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Ishigaki T, Ishida T, Ino T, Okunuki T, Yokoyama H, Edama M. Relationship between compressive stiffness and tensile stiffness in the human Achilles tendon in vivo. J Bodyw Mov Ther 2025; 42:1073-1078. [PMID: 40325638 DOI: 10.1016/j.jbmt.2025.03.011] [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: 10/16/2024] [Revised: 01/27/2025] [Accepted: 03/02/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Tendon elongation is measured using ultrasound images during isometric ramp contractions in traditional measurement techniques for human tendon mechanical properties, and tendon tensile stiffness (TS) is calculated from the slope of specific force intervals in the tendon force-elongation curve. Recently, the compressive stiffness (CS) of tendons, measured using a myotonometer, has attracted attention as a new technique for investigating tendon mechanical properties in vivo. This study aimed to clarify the relationship between tensile and compressive Achilles tendon stiffness in vivo. METHODS Thirty young healthy adults (20.7 ± 18 years) participated in this study. TS was measured using B-mode ultrasonography and a dynamometer and calculated from the slope of the specific force intervals (25-45%, 30-70%, 50-100%, and 90-100% maximum voluntary contraction) in the tendon force-elongation curve. CS in the resting condition was measured at 3, 4, 5, 6, and 7 cm proximal to the calcaneus Achilles tendon insertion. The data obtained from each measurement region, as well as the average of those data, were used for further correlation analysis. The relationship between TS and CS was evaluated using Spearman rank correlation coefficient. RESULTS Correlation analysis demonstrated no relationship between TS and CS regardless of the force intervals in TS (r = - 0.019-0.251, P = 0.181-0.980). CONCLUSION The current results suggest that each measurement technique for the TS and CS evaluates different tendon mechanical properties. Researchers and clinicians should consider the characteristics of these two measurement techniques and select the appropriate method depending on the research purpose.
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Affiliation(s)
- Tomonobu Ishigaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata city, 950-3198, Niigata, Japan; Athlete Support Research Center, Niigata University of Health and Welfare, Niigata city, 950-3198, Niigata, Japan; Institute of Life Innovation Research Center, Toyo University, Kita-ku, Tokyo, 115-0053, Japan.
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, 060-0812, Hokkaido, Japan.
| | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, 006-8585, Hokkaido, Japan.
| | - Takumi Okunuki
- Institute of Life Innovation Research Center, Toyo University, Kita-ku, Tokyo, 115-0053, Japan; Japan Society for the Promotion of Sciences, Chiyoda-ku, 102-0083, Tokyo, Japan.
| | - Hiroko Yokoyama
- Faculty of Health Sciences, Tohoku Fukushi University, Sendai, 981-0943, Miyagi, Japan.
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata city, 950-3198, Niigata, Japan; Athlete Support Research Center, Niigata University of Health and Welfare, Niigata city, 950-3198, Niigata, Japan.
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Paantjens MA, Helmhout PH, Backx FJG, Martens MTAW, Bakker EWP. Prognostic value of ultrasound tissue characterisation for a recurrence of mid-portion Achilles tendinopathy in military service members: a prospective cohort study. BMJ Mil Health 2025; 171:26-32. [PMID: 37709504 PMCID: PMC11877116 DOI: 10.1136/military-2023-002521] [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: 07/04/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Tendon structure in mid-portion Achilles tendinopathy (mid-AT) appears poorly associated with symptoms. Yet, degenerative tendon changes on imaging have been associated with an increased risk of mid-AT. We aimed to investigate the prognostic value of ultrasound tissue characterisation (UTC) for a mid-AT recurrence in service members reporting to be recovered following standard care. METHODS Mid-portion aligned fibrillar structure was quantified post-treatment in 37 participants. Recurrences were determined after 1 year of follow-up, based on self-perceived recurrence (yes/no) combined with a decrease in post-treatment Victorian Institute of Sports Assessment-Achilles score of at least the minimal important change of 7 points. Receiver operating characteristic curve analyses were used to determine a threshold for dichotomisation of outcomes for aligned fibrillar structure (normal representation/under-representation). Using multivariable logistic regression, the association between a mid-AT recurrence (yes/no) and the dichotomised aligned fibrillar structure was determined. RESULTS Eight participants (22%) experienced a recurrence. The threshold for aligned fibrillar structure was set at 73.2% (95% CI: 69.4% to 77.8%) according to Youden's index. Values below this threshold were significantly associated with a mid-AT recurrence (odds ratio (OR) 9.7, 95% CI: 1.007 to 93.185). The OR for a mid-AT recurrence was 1.1 (95% CI: 1.002 to 1.150) for each additional month of symptom duration. The explained variance of our multivariable logistic regression model was 0.423; symptom duration appeared to be a better predictor than aligned fibrillar structure. CONCLUSIONS This study identified mid-portion aligned fibrillar structure and symptom duration as potential prognostic factors for a mid-AT recurrence in military service members. The threshold for aligned fibrillar structure of 73.2% can guide preventative interventions (eg, training load adjustments or additional tendon load programmes) aiming to improve tendon structure to minimise the future recurrence risk. TRIAL REGISTRATION NUMBER https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm, file number ToetsingOnline NL69527.028.19.
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Affiliation(s)
- M A Paantjens
- Sports Medicine Centre, Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P H Helmhout
- Centre of Excellence, Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, The Netherlands
| | - F J G Backx
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M T A W Martens
- Fontys University of Applied Science, Paramedical Department, Eindhoven, The Netherlands
| | - E W P Bakker
- Department Epidemiology and Data Science, Division EPM, University Medical Center Amsterdam, Amsterdam, The Netherlands
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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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Paantjens MA, Helmhout PH, Gerardus Backx FJ, Willibrord Martens MTA, van Dongen JPA, Petrus Bakker EW. Intra- and Inter-Rater Reliability of Processing Ultrasound Tissue Characterization Scans in Midportion Achilles Tendinopathy. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:9348298. [PMID: 38655162 PMCID: PMC11022779 DOI: 10.1155/2022/9348298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/31/2022] [Indexed: 04/26/2024]
Abstract
Purpose Ultrasound tissue characterization (UTC) is used to visualize and quantify the Achilles tendon structure. We investigated the intra-rater and inter-rater reliability of UTC for quantifying the midportion tendon structure and the area of maximum degeneration (AoMD) in military personnel with midportion Achilles tendinopathy. Method UTC scans of 50 patients (16-60 years) were processed twice by rater 1 and once by rater 2. First, the midportion tendon structure was quantified and subsequently the AoMD. The intraclass correlation coefficient (ICC) was calculated for echo-types I, II, III, IV, aligned fibrillar structure (echo-types I + II), and disorganized tendon structure (echo-types III + IV). Results For midportion tendon structure, all ICC values were excellent for intra-rater reliability (range: 0.97 to 0.99) and inter-rater reliability (range: 0.98 to 0.99). Regarding the AoMD, intra-rater reliability showed excellent ICC values for all echo-types (range: 0.94 to 0.98) except for echo-type II (0.85). Inter-rater reliability showed excellent ICC values for all echo-types (range: 0.92 to 0.98). Conclusion Processing of UTC scans is highly reliable in quantifying the midportion Achilles tendon structure and the AoMD.
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Affiliation(s)
- Marc Adriaan Paantjens
- Sports Medicine Centre, Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pieter Herman Helmhout
- Centre of Excellence, Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, Netherlands
| | | | | | | | - Eric Wilhelmus Petrus Bakker
- Department Epidemiology and Data Science, Division EPM, University Medical Center Amsterdam, Amsterdam, Netherlands
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