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Steinberg N, Elbaz L, Eliakim A, Nemet D, Bar-Sella S, Peleg S, Dar G. Tendon structure, clinical tests, and pain during-loading in young female competitive gymnasts. J Sports Sci 2024; 42:1605-1616. [PMID: 39299935 DOI: 10.1080/02640414.2024.2403290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
To examine the relationship between Achilles-tendon (AT) and patellar-tendon (PT) structure, clinical-examination and tendon pain in young gymnasts; and, to explore the associations between these factors and age, maturation, and training-load. Two hundred and seventy-four female gymnasts (aged 12.1±1.9 yrs) were assessed for anthropometric measures, pubertal-stage, and training-load. They had clinical-tests (pain-on-palpation for AT and pain-on-palpation and Royal-London Hospital-Test for PT), were asked about tendon-pain during-loading and were assessed for tendon-structure. Gymnasts with positive clinical-tests (with and without pain during-loading) presented a significantly higher prevalence of disorganized AT and PT compared to gymnasts with negative clinical-tests (with and without pain during-loading) (p<0.05). A significant pubertyXpositive clinical-test interaction was found for disorganized PT structure, whereby a disorganized structure was more prevalent among post-pubertal gymnasts with positive clinical-tests compared to pre-pubertal participants with negative clinical-tests (F(1, 263)=9.436, p=0.002). In gymnasts with positive clinical-tests, significant correlations were found between disorganized AT and PT structures and age, and training-load (p<0.05). An increased prevalence of disorganized tendon structure (regardless of pain during-loading) was seen in participants with positive clinical-tests. This disorganized tendon-structure was found to be significantly related to increased age, post-pubertal stage, and higher training hours in gymnasts with positive clinical-tests.
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Affiliation(s)
- Nili Steinberg
- The Academic College Levinsky-Wingate, Wingate Campus, Netanya, Israel
| | - Liav Elbaz
- The Academic College Levinsky-Wingate, Wingate Campus, Netanya, Israel
| | - Alon Eliakim
- Child Health and Sport Center, Pediatrics, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Nemet
- Child Health and Sport Center, Pediatrics, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Bar-Sella
- The Academic College Levinsky-Wingate, Wingate Campus, Netanya, Israel
| | - Smadar Peleg
- The Academic College Levinsky-Wingate, Wingate Campus, Netanya, Israel
| | - Gali Dar
- Department of Physical Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel
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Ortega-Cebrián S, Soler-Rich R, Orozco L, Rodas G. Evaluation of Patellar Tendon Structural Changes following Biological Treatments: Secondary Analysis of Double-Blinded Clinical Trial of Bone Marrow Mesenchymal Stromal Cells and Leukocyte-Poor Platelet-Rich Plasma. Biomedicines 2024; 12:1599. [PMID: 39062172 PMCID: PMC11275081 DOI: 10.3390/biomedicines12071599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
Objective quantification of tendon structural changes through imaging is only achieved by evaluating tendon structure using ultrasound tissue characterization (UTC) technology. This study compares the effects of bone marrow mesenchymal stromal cells (BM-MSC) and leukocyte-poor platelet-rich plasma (Lp-PRP) on tendon structure and clinical outcomes in male patients with patellar tendinopathy measured with UTC at 3, 6, and 12 months after treatment. This is a double-blinded clinical trial with a randomized active control study with 20 male patients diagnosed with patellar tendinopathy who underwent BM-MSC and Lp-PRP. Bilateral ultrasound tissue characterization scans of the patellar tendon were carried out after 3, 6, and 12 months, as well as tests for strength and pain. UTC patellar tendon was analyzed at the insertion, proximal, and mid-tendon. BM-MSC showed a greater capacity to promote further positive changes than Lp-PRP. Lp-PRP presented higher disorganized echo-type II in the mid-tendon (p = 0.04; ES = 1.06) and III (p = 0.02; ES = -1.47) after 3 months in the Lp-PRP group. Similar results were seen after 6 and 12 months. Pain and strength data show improvement in the treated tendon. BM-MSC treatment demonstrates a superior capacity to promote tendon regeneration and organization, restore strength, and reduce pain compared to Lp-PRP, after 3, 6, and 12 months in male patients with patellar tendinopathy.
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Affiliation(s)
- Silvia Ortega-Cebrián
- Physiotherapy Department, Facultat Fisioteràpia, Universitat Internacional de Catalunya (UIC), Carrer Josep Trueta, Sant Cugat de Vallès, 08017 Barcelona, Spain
- Medical Department of Football Club Barcelona (FIFA Medical Center of Excellence), Barça Innovation Hub of Football Club Barcelona, 08970 Barcelona, Spain
| | - Robert Soler-Rich
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, 08022 Barcelona, Spain
| | - Lluis Orozco
- Institut de Teràpia Regenerativa Tissular, Centro Médico Teknon, 08022 Barcelona, Spain
| | - Gil Rodas
- Medical Department of Football Club Barcelona (FIFA Medical Center of Excellence), Barça Innovation Hub of Football Club Barcelona, 08970 Barcelona, Spain
- Sports and Exercise Medicine Unit, Hospital Clinic and Sant Joan de Déu, 08029 Barcelona, Spain
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Steinberg N, Funk S, Zeev A, Waddington G, Svorai-Litvak S, Pantanowitz M. Achilles Tendon and Patellar Tendon Structure in Combat Soldiers Following Prevention Exercises. Mil Med 2023; 188:678-688. [PMID: 35134964 DOI: 10.1093/milmed/usac009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Military training that increases physical stress on musculoskeletal morphology also increases the risk of orthopedic injuries. Somatosensory prevention programs that reduce stress and improve functionality could be beneficial for better organization of tendon structure. The aim of this study was to investigate the impact of a somatosensory prevention exercise on the tendon structure (percentage of echo-type fibers; A-P and M-L diameters and cross-sectional area) of the Achilles tendon and patellar tendon among combat soldiers. MATERIALS AND METHODS These tendons of male Infantry soldiers aged 18-21 were screened before and after a 14-week training course. The intervention group, who performed preventative exercises, included 108 soldiers (BMI = 23.85 ± 2.76), while the control group, who participated in the same military course without these exercises, included 98 soldiers (BMI = 24.26 ± 4.03). Ultrasound scanning for tendon structure included percent of echo-type I-IV fibers, A-P diameter, M-L diameter, and cross-sectional area parameters. RESULTS Time by group interaction was found for echo-type I and II in both tendons. No significant differences were found between the two groups in the pretesting percentage of echo-type IV fibers of the Achilles tendon (P = .522), in echo-type III fibers of the Achilles tendon (P = .833), and echo-type IV fibers of the patellar tendon (P = .162). Greater pre-post differences in echo-type III and IV fibers were found in the control group compared with the intervention group for both the Achilles tendon (P = .021, P = .002) and the patellar tendon (P < .001, P < .001). CONCLUSION Increased damaged fibers (echo-type III and IV) of both tendons were found among the control group, yet not among soldiers who performed prevention exercises.
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Affiliation(s)
- Nili Steinberg
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
| | - Shani Funk
- Combat Fitness Department, Doctrine and Research Branch, IDF, Netanya 01443, Israel
| | - Aviva Zeev
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
| | - Gordon Waddington
- Faculty of Health, University of Canberra, Canberra, ACT 2617, Australia
| | | | - Michal Pantanowitz
- Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya 42902, Israel
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Cencini S, Perrott M, Docking S, Cook J. Proximal patellar tendon abnormalities on ultrasound can develop in male adolescent basketball players: A longitudinal study. Phys Ther Sport 2023; 60:63-69. [PMID: 36682095 DOI: 10.1016/j.ptsp.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/19/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Adolescent patellar tendinopathy is reported but the pubertal-stage of onset of abnormal tendon structure has not been investigated with grayscale ultrasound. AIMS To investigate abnormal tendon structure using grayscale ultrasound and its association with pubertal-stage and pain. METHODS Forty-three male basketball players aged 13.7 years (SD 1.0) had patellar tendon ultrasound scans every 6 months for 2.5 years. Pubertal-stage (peak height velocity) was calculated using the Mirwauld equation. Tendon thickness, hypoechogenicity and pain during single leg decline squat (SLDS) were recorded. Tendons were classified: hypoechoic, normal or immature. RESULTS Two tendons were hypoechoic at baseline. Six developed hypoechogenicity over 2.5 years (eight tendons [9%], six participants [14%]), all in peri and post-PHV players. Twenty-six tendons (17 participants) were classified as immature during the study. Hypoechoic tendons were thicker (5.3 mm SD 1.2) than normal (3.9 mm SD 0.7) tendons (p < 0.001). There was no difference in the proportion of participants reporting pain during SLDS in the hypoechoic (N = 3) and normal (N = 11) groups (p = 0.33), or in hypoechoic tendon thickness between those reporting pain (6.5 mm, SD 1.7) or not (5.2 mm, SD 0.9, p = 0.17). DISCUSSION This study using grayscale ultrasound found that basketball players with hypoechogenicity were peri or post-PHV. Abnormal structure was not always associated with pain.
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Affiliation(s)
- Sebastiano Cencini
- Department of Medicine, Surgery and Neuroscience, University of Siena, (Santa Maria alle Scotte Hospital), Siena, Italy
| | - Margaret Perrott
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.
| | - Sean Docking
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; Monash Department of Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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Steinberg N, Pantanowitz M, Zeev A, Svorai Band S, Funk S, Nemet D. Achilles and patellar tendon structure following a prevention program in male combat soldiers. PHYSICIAN SPORTSMED 2022; 50:531-540. [PMID: 34488525 DOI: 10.1080/00913847.2021.1976601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of the study were to compare the prevalence of soldiers with musculoskeletal symptoms between soldiers that participated in a prevention program (INT) and a control group (CONT); and, to assess whether 'high risk' for a symptom indicator [participants with patellar tendon (PT) echo-type III+IV >10% or Achilles tendon (AT) echo-type III >8.5%] applies when a prevention intervention is used. METHODS Soldiers from two consecutive infantry commanders courses (year 1-CONT, n = 165; year 2-INT, n = 196) were examined pre-course for AT and PT structure using ultrasound tissue characterization (UTC), and their musculoskeletal overuse symptoms were assessed and recorded by military physicians throughout the course. A prevention program was provided to the INT group (year 2) during the 14-week course. RESULTS No significant differences were found in the prevalence of soldiers with symptoms between the two groups [INT: 39 (19.9%), CONT: 40 (24.2%); p = .32]. Using the indicator at baseline, 20 soldiers (10.2%) were suggested to be at 'high risk.' Of those 20 soldiers, 17 actually had symptoms during the course (positive predictive value-85%). The prevalence of soldiers with a suggested 'high risk' according to our indicator who had no symptoms during the course was low (3/20, 15%). Twenty-two soldiers who had symptoms during the course had not been suggested to be at 'high risk' by our indicator. CONCLUSION Our intervention did not reduce the prevalence of soldiers with symptoms. Our 'high risk' pre-course, AT and PT structure indicator is valid and can be used as a screening tool to reduce the prevalence of symptoms in combat soldiers; with the caution that soldiers that were not identified by the indicator, might also have symptoms along the course.
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Affiliation(s)
- Nili Steinberg
- Life science, Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | - Michal Pantanowitz
- Life science, Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | - Aviva Zeev
- Life science, Wingate College of Physical Education and Sports Sciences, Wingate Institute, Netanya, Israel
| | | | - Shany Funk
- Combat Fitness Department, Doctrine and Research Branch, Israel
| | - Dan Nemet
- Child Health and Sport Center, Pediatric Department, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
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Ortega-Cebrián S, Navarro R, Seda S, Salas S, Guerra-Balic M. Patellar Tendon Structural Adaptations Occur during Pre-Season and First Competitive Cycle in Male Professional Handball Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212156. [PMID: 34831912 PMCID: PMC8624795 DOI: 10.3390/ijerph182212156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022]
Abstract
Background: While there is evidence that tendon adapts to training load, structural alterations in the patellar tendon in response to training loads are still unclear. The aim of this study is to identify changes in patellar tendon structure throughout pre-season and after finalizing the first competitive cycle. Methods: Nineteen professional handball players participated in the aforesaid cross-sectional study, in which patellar tendon scan and counter movement jump (CMJ) performance were conducted. Measurements were taken on the first and last day of pre-season training, and at the end of the first competitive cycle. Results: The results revealed that variation on the tendon structure occurred, mainly at the end of pre-season training; for injured tendons this occurred at the proximal (Right p = 0.02), distal (Right p = 0.01), and (Left p = 0.02) tendon, while changes in healthy tendons occurred at the mid (Left p = 0.01) and distal tendon (Right p = 0.01). At the end of the first competitive cycle, changes were observed in the distal injured tendon (p = 0.02). Conclusion: Patellar tendon shows greater structural change after completing pre-season training than at the end of the first competitive cycle, from which it may be inferred that gradual loading during pre-season training allows the tendon to adapt and potentially decrease the onset of patellar tendinopathy.
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Affiliation(s)
- Silvia Ortega-Cebrián
- Physiotherapy Department, Facultat Fisioteràpia, Universitat Internacional de Catalunya (UIC), Carrer Josep Trueta, Sant Cugat de Vallès, 08017 Barcelona, Spain
- Futbol Club Barcelona, Medical Department, Ciutat Esportiva Joan Gamper, Avinguda, Once Setembre, Sant Joan Despí, 08970 Barcelona, Spain; (R.N.); (S.S.); (S.S.)
- Correspondence: ; Tel.: +34-932541800
| | - Ramon Navarro
- Futbol Club Barcelona, Medical Department, Ciutat Esportiva Joan Gamper, Avinguda, Once Setembre, Sant Joan Despí, 08970 Barcelona, Spain; (R.N.); (S.S.); (S.S.)
| | - Sergi Seda
- Futbol Club Barcelona, Medical Department, Ciutat Esportiva Joan Gamper, Avinguda, Once Setembre, Sant Joan Despí, 08970 Barcelona, Spain; (R.N.); (S.S.); (S.S.)
| | - Sebastià Salas
- Futbol Club Barcelona, Medical Department, Ciutat Esportiva Joan Gamper, Avinguda, Once Setembre, Sant Joan Despí, 08970 Barcelona, Spain; (R.N.); (S.S.); (S.S.)
| | - Myriam Guerra-Balic
- Faculty of Psychology, Education and Sports Sciences, University Ramon Llull, Spain FPCEE-Blanquerna, 08022 Barcelona, Spain;
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Sarto F, Spörri J, Fitze DP, Quinlan JI, Narici MV, Franchi MV. Implementing Ultrasound Imaging for the Assessment of Muscle and Tendon Properties in Elite Sports: Practical Aspects, Methodological Considerations and Future Directions. Sports Med 2021; 51:1151-1170. [PMID: 33683628 PMCID: PMC8124062 DOI: 10.1007/s40279-021-01436-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/16/2022]
Abstract
Ultrasound (US) imaging has been widely used in both research and clinical settings to evaluate the morphological and mechanical properties of muscle and tendon. In elite sports scenarios, a regular assessment of such properties has great potential, namely for testing the response to training, detecting athletes at higher risks of injury, screening athletes for structural abnormalities related to current or future musculoskeletal complaints, and monitoring their return to sport after a musculoskeletal injury. However, several practical and methodological aspects of US techniques should be considered when applying this technology in the elite sports context. Therefore, this narrative review aims to (1) present the principal US measures and field of applications in the context of elite sports; (2) to discuss, from a methodological perspective, the strengths and shortcomings of US imaging for the assessment of muscle and tendon properties; and (3) to provide future directions for research and application.
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Affiliation(s)
- Fabio Sarto
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Daniel P Fitze
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonathan I Quinlan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Marco V Narici
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- CIR-MYO Myology Centre, University of Padova, Padova, Italy
| | - Martino V Franchi
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
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The influence of a multidisciplinary intervention program on Achilles tendon structure in children with overweight and obesity. Eur J Pediatr 2020; 179:1787-1796. [PMID: 32451724 DOI: 10.1007/s00431-020-03685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
The effects of childhood obesity on tendon structure and its relation to physical activity are barely known. We aimed to investigate the influence of a 6-month multidisciplinary childhood obesity management program (which included dietary intervention and an exercise program) on Achilles tendon structure in overweight/obese children. Twenty-five overweight/obese children (overweight group) who participated in a 6-month multidisciplinary childhood obesity program, and 27 normal-weight controls were examined for anthropometric measurements and for Achilles tendon structure (using ultrasound tissue characterization to capture a three-dimensional structure of four echo type fibers and the cross-sectional area) at baseline, 3, and 6 months. The BMI of the overweight group significantly decreased from the pre- to the post-intervention period, (p = .002, η2 = .229), yet among the control group, the BMI significantly increased (p = .002, η2 = .222). Interactions (pre-post × group) showed a significant decrease in the prevalence of echo type I and in echo type III fibers and a significant increase in the prevalence of echo type II fibers and in the cross-sectional area along the intervention. No significant changes in echo type fibers were found in the control group along the 6 months.Conclusion: At pre-intervention, the overweight group had significantly "worse" tendon structure, with a lower prevalence of echo type II fiber and a higher prevalence of echo type III fibers compared with the control group. Following the 6-month intervention, the tendon structure of the overweight group was "positively" changed, with reduced echo type III fibers and increased echo type II fibers. What is Known: • Physical activity and weight reduction programs are efficient for obese children. • Obese children tend to suffer orthopedic problems and pain during physical activity. What is New: • Pre-intervention, obese children had 'worse' tendon structure compared to controls. • Following 6-month program, tendon structure of obese children 'positively' changed.
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Charcharis G, Mersmann F, Bohm S, Arampatzis A. Morphological and Mechanical Properties of the Quadriceps Femoris Muscle-Tendon Unit From Adolescence to Adulthood: Effects of Age and Athletic Training. Front Physiol 2019; 10:1082. [PMID: 31507446 PMCID: PMC6718516 DOI: 10.3389/fphys.2019.01082] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/07/2019] [Indexed: 12/30/2022] Open
Abstract
The combined effects of mechanical loading and maturation during adolescence are still not well understood. The purpose of the study was to investigate the development of the quadriceps femoris muscle-tendon unit from early adolescence (EA), late adolescence (LA) to young adulthood (YA), and examine how it is influenced by athletic training in a cross-sectional design. Forty-one male athletes and forty male non-athletes from three different age groups (EA: 12-14 years, n = 29; LA: 16-18 years, n = 27; and YA: 20-35 years, n = 25) participated in the present study. Maximum strength of the knee extensor muscles, architecture of the vastus lateralis (VL) muscle and patellar tendon stiffness were examined using dynamometry, motion capture, electromyography, and ultrasonography. Muscle strength and tendon stiffness significantly increased (p < 0.001) from EA to LA without any further alterations (p > 0.05) from LA to YA. Athletes compared to non-athletes showed significantly greater (p < 0.001) absolute muscle strength (EA: 3.52 ± 0.75 vs. 3.20 ± 0.42 Nm/kg; LA: 4.47 ± 0.61 vs. 3.83 ± 0.56 Nm/kg; and YA: 4.61 ± 0.55 vs. 3.60 ± 0.53), tendon stiffness (EA: 990 ± 317 vs. 814 ± 299 N/mm; LA: 1266 ± 275 vs. 1110 ± 255 N/mm; and YA: 1487 ± 354 vs. 1257 ± 328), and VL thickness (EA: 19.7 ± 3.2 vs. 16.2 ± 3.4 mm; LA: 23.0 ± 4.2 vs. 20.1 ± 3.3 mm; and YA: 25.5 ± 4.2 vs. 23.9 ± 3.9 mm). Athletes were more likely to reach strain magnitudes higher than 9% strain compared to non-athlete controls (EA: 28 vs. 15%; LA: 46 vs. 16%; and YA: 66 vs. 33%) indicating an increased mechanical demand for the tendon. Although the properties of the quadriceps femoris muscle-tendon unit are enhanced by athletic training, their development from early-adolescence to adulthood remain similar in athletes and non-athletes with the major alterations between early and LA. However, both age and athletic training was associated with a higher prevalence of imbalances within the muscle-tendon unit and a resultant increased mechanical demand for the patellar tendon.
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Affiliation(s)
- Georgios Charcharis
- 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
| | - 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
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Pereira CS, Santos RCG, Whiteley R, Finni T. Reliability and methodology of quantitative assessment of harvested and unharvested patellar tendons of ACL injured athletes using ultrasound tissue characterization. BMC Sports Sci Med Rehabil 2019; 11:12. [PMID: 31360525 PMCID: PMC6639951 DOI: 10.1186/s13102-019-0124-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
Background Ultrasound tissue characterization (UTC) imaging has been previously used to describe the characteristics of patellar and Achilles tendons. UTC imaging compares and correlates successive ultrasonographic transverse tendon images to calculate the distribution of four color-coded echo-types that represent different tendon tissue types. However, UTC has not been used to describe the characteristics of patellar tendons after anterior cruciate ligament reconstruction (ACLR). The aim of this cross-sectional study was to assess the intra and inter-rater reliability of the UTC in unharvested and harvested patellar tendons of patients undergoing ACLR. Methods Intra and inter-rater reliability of both UTC data collection and analysis were assessed. Ten harvested and twenty unharvested patellar tendons from eighteen participants were scanned twice by the same examiner. Eleven harvested and ten unharvested patellar tendons from sixteen participants were scanned and analyzed twice by two different examiners. Twenty harvested and nineteen unharvested patellar tendons from twenty-three participants were analyzed twice by two examiners. Results Quantification of the proportion of echo-types I, II, III and IV in the areas of interest: (1) patella apex, (2) proximal tendon, (3) mid tendon, (4) distal tendon, and overall tendon of harvested and unharvested patellar tendons all displayed excellent intra-rater reliability (ICC2,1: 0.94 to 0.99), excellent inter-rater reliability for harvested and unharvested patellar tendon scanning and analysis (ICC2,1: 0.89 to 0.98), and excellent inter-rater reliability for analysis (ICC2,1: 0.95 to 0.99). Intra-rater reliability for the measure of volume was good (ICC2,1: 0.69 harvested, 0.67 unharvested), whilst mixed results were observed for the measure of mid tendon thickness (ICC2,1: 0.88 harvested, 0.57 unharvested). Inter-rater reliability for scanning and analysis was good for volume (ICC2,1: 0.67) and excellent for thickness (ICC2,1: 0.97), while the inter-rater reliability for analysis was fair to poor for volume (ICC2,1: 0.59 harvested, 0.30 unharvested), and excellent to poor for mid tendon thickness (ICC2,1: 0.85 harvested, 0.24 unharvested). Conclusion UTC imaging is a reliable tool to characterize the quality of most aspects of unharvested and harvested patellar tendons in subjects undergoing ACLR.
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Affiliation(s)
- Carla S Pereira
- 1ASPETAR Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, Doha, PO Box 29222, Qatar.,2Faculty of Sport and Health Sciences, Biology of Physical Activity, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Rafael C G Santos
- 1ASPETAR Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, Doha, PO Box 29222, Qatar
| | - Rod Whiteley
- 1ASPETAR Orthopaedic and Sports Medicine Hospital, Sports City Street, Inside Aspire Zone, Al Buwairda St, Doha, PO Box 29222, Qatar
| | - Taija Finni
- 2Faculty of Sport and Health Sciences, Biology of Physical Activity, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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van Ark M, Rabello LM, Hoevenaars D, Meijerink J, van Gelderen N, Zwerver J, van den Akker-Scheek I. Inter- and intra-rater reliability of ultrasound tissue characterization (UTC) in patellar tendons. Scand J Med Sci Sports 2019; 29:1205-1211. [PMID: 31033002 DOI: 10.1111/sms.13439] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/02/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Ultrasound tissue characterization (UTC) is used in research and clinical practice to quantify tendon structure of the patellar tendon. This is the first study to investigate the inter- and intra-rater reliability for UTC of the patellar tendon on a large scale. METHOD Fifty participants (25 patellar tendinopathy, 25 asymptomatic) were recruited. The affected patellar tendons in symptomatic and right tendons in asymptomatic participants were scanned with UTC twice by one researcher and once by another. The same was done for contour marking (needed to analyze a UTC scan) of the tendon. Intraclass correlation coefficient (ICC (2,1)) for echo-types I, II, III, IV, aligned fibrillar structure (echo-types I + II), and disorganized structure (echo-types III + IV) were calculated. This was done for UTC scans as well as solely marking contours. RESULTS Inter-rater reliability showed fair to good ICC values for echo-types I (0.65) and II (0.46) and excellent ICC values for echo-type III (0.81), echo-type IV (0.83), aligned fibrillar structure (0.82), and disorganized structure (0.82). Intra-rater reliability showed excellent ICC values for echo-types I (0.76), III (0.88), IV (0.85), aligned fibrillar structure (0.88), and disorganized fibrillar structure (0.88) and a fair to good value for echo-type II (0.61). Contour marking showed excellent ICC values for all echo-types. CONCLUSION This study showed that UTC scans for patellar tendons have overall good intra-rater and inter-rater reliability. To optimize reliability of UTC scans of the patellar tendon, using the same rater and using aligned fibrillar structure (echo-types I + II combined) and disorganized structure (echo-types III + IV combined) as outcome measures can be considered.
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Affiliation(s)
- Mathijs van Ark
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.,Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands
| | - Lucas Maciel Rabello
- Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dirk Hoevenaars
- Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost Meijerink
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.,Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niels van Gelderen
- Department of Physiotherapy, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands.,Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes Zwerver
- Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Sport and Exercise Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Orthopedics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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