have provided insights into the composition, quality, and structure-function of musculoskeletal tissues. Low signal-to-noise ratio has limited application to tendon. Advances in scanning sequences and sample positioning have improved signal from tendon allowing for evaluation of structure and function. The purpose of this study was to elucidate relationships between tendon qMRI metrics (T1, T2, T1ρ and diffusion tensor imaging [DTI] metrics) with tendon tissue mechanics, collagen concentration and organization. Sixteen human Achilles tendon specimens were collected, imaged with qMRI, and subjected to mechanical testing with quantitative polarized light imaging. T2 values were related to tendon mechanics [peak stress (rsp = 0.51, p = 0.044), equilibrium stress (rsp = 0.54, p = 0.033), percent relaxation (rsp = -0.55, p = 0.027), hysteresis (rsp = -0.64, p = 0.007), linear modulus (rsp = 0.67, p = 0.009)]. T1ρ had a statistically significant relationship with percent relaxation (r = 0.50, p = 0.048). Collagen content was significantly related to DTI measures (range of r = 0.56-0.62). T2 values from a single slice of the midportion of human Achilles tendons were strongest predictors of tendon tensile mechanical metrics. DTI diffusivity indices (mean diffusivity, axial diffusivity, radial diffusivity) were strongly correlated with collagen content. These findings build on a growing body of literature supporting the feasibility of qMRI to characterize tendon tissue and noninvasively measure tendon structure and function. Statement of Clinical Significance: Quantitative MRI can be applied to characterize tendon tissue and is a noninvasive measure that relates to tendon composition and mechanical behavior.
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Affiliation(s)
- Jennifer A. Zellers
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Masoud Edalati
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
| | - Jeremy D. Eekhoff
- Department of Biomedical Engineering; Washington University in St. Louis
| | - Reika McNish
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
| | - Simon Y. Tang
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Spencer P. Lake
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
- Department of Mechanical Engineering & Materials Science; Washington University in St. Louis
| | - Michael J. Mueller
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
| | - Mary K. Hastings
- Program in Physical Therapy; Washington University School of Medicine in St. Louis
- Department of Orthopaedic Surgery; Washington University School of Medicine in St. Louis
| | - Jie Zheng
- Mallinckrodt Institute of Radiology; Washington University School of Medicine in St. Louis
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2
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Williamson PM, Yeritsyan D, Peacock T, Chainani P, Momenzadeh K, Asciutto D, Pathirana P, Avakian C, Stewart I, Kheir N, Abbasian M, DeAngelis JP, Ramappa AJ, Nazarian A. A passive ankle dorsiflexion testing system to assess mechanobiological and structural response to cyclic loading in rat Achilles tendon. J Biomech 2023; 156:111664. [PMID: 37302164 PMCID: PMC10439675 DOI: 10.1016/j.jbiomech.2023.111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/16/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
Tendinopathy is thought to be caused by repeated overload of the tendon with insufficient recovery time, leading to an inadequate healing response and incomplete recovery of preinjury material strength and function. The etiology of tendinopathy induced by mechanical load is being explored with a variety of mechanical load scenarios in small animals. This study establishes a testing system that applies passive ankle dorsiflexion to a rat hindlimb, estimates the force applied to the tendon during cyclic loading and enables the assessment of subsequent structural and biological changes. We demonstrated that the system had no drift in the applied angle, and the registered maximum angle and torque inputs and outputs were consistent between tests. We showed that cyclic loading decreased hysteresis and loading and unloading moduli with increasing cycles applied to the tendon. Histology showed gross changes to tendon structure. This work establishes a system for passively loading the rat Achilles tendon in-vivo in a physiological manner, facilitating future studies that will explore how mechanics, structure, and biology are altered by mechanical repetitive loading.
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Affiliation(s)
- Patrick M Williamson
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Boston University, Mechanical Engineering Department, Boston, MA
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas Peacock
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Pooja Chainani
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Boston University, Mechanical Engineering Department, Boston, MA
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dominic Asciutto
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Priyan Pathirana
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christina Avakian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Isabella Stewart
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph P DeAngelis
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Yerevan State Medical University. Yerevan, Armenia.
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3
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Michikura M, Ogura M, Hori M, Matsuki K, Makino H, Hosoda K, Harada-Shiba M. Association between Achilles Tendon Softness and Atherosclerotic Cardiovascular Disease in Patients with Familial Hypercholesterolemia. J Atheroscler Thromb 2022; 29:1603-1612. [PMID: 35013021 DOI: 10.5551/jat.63151] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Achilles tendon (AT) xanthomas are a specific physical finding of familial hypercholesterolemia (FH) and AT thickness has been used for its diagnosis and evaluation of its severity. Recently, we reported that the AT of FH patients was softer than that of non-FH patients and the combined use of a cut-off value for AT softness with that for AT thickness improved diagnostic accuracy. However, an association between AT softness and severity of atherosclerosis has not been reported. Accordingly, the present study aimed to investigate whether AT softness was associated with carotid atherosclerosis and presence of atherosclerotic cardiovascular disease (ASCVD) in FH. METHODS The AT of 176 genetically diagnosed FH patients and 98 non-FH patients was examined to measure AT thickness and the elasticity index (EI) as an indicator for assessing AT softness using ultrasonography. RESULTS Increased age was associated with AT softness, and overweight was negatively related to AT softness. There were significant inverse correlations between EI and maximum and mean intima-media thickness (IMT) within the common carotid artery only among FH patients. In multiple linear regression analysis, although the relationship between EI and mean IMT was attenuated, the association between EI and maximum IMT remained robust. In logistic regression analysis adjusted for age, sex and traditional cardiovascular risk factors (smoking history, presence of hypertension, presence of diabetes mellitus, overweight, LDL-cholesterol, HDL-cholesterol, and Log triglycerides), EI was associated with presence of ASCVD (Odds ratio per 1-SD increase, 0.37;95% CI, 0.15 - 0.86; P=0.0252). CONCLUSION The degree of lipid deposition in the AT of FH patients could be assessed by its thickness as well as its softness. AT softness is not only useful in diagnosing FH but is also associated with the severity of carotid atherosclerosis and presence of ASCVD. In addition, these findings suggest that AT softness would be helpful in risk assessment for FH patients.
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Affiliation(s)
- Masahito Michikura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center Hospital
| | - Masatsune Ogura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of General Medical Science, Chiba University Graduate School of Medicine.,Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Mika Hori
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of Endocrinology, Research Institute of Environmental Medicine, Nagoya University
| | - Kota Matsuki
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine
| | - Hisashi Makino
- Department of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center Hospital
| | - Kiminori Hosoda
- Department of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center Hospital
| | - Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
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4
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Ehrle A, Lilge S, Clegg PD, Maddox TW. Equine flexor tendon imaging part 2: Current status and future directions in advanced diagnostic imaging, with focus on the deep digital flexor tendon. Vet J 2021; 278:105763. [PMID: 34678501 DOI: 10.1016/j.tvjl.2021.105763] [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: 01/30/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Flexor tendon injuries are a common cause of lameness and early retirement in equine athletes. While ultrasonography is most frequently utilised, advanced diagnostic imaging modalities are becoming more widely available for detection and monitoring of flexor tendon lesions. Part two of this literature review details current experience with low- and high-field magnetic resonance imaging (MRI) and computed tomography (CT) for the diagnosis of equine flexor tendinopathy with a focus on the deep digital flexor tendon. Implications of the 'magic angle' artefact as well as injection techniques and the use of contrast media are discussed. Future developments in tendon imaging aim to gain enhanced structural information about the tendon architecture with the prospect to prevent injury. Techniques as described for the assessment of the human Achilles tendon including ultra-high field MRI and positron emission tomography are highlighted.
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Affiliation(s)
- Anna Ehrle
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; Equine Clinic, Freie Universität Berlin, 10965 Berlin, Germany.
| | - Svenja Lilge
- Equine Clinic, Freie Universität Berlin, 10965 Berlin, Germany
| | - Peter D Clegg
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston CH64 7TE, UK
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5
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Patel D, Zamboulis DE, Spiesz EM, Birch HL, Clegg PD, Thorpe CT, Screen HR. Structure-function specialisation of the interfascicular matrix in the human achilles tendon. Acta Biomater 2021; 131:381-390. [PMID: 34271169 PMCID: PMC8388240 DOI: 10.1016/j.actbio.2021.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/14/2021] [Accepted: 07/08/2021] [Indexed: 01/24/2023]
Abstract
Tendon consists of highly aligned collagen-rich fascicles surrounded by interfascicular matrix (IFM). Some tendons act as energy stores to improve locomotion efficiency, but such tendons commonly obtain debilitating injuries. In equine tendons, energy storing is achieved primarily through specialisation of the IFM. However, no studies have investigated IFM structure-function specialisation in human tendons. Here, we compare the human positional anterior tibial tendon and energy storing Achilles tendons, testing the hypothesis that the Achilles tendon IFM has specialised composition and mechanical properties, which are lost with ageing. Data demonstrate IFM specialisation in the energy storing Achilles, with greater elasticity and fatigue resistance than in the positional anterior tibial tendon. With ageing, alterations occur predominantly to the proteome of the Achilles IFM, which are likely responsible for the observed trends towards decreased fatigue resistance. Knowledge of these key energy storing specialisations and their changes with ageing offers crucial insight towards developing treatments for tendinopathy. Statement of significance Developing effective therapeutics or preventative measures for tendon injury necessitates the understanding of healthy tendon function and mechanics. By establishing structure-function relationships in human tendon and determining how these are affected by ageing, potential targets for therapeutics can be identified. In this study, we have used a combination of mechanical testing, immunolabelling and proteomics analysis to study structure-function specialisations in human tendon. We demonstrate that the interfascicular matrix is specialised for energy storing in the Achilles tendon, and that its proteome is altered with ageing, which is likely responsible for the observed trends towards decreased fatigue resistance. Knowledge of these key energy storing specialisations and their changes with ageing offers crucial insight towards developing treatments and preventative approaches for tendinopathy.
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6
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Szaro P, Nilsson-Helander K, Carmont M. MRI of the Achilles tendon-A comprehensive pictorial review. Part one. Eur J Radiol Open 2021; 8:100342. [PMID: 33850971 PMCID: PMC8039565 DOI: 10.1016/j.ejro.2021.100342] [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: 01/27/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/28/2022] Open
Abstract
Presence of normal septation between subtendons may mimic an intrasubstance tear. MRI is superior to ultrasound in detection of partial tears. Ultrasound is as useful as MRI in detection of tendinopathy and full-thickness tears. Kager's fat pad is involved in infection more than in postoperative changes. The Achilles tendon xanthoma has a higher signal on T1- and T2-weighted sequences.
The normal Achilles tendon is composed of twisted subtendons separated by thin high signal septae, which are a potential pitfall on MRI because they mimic a tendon tear. Tendinopathy and full thickness tears may be assessed effectively both on MRI and ultrasound. MRI is superior to ultrasound in detection of partial tears and for postoperative assessment. The use of fat suppression sequences allows the ability to detect focal lesions. Sagittal and coronal sections are useful for assessing the distance between stumps of a ruptured tendon. Sequences with contrast are indicated in postoperative investigations and suspicion of infection, arthritis or tumor. MRI may reveal inflammatory changes with minor symptoms long before the clinical manifestations of seronegative spondyloarthropathy. The most common non-traumatic focal lesion of the Achilles tendon is Achilles tendon xanthoma, which is manifested by intermediate or slightly higher signal on T1- and T2-weighted images compared to that in the normal Achilles tendon. Other tumors of the Achilles tendon are very rare, whereas the involvement of the tendon from tumor in adjacent structures is more frequent. The novel MRI sequences may help to detect disorders of the Achilles tendon more specifically before clinical manifestation. Regeneration or remodeling of the Achilles tendon can be non‐invasively detected and monitored in diffusion tensor imaging. Assessment of healing is possible using T2-mapping while evaluating the tendon vascularization in intravoxel incoherent motion MRI.
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Affiliation(s)
- Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Musculoskeletal Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - Katarina Nilsson-Helander
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Michael Carmont
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.,The Department of Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, UK
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7
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Anjum MAR, Gonzalez FM, Swain A, Leisen J, Hosseini Z, Singer A, Umpierrez M, Reiter DA. Multi-component T 2 ∗ relaxation modelling in human Achilles tendon: Quantifying chemical shift information in ultra-short echo time imaging. Magn Reson Med 2021; 86:415-428. [PMID: 33590557 DOI: 10.1002/mrm.28686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE To examine multi-component relaxation modelling for quantification of on- and off-resonance relaxation signals in multi-echo ultra-short echo time (UTE) data of human Achilles tendon (AT) and compare bias and dispersion errors of model parameters to that of the bi-component model. THEORY AND METHODS Multi-component modelling is demonstrated for quantitative multi-echo UTE analysis of AT and supported using a novel method for determining number of MR-visible off-resonance components, UTE data from six healthy volunteers, and analysis of proton NMR measurements from ex vivo bovine AT. Cramer-Rao lower bound expressions are presented for multi- and bi-component models and parameter estimate variances are compared. Bias error in bi-component estimates is characterized numerically. RESULTS Two off-resonance components were consistently detected in all six volunteers and in bovine AT data. Multi-component model exhibited superior quality of fit, with a marginal increase in estimate variance, when compared to the bi-component model. Bi-component estimates exhibited notable bias particularly in R 2 , 1 ∗ in the presence of off-resonance components. CONCLUSION Multi-component modelling more reliably quantifies tendon matrix water components while also providing quantitation of additional non-water matrix constituents. Further work is needed to interpret the origin of the observed off-resonance signals with preliminary assignments made to chemical groups in lipids and proteoglycans.
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Affiliation(s)
- Muhammad A R Anjum
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Felix M Gonzalez
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Anshuman Swain
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Johannes Leisen
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Zahra Hosseini
- MR R&D Collaborations, Siemens Medical Solutions Inc., Atlanta, Georgia, USA
| | - Adam Singer
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Monica Umpierrez
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - David A Reiter
- Department of Radiology & Imaging Sciences, School of Medicine, Emory University, Atlanta, Georgia, USA.,Department of Orthopedics, School of Medicine, Emory University, Atlanta, Georgia, USA
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8
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Passive Mechanical Properties of Human Medial Gastrocnemius and Soleus Musculotendinous Unit. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8899699. [PMID: 33628828 PMCID: PMC7889354 DOI: 10.1155/2021/8899699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
The in vivo characterization of the passive mechanical properties of the human triceps surae musculotendinous unit is important for gaining a deeper understanding of the interactive responses of the tendon and muscle tissues to loading during passive stretching. This study sought to quantify a comprehensive set of passive muscle-tendon properties such as slack length, stiffness, and the stress-strain relationship using a combination of ultrasound imaging and a three-dimensional motion capture system in healthy adults. By measuring tendon length, the cross-section areas of the Achilles tendon subcompartments (i.e., medial gastrocnemius and soleus aspects), and the ankle torque simultaneously, the mechanical properties of each individual compartment can be specifically identified. We found that the medial gastrocnemius (GM) and soleus (SOL) aspects of the Achilles tendon have similar mechanical properties in terms of slack angle (GM: -10.96° ± 3.48°; SOL: -8.50° ± 4.03°), moment arm at 0° of ankle angle (GM: 30.35 ± 6.42 mm; SOL: 31.39 ± 6.42 mm), and stiffness (GM: 23.18 ± 13.46 Nmm-1; SOL: 31.57 ± 13.26 Nmm-1). However, maximal tendon stress in the GM was significantly less than that in SOL (GM: 2.96 ± 1.50 MPa; SOL: 4.90 ± 1.88 MPa, p = 0.024), largely due to the higher passive force observed in the soleus compartment (GM: 99.89 ± 39.50 N; SOL: 174.59 ± 79.54 N, p = 0.020). Moreover, the tendon contributed to more than half of the total muscle-tendon unit lengthening during the passive stretch. This unequal passive stress between the medial gastrocnemius and the soleus tendon might contribute to the asymmetrical loading and deformation of the Achilles tendon during motion reported in the literature. Such information is relevant to understanding the Achilles tendon function and loading profile in pathological populations in the future.
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9
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Otter S, Payne C, Jones AM, Webborn N, Watt P. Differences in Achilles tendon stiffness in people with gout: a pilot study. BMC Musculoskelet Disord 2020; 21:658. [PMID: 33028270 PMCID: PMC7542740 DOI: 10.1186/s12891-020-03598-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background Gout has been associated with weaker foot/leg muscles and altered gait patterns. There is also evidence of on-going foot pain and an increased risk of tendinopathy, with the Achilles and patella tendons most frequently affected in gout. Additionally, the inflammation associated with gout may change tissue elasticity. Ultrasound imaging utilising shear wave elastography (SWE) offers a non-invasive method of quantifying changes in tendon stiffness. SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with gout compared to controls (non-gout). Methods A cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated, and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along the centre of a longitudinal section of the mid-portion of each Achilles tendon. Prior to data collection, intra-observer error was good (>0.69). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI). Results A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04 m/s (95% CI (0.38 to 1.7) p = 0.003 and left Achilles mdiff = 0.7 m/s (95% CI 0.09 to 1.32) p = 0.025. No relationship between the presence of tophi and SWE values were detected. Conclusion Subjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.
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Affiliation(s)
- Simon Otter
- School of Health Sciences, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR, UK. .,Centre for Regenerative Medicine and Devices, University of Brighton, Lewes Road, Brighton, BN2 4AT, UK.
| | - Catherine Payne
- School of Sport and Service Management, University of Brighton, Hillbrow, Denton Road, Eastbourne, BN20 7SR, UK
| | - Anna-Marie Jones
- Research and Development, Sussex Partnership NHS Foundation Trust, Swandean, Arundel Road, Worthing, BN13 3EP, UK
| | - Nick Webborn
- Centre for Regenerative Medicine and Devices, University of Brighton, Lewes Road, Brighton, BN2 4AT, UK
| | - Peter Watt
- Centre for Regenerative Medicine and Devices, University of Brighton, Lewes Road, Brighton, BN2 4AT, UK.,School of Sport and Service Management, University of Brighton, Hillbrow, Denton Road, Eastbourne, BN20 7SR, UK
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10
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Chen PY, Yang TH, Kuo LC, Shih CC, Huang CC. Characterization of Hand Tendons Through High-Frequency Ultrasound Elastography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:37-48. [PMID: 31478846 DOI: 10.1109/tuffc.2019.2938147] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Tendon stiffness plays an important role in the tendon healing process, and many studies have indicated that measuring the shear wave velocity (SWV) on tendons relates to their stiffness. Because the thickness of hand tendons is a few millimeters, high-resolution imaging is required for visualizing hand tissues. However, the resolution of current ultrasound elastography systems is insufficient. In this study, a high-frequency (HF) ultrasound elastography system is proposed for measuring the SWVs of hand tendons. The HF ultrasound elastography system uses an external vibrator to create shear waves on hand tendons. Then, it uses a 40-MHz HF ultrasound array transducer with ultrafast ultrasound imaging technology to measure the SWV for characterizing hand tendons. A handheld device that combines a transducer and a vibrator allows the user to scan hand tissues. The biases of HF ultrasound elastography were measured in gelatin phantom experiments and were less than 6% compared to standard mechanical testing approach. Human experiments showed the ability to use HF ultrasound elastography to distinguish different SWVs of hand tendons. The SWVs were 0.73 ± 0.65 m/s and 1 ± 0.54 m/s for flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP), respectively, and 0.52 ± 0.14 m/s and 4.02 ± 0.77 m/s for extensor tendon under stretch and contraction conditions, respectively. The simplicity and convenience of the HF ultrasound elastography system for measuring hand tendon stiffness make it a promising tool for evaluating the severity of hand injuries and the performance of rehabilitation after hand injuries.
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Abstract
OBJECTIVE. For many years, MRI of the musculoskeletal system has relied mostly on conventional sequences with qualitative analysis. More recently, using quantitative MRI applications to complement qualitative imaging has gained increasing interest in the MRI community, providing more detailed physiologic or anatomic information. CONCLUSION. In this article, we review the current state of quantitative MRI, technical and software advances, and the most relevant clinical and research musculoskeletal applications of quantitative MRI.
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12
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Docking SI, Cook J. How do tendons adapt? Going beyond tissue responses to understand positive adaptation and pathology development: A narrative review. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2019; 19:300-310. [PMID: 31475937 PMCID: PMC6737558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Understanding how tendons adapt to load is crucial to understanding how training can improve performance, minimise the risk of injury and aid rehabilitation. Adaptation is the positive response of an organism or tissue to benefit its function. In tendons, numerous tissue responses to load have been identified in vivo. Changes in tendon dimensions, structure on imaging, mechanical properties, and blood flow have been reported in response to mechanical stimuli. However, research has focused on tissue level changes with little understanding of how changes at the tissue level affect the person, their athletic performance or injury risk. Tendons can have a paradoxical response to load, load can induce positive adaptation, however it is also a major factor in the development of tendon pathology and pain. Tendon pathology is a risk factor for developing symptoms, yet the high rate of asymptomatic pathology suggests that the pathological tendon must adapt to be able to tolerate load. Similarly, there is mounting evidence to suggest that tendon remodelling or repair is not necessary for a positive clinical outcome following rehabilitation, suggesting that the tendon must adapt via other mechanisms. This narrative review synthesises evidence of how normal and pathological tendons adapts to load, and how this relates to adaptation of load capacity and function of the individual.
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Affiliation(s)
- Sean I. Docking
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Australia,Corresponding author: Dr Sean Docking, La Trobe University Sport & Exercise Medicine Research Centre, La Trobe University, Bundoora VIC 3086, Australia E-mail:
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Australia
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Völlner F, Pilsl U, Craiovan B, Zeman F, Schneider M, Wörner M, Grifka J, Weber M. Stability of knee ligament complex of Thiel-embalmed cadaver compared to in vivo knee. J Mech Behav Biomed Mater 2017; 71:392-396. [PMID: 28411549 DOI: 10.1016/j.jmbbm.2017.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The first biomechanical evaluation of new implants is usually carried out with cadavers. Fixation of Thiel-embalmed cadavers is supposed to preserve the histological structure, colour and consistency of the tissue and has a low risk of infection and toxicity. However, the biomechanical properties of Thiel-fixated tissue are still unknown. The aim of this study was to quantify the effect of the Thiel-embalming method on the elastic properties of the ligament complex of the knee compared to in vivo knees during total knee arthroplasty. METHODS The results of biomechanical tensile tests with 10 Thiel-embalmed knees were compared with the findings of 10 patients who underwent total knee arthroplasty with a standardised knee balancer at our department. We reconstructed the force-elongation curves of the medial and lateral ligament complex and calculated the stiffness in direct correlation with overall soft tissue stability in full extension and in 90° of flexion. RESULTS All curves consisted of a non-linear part at the beginning and a linear part from about 80N onwards. In full extension, median stiffness in the cadavers was 26.6N/mm for the medial compartment and 31.6N/mm for the lateral compartment. The values for in vivo were 25.7N/mm for the medial compartment and 25.3N/mm for the lateral compartment (p=0.684 for the medial compartment and p=0.247 for the lateral compartment). In 90° of flexion, median stiffness in the cadaver group was 24.7N/mm for the medial compartment and 22.2N/mm for the lateral compartment. In vivo, median stiffness was 30.3N/mm for the medial compartment and 29.2N/mm for the lateral compartment (p=0.009 for the medial compartment and p=0.143 for the lateral compartment). CONCLUSION Stiffness of the medial and lateral ligament complex in the knee was comparable between Thiel-embalmed cadavers and in vivo patients during total knee arthroplasty. Thiel fixation seems to preserve the soft tissue properties similar to those in vivo.
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Affiliation(s)
- Florian Völlner
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany.
| | - Ulrike Pilsl
- Institute of Macroscopic and Clinical Anatomy, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | - Benjamin Craiovan
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Florian Zeman
- Center of Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Michael Schneider
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Michael Wörner
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopaedic Surgery, University Medical Centre Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
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