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Weidlich K, Domroes T, Bohm S, Arampatzis A, Mersmann F. Addressing muscle-tendon imbalances in adult male athletes with personalized exercise prescription based on tendon strain. Eur J Appl Physiol 2024:10.1007/s00421-024-05525-z. [PMID: 38842575 DOI: 10.1007/s00421-024-05525-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE Imbalances of muscle strength and tendon stiffness can increase the operating strain of tendons and risk of injury. Here, we used a new approach to identify muscle-tendon imbalances and personalize exercise prescription based on tendon strain during maximum voluntary contractions (εmax) to mitigate musculotendinous imbalances in male adult volleyball athletes. METHODS Four times over a season, we measured knee extensor strength and patellar tendon mechanical properties using dynamometry and ultrasonography. Tendon micromorphology was evaluated through an ultrasound peak spatial frequency (PSF) analysis. While a control group (n = 12) continued their regular training, an intervention group (n = 10) performed exercises (3 × /week) with personalized loads to elicit tendon strains that promote tendon adaptation (i.e., 4.5-6.5%). RESULTS Based on a linear mixed model, εmax increased significantly in the control group over the 9 months of observation (pCon = 0.010), while there was no systematic change in the intervention group (pInt = 0.575). The model residuals of εmax, as a measure of imbalances in muscle-tendon adaptation, demonstrated a significant reduction over time exclusively in the intervention group (pInt = 0.007). While knee extensor muscle strength increased in both groups by ~ 8% (pCon < 0.001, pInt = 0.064), only the intervention group showed a trend toward increased normalized tendon stiffness (pCon = 0.824, pInt = 0.051). PSF values did not change significantly in either group (p > 0.05). CONCLUSION These results suggest that personalized exercise prescription can reduce muscle-tendon imbalances in athletes and could provide new opportunities for tendon injury prevention.
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Affiliation(s)
- Kolja Weidlich
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, Berlin, Germany
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Philippstr. 13, Haus 11, 10115, 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, Philippstr. 13, Haus 11, 10115, 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, Philippstr. 13, Haus 11, 10115, 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, Philippstr. 13, Haus 11, 10115, Berlin, Germany.
- Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany.
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Lambrianides Y, Epro G, Arampatzis A, Karamanidis K. Evidence of different sensitivity of muscle and tendon to mechano-metabolic stimuli. Scand J Med Sci Sports 2024; 34:e14638. [PMID: 38671559 DOI: 10.1111/sms.14638] [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: 01/13/2024] [Revised: 03/25/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
This study aimed to examine the temporal dynamics of muscle-tendon adaptation and whether differences between their sensitivity to mechano-metabolic stimuli would lead to non-uniform changes within the triceps surae (TS) muscle-tendon unit (MTU). Twelve young adults completed a 12-week training intervention of unilateral isometric cyclic plantarflexion contractions at 80% of maximal voluntary contraction until failure to induce a high TS activity and hence metabolic stress. Each participant trained one limb at a short (plantarflexed position, 115°: PF) and the other at a long (dorsiflexed position, 85°: DF) MTU length to vary the mechanical load. MTU mechanical, morphological, and material properties were assessed biweekly via simultaneous ultrasonography-dynamometry and magnetic resonance imaging. Our hypothesis that tendon would be more sensitive to the operating magnitude of tendon strain but less to metabolic stress exercise was confirmed as tendon stiffness, Young's modulus, and tendon size were only increased in the DF condition following the intervention. The PF leg demonstrated a continuous increment in maximal AT strain (i.e., higher mechanical demand) over time along with lack of adaptation in its biomechanical properties. The premise that skeletal muscle adapts at a higher rate than tendon and does not require high mechanical load to hypertrophy or increase its force potential during exercise was verified as the adaptive changes in morphological and mechanical properties of the muscle did not differ between DF and PF. Such differences in muscle-tendon sensitivity to mechano-metabolic stimuli may temporarily increase MTU imbalances that could have implications for the risk of tendon overuse injury.
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Affiliation(s)
- Yiannis Lambrianides
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
| | - Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
| | - 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
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
- Department of Sport Science, Faculty for Mathematics and Natural Sciences, University of Koblenz, Koblenz, Germany
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Ma S, Zheng S, Li D, Hu W, Wang L. Melt Electrowriting Combined with Fused Deposition Modeling Printing for the Fabrication of Three-Dimensional Biomimetic Scaffolds for Osteotendinous Junction Regeneration. Int J Nanomedicine 2024; 19:3275-3293. [PMID: 38601348 PMCID: PMC11005997 DOI: 10.2147/ijn.s449952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/28/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose This study aims to explore a novel scaffold for osteotendinous junction regeneration and to preliminarily verify its osteogenic and tenogenic abilities in vitro. Methods A polycaprolactone (PCL) scaffold with aligned and orthogonal fibers was created using melt electrowriting (MEW) and fused deposition modeling (FDM). The scaffold was coated with Type I collagen, and hydroxyapatite was carefully added to separate the regions intended for bone and tendon regeneration, before being rolled into a cylindrical shape. Human adipose-derived stem cells (hADSCs) were seeded to evaluate viability and differentiation. Scaffold characterization was performed with Scanning Electron Microscope (SEM). Osteogenesis was assessed by alkaline phosphatase (ALP) and Alizarin red staining, while immunostaining and transcription-quantitative polymerase chain reaction (RT-qPCR) evaluated osteogenic and tendogenic markers. Results Scaffolds were developed in four variations: aligned (A), collagen-coated aligned (A+C), orthogonal (O), and mineral-coated orthogonal (O+M). SEM analysis confirmed surface morphology and energy-dispersive X-ray spectroscopy (EDS) verified mineral coating on O+M types. Hydrophilicity and mechanical properties were optimized in modified scaffolds, with A+C showing increased tensile strength and O+M improved in compression. hADSCs demonstrated good viability and morphology across scaffolds, withO+M scaffolds showing higher cell proliferation and osteogenic potential, and A and A+C scaffolds supporting tenogenic differentiation. Conclusion This study confirms the potential of a novel PCL scaffold with distinct regions for osteogenic and tenogenic differentiation, supporting the regeneration of osteotendinous junctions in vitro.
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Affiliation(s)
- Shengshan Ma
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
- Department of Sports Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China
| | - Suyang Zheng
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Dong Li
- Department of Trauma Center, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, Jiangsu, People’s Republic of China
| | - Wenhao Hu
- Department of Orthopedic Surgery, The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University, Huai’an, Jiangsu, People’s Republic of China
| | - Liming Wang
- Department of Orthopedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
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Tsai MS, Domroes T, Pentidis N, Koschinski S, Schroll A, Bohm S, Arampatzis A, Mersmann F. Effect of the temporal coordination and volume of cyclic mechanical loading on human Achilles tendon adaptation in men. Sci Rep 2024; 14:6875. [PMID: 38519507 PMCID: PMC10960029 DOI: 10.1038/s41598-024-56840-6] [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: 11/17/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
Human tendons adapt to mechanical loading, yet there is little information on the effect of the temporal coordination of loading and recovery or the dose-response relationship. For this reason, we assigned adult men to either a control or intervention group. In the intervention group, the two legs were randomly assigned to one of five high-intensity Achilles tendon (AT) loading protocols (i.e., 90% maximum voluntary contraction and approximately 4.5 to 6.5% tendon strain) that were systematically modified in terms of loading frequency (i.e., sessions per week) and overall loading volume (i.e., total time under loading). Before, at mid-term (8 weeks) and after completion of the 16 weeks intervention, AT mechanical properties were determined using a combination of inverse dynamics and ultrasonography. The cross-sectional area (CSA) and length of the free AT were measured using magnetic resonance imaging pre- and post-intervention. The data analysis with a linear mixed model showed significant increases in muscle strength, rest length-normalized AT stiffness, and CSA of the free AT in the intervention group (p < 0.05), yet with no marked differences between protocols. No systematic effects were found considering the temporal coordination of loading and overall loading volume. In all protocols, the major changes in normalized AT stiffness occurred within the first 8 weeks and were mostly due to material rather than morphological changes. Our findings suggest that-in the range of 2.5-5 sessions per week and 180-300 s total high strain loading-the temporal coordination of loading and recovery and overall loading volume is rather secondary for tendon adaptation.
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Affiliation(s)
- Meng-Shiuan Tsai
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Nikolaos Pentidis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Sophia Koschinski
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.
- Berlin School of Movement Science, Berlin, Germany.
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Domroes T, Weidlich K, Bohm S, Mersmann F, Arampatzis A. Personalized tendon loading reduces muscle-tendon imbalances in male adolescent elite athletes. Scand J Med Sci Sports 2024; 34:e14555. [PMID: 38268075 DOI: 10.1111/sms.14555] [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: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
An imbalanced adaptation of muscle strength and tendon stiffness in response to training may increase tendon strain (i.e., the mechanical demand on the tendon) and consequently tendon injury risk. This study investigated if personalized tendon loading inducing tendon strain within the effective range for adaptation (4.5%-6.5%) can reduce musculotendinous imbalances in male adolescent handball athletes (15-16 years). At four measurement time points during a competitive season, we assessed knee extensor muscle strength and patellar tendon mechanical properties using dynamometry and ultrasonography and estimated the tendon's structural integrity with a peak spatial frequency (PSF) analysis of proximal tendon ultrasound scans. A control group (n = 13) followed their usual training routine, an intervention group (n = 13) integrated tendon exercises into their training (3x/week for ~31 weeks) with a personalized intensity corresponding to an average of ~6.2% tendon strain. We found a significant time by group interaction (p < 0.005) for knee extensor muscle strength and normalized patellar tendon stiffness with significant increases over time only in the intervention group (p < 0.001). There were no group differences or time-dependent changes in patellar tendon strain during maximum voluntary contractions or PSF. At the individual level, the intervention group demonstrated lower fluctuations of maximum patellar tendon strain during the season (p = 0.005) and a descriptively lower frequency of athletes with high-level tendon strain (≥9%). The findings suggest that the personalized tendon loading program reduced muscle-tendon imbalances in male adolescent athletes, which may provide new opportunities for tendon injury prevention.
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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
| | - 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
| | - 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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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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Lee J, Tang JCY, Dutton J, Dunn R, Fraser WD, Enright K, Clark DR, Stewart CE, Erskine RM. The collagen synthesis response to an acute bout of resistance exercise is greater when ingesting 30 g versus 15 g and 0 g hydrolyzed collagen in resistance-trained young men. J Nutr 2023:S0022-3166(23)72738-7. [PMID: 38007183 DOI: 10.1016/j.tjnut.2023.10.030] [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: 07/19/2023] [Revised: 09/27/2023] [Accepted: 10/26/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Resistance exercise (RE) stimulates collagen synthesis in skeletal muscle and tendon but there is limited and equivocal evidence regarding an effect of collagen supplementation and exercise on collagen synthesis. Furthermore, it is not known if a dose-response exists regarding the effect of hydrolyzed collagen (HC) ingestion and RE on collagen synthesis. OBJECTIVE We aimed to determine the HC dose-response effect on collagen synthesis following high-intensity RE in resistance-trained young men. METHODS Using a double-blind, randomized cross-over design, 10 resistance-trained men (age: 26±3 years; height: 1.77±0.04 m; mass: 79.7±7.0 kg) ingested 0g, 15g or 30g HC with 50mg vitamin C 1h prior to performing four sets' barbell back-squat RE at 10-repetition maximum load, after which they rested for six hours. Blood samples were collected throughout each of the three interventions to analyse procollagen type Ⅰ N-terminal propeptide (PⅠNP) and β-isomerized C-terminal telopeptide of type I collagen (β-CTX) concentration, and the concentration of 18 collagen amino acids. RESULTS The serum PⅠNP concentration×time area-under-the-curve (AUC) was greater for 30g (267±79 μg∙L-1∙h) than 15g (235±70 μg∙L-1∙h, P=0.039) and 0g HC (219±88 μg∙L-1∙h, P=0.005) but there was no difference between 0g and 15g HC (P=0.675). The AUCs of glycine and proline were greater for 30g than for 15g and 0g HC (P<0.05). Plasma β-CTX concentration decreased from -1h to +6h (P<0.05), with no differences between interventions. CONCLUSION The greater PINP AUC suggests 30g HC ingested prior to high-intensity RE augments whole body collagen synthesis more than 15g and 0g HC in resistance-trained young men.
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Affiliation(s)
- Joonsung Lee
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Jonathan C Y Tang
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich, UK; Clinical Biochemistry, Departments of Laboratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - John Dutton
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rachel Dunn
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich, UK; Clinical Biochemistry, Departments of Laboratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - William D Fraser
- Bioanalytical Facility, Norwich Medical School, University of East Anglia, Norwich, UK; Clinical Biochemistry, Departments of Laboratory Medicine, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK; Departments of Diabetes and Endocrinology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Kevin Enright
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David R Clark
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Claire E Stewart
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Robert M Erskine
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK; Institute of Sport, Exercise and Health, University College London, London, UK.
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Frémondière P, Thollon L, Marchal F, Desseauve D. The impact of femoral rotation on sacroiliac articulation during pregnancy. Is there evidence to support Farabeuf's hypothesis by finite element modelization? Eur J Obstet Gynecol Reprod Biol 2023; 290:78-84. [PMID: 37738891 DOI: 10.1016/j.ejogrb.2023.08.381] [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: 06/06/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Counter-nutation movement is deemed crucial during the management of the birth process. It is a combination of lateral ilia expansion and backward displacement of the promontory resulting from the external rotations of the femurs producing an enlargement of the pelvic inlet. However, since its description by Farabeuf, this mechanism has never been challenged and analyzed in a dynamic finite element study. METHODS Based on a female pelvic mesh and sacroiliac ligaments, we simulated external rotations of both femurs with imposed rotation of the two acetabulum centers. We hypothesize that lateral ilia expansion generates a sacrum movement resulting in a backward displacement of the promontory and a pelvic inlet enlargement. RESULTS Finite element simulation confirms our hypothesis and reveals that ilio-sacro-transverse and axile ligaments play an essential role in this mechanism. Indeed, the increase in stiffness (ranging from 500 MPa to 750 MPa) of these ligaments accentuates the counter-nutation movement and the opening of the inlet. Instead of the anatomic congruence between the ilium and the sacrum, the sacroiliac ligaments may explain the counter-nutation. After a 6° of femur rotation, the inlet area increases to 11 cm2 (141 cm2 vs. 130 cm2). This enlargement could be noteworthy in case of obstructed labor or shoulder dystocia. Moreover, the association between external rotation and flexion of the femurs could be more efficient for opening the pelvic inlet. CONCLUSIONS Our result did not support the original assumption of Farabeuf. By revealing how postural adjustment increases the bony birth canal, this study provides essential information for the clinical management of the delivery.
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Affiliation(s)
- Pierre Frémondière
- Aix Marseille Univ, CNRS, EFS, ADES, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France; Aix Marseille Univ, School of Midwifery, Faculty of Medical and Paramedical Sciences, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France.
| | - Lionel Thollon
- Aix Marseille Univ, Univ Gustave Eiffel, LBA, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - François Marchal
- Aix Marseille Univ, CNRS, EFS, ADES, 51 boulevard Pierre Dramard, 13344 Marseille cedex 15, France
| | - David Desseauve
- Department of Women-Mother-Child, Gynecology and Obstetrics Unit, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Gynecology and Obstetrics Unit, Hôpital de la Croix-Rousse 103 Grande rue de la Croix-Rousse, 69004 Lyon, France.
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9
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Mersmann F, Domroes T, Tsai MS, Pentidis N, Schroll A, Bohm S, Arampatzis A. Longitudinal Evidence for High-Level Patellar Tendon Strain as a Risk Factor for Tendinopathy in Adolescent Athletes. SPORTS MEDICINE - OPEN 2023; 9:83. [PMID: 37673828 PMCID: PMC10482817 DOI: 10.1186/s40798-023-00627-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND High tendon strain leads to sub-rupture fatigue damage and net-catabolic signaling upon repetitive loading. While high levels of tendon strain occur in adolescent athletes at risk for tendinopathy, a direct association has not yet been established. Therefore, in this prospective longitudinal study, we examined the hypothesis that adolescent athletes who develop patellar tendon pain have shown increased levels of strain in advance. METHODS In 44 adolescent athletes (12-17 years old), patellar tendon mechanical properties were measured using ultrasonography and inverse dynamics at four time points during a season. Fourteen athletes developed clinically relevant tendon pain (SYM; i.e., reduction of the VISA-P score of at least 13 points), while 23 remained asymptomatic (ASYM; VISA-P score of > 87 points). Seven cases did not fall into one of these categories and were excluded. Tendon mechanical properties of SYM in the session before the development of symptoms were compared to a randomly selected session in ASYM. RESULTS Tendon strain was significantly higher in SYM compared to ASYM (p = 0.03). The risk ratio for developing symptoms was 2.3-fold higher in athletes with tendon strain ≥9% (p = 0.026). While there was no clear evidence for systematic differences of the force applied to the tendon or tendon stiffness between SYM and ASYM (p > 0.05), subgroup analysis indicated that tendon force increased prior to the development of symptoms only in SYM (p = 0.034). DISCUSSIO The study provides novel longitudinal evidence that high tendon strain could be an important risk factor for patellar tendinopathy in adolescent athletes. We suggest that inadequate adaptation of tendon stiffness to increases in muscle strength may occur if adolescent athletes are subject to mechanical loading which does not provide effective tendon stimulation.
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Affiliation(s)
- Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany.
- Berlin School of Movement Science, Berlin, Germany.
| | - Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Meng-Shiuan Tsai
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Nikolaos Pentidis
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität Zu Berlin, Unter Den Linden 6, 10099, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
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Römer C, Zessin E, Czupajllo J, Fischer T, Wolfarth B, Lerchbaumer MH. Effect of Physical Parameters and Training Load on Patellar Tendon Stiffness in Professional Athletes. Diagnostics (Basel) 2023; 13:2541. [PMID: 37568903 PMCID: PMC10417388 DOI: 10.3390/diagnostics13152541] [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: 06/30/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Injuries of the patellar tendon commonly occur as a result of mechanical loading of the tendon during physical activity. Shear wave elastography (SWE) is an established technique for assessing tendon stiffness, and has good interindividual reliability. The aim of this study was to investigate the impacts of physical parameters and different sports on patellar tendon stiffness in professional athletes using SWE. METHODS Standardized patellar tendon SWE was performed in a relaxed supine position with a small roll under the knee (20° flexion) in 60 healthy professional athletes (30 female, 30 male). Multiple linear regression was performed for patellar tendon stiffness including gender, age, body mass index (BMI), and type of sport. RESULTS Patellar tendon stiffness showed no significant difference between female (3.320 m/s) and male (3.416 m/s) professional athletes. Mean age (female: 20.53 years; male: 19.80 years) and BMI (female: 23.24 kg/m2; male: 23.52 kg/m2) were comparable. Female professional athletes with oral contraceptive (OC) intake showed higher patellar tendon stiffness than athletes without OC intake (3.723 versus 3.017; p = 0.053), but not significantly. CONCLUSION In professional athletes, there are no significant differences in patellar tendon stiffness according to gender, age, BMI and type of sport (handball, volleyball, soccer, sprint, hammer throw). Oral contraceptives may not have an impact on patellar tendon stiffness in female athletes. Further studies are necessary.
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Affiliation(s)
- Claudia Römer
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Enrico Zessin
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
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11
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Johnston A, Callanan A. Recent Methods for Modifying Mechanical Properties of Tissue-Engineered Scaffolds for Clinical Applications. Biomimetics (Basel) 2023; 8:biomimetics8020205. [PMID: 37218791 DOI: 10.3390/biomimetics8020205] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
The limited regenerative capacity of the human body, in conjunction with a shortage of healthy autologous tissue, has created an urgent need for alternative grafting materials. A potential solution is a tissue-engineered graft, a construct which supports and integrates with host tissue. One of the key challenges in fabricating a tissue-engineered graft is achieving mechanical compatibility with the graft site; a disparity in these properties can shape the behaviour of the surrounding native tissue, contributing to the likelihood of graft failure. The purpose of this review is to examine the means by which researchers have altered the mechanical properties of tissue-engineered constructs via hybrid material usage, multi-layer scaffold designs, and surface modifications. A subset of these studies which has investigated the function of their constructs in vivo is also presented, followed by an examination of various tissue-engineered designs which have been clinically translated.
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Affiliation(s)
- Andrew Johnston
- Institute for Bioengineering, School of Engineering, University of Edinburgh, Edinburgh EH9 3DW, UK
| | - Anthony Callanan
- Institute for Bioengineering, School of Engineering, University of Edinburgh, Edinburgh EH9 3DW, UK
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12
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Hoppe ED, Birman V, Kurtaliaj I, Guilliams CM, Pickard BG, Thomopoulos S, Genin GM. A discrete shear lag model of the mechanics of hitchhiker plants, and its prospective application to tendon-to-bone repair. Proc Math Phys Eng Sci 2023. [DOI: 10.1098/rspa.2022.0583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Tendon-to-bone repairs often fail when sutures pull through tendon, like a wire through cheese. Repair strength is maximized when loads are balanced equally among all sutures, relative to the pullout resistance of the tendon and the strength of the sutures. This problem of balancing loads across multiple, discrete attachment sites has been solved in nature by hitchhiker plants that proliferate by adhering relatively stiff fruit to relatively soft fur and fabrics through arrays of hooks. We, therefore, studied the fruits of such a plant,
Harpagonella palmeri
, and developed a discrete shear lag analysis of the force distributions in
H. palmeri
's linear arrays of long, slender hooks of varied lengths and spacing. Results suggested that strategies were used by the plant to distribute loads, including variations in the spacing and stiffnesses of hooks that serve to equalize forces over attachment sites. When applying these models to suturing schemes for surgical reattachment of tendon to bone, results suggested that strategies exhibited by
H. palmeri
show promise for balancing forces over sutures, potentially doubling repair strength relative to what could be achieved with a uniform suture distribution. Results suggest a potential pathway for strengthening surgical repairs, and more broadly for optimizing fasteners for bi-material attachment.
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Affiliation(s)
- Ethan D. Hoppe
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
| | - Victor Birman
- Department of Mechanical and Aerospace Engineering, Missouri University of Science and Technology, Rolla, MO
| | - Iden Kurtaliaj
- Department of Orthopedic Surgery, Columbia University, New York, NY
| | | | - Barbara G. Pickard
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
| | | | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Washington University in St. Louis, St. Louis, MO
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13
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Graça AL, Domingues RMA, Gomez-Florit M, Gomes ME. Platelet-Derived Extracellular Vesicles Promote Tenogenic Differentiation of Stem Cells on Bioengineered Living Fibers. Int J Mol Sci 2023; 24:ijms24043516. [PMID: 36834925 PMCID: PMC9959969 DOI: 10.3390/ijms24043516] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Tendon mimetic scaffolds that recreate the tendon hierarchical structure and niche have increasing potential to fully restore tendon functionality. However, most scaffolds lack biofunctionality to boost the tenogenic differentiation of stem cells. In this study, we assessed the role of platelet-derived extracellular vesicles (EVs) in stem cells' tenogenic commitment using a 3D bioengineered in vitro tendon model. First, we relied on fibrous scaffolds coated with collagen hydrogels encapsulating human adipose-derived stem cells (hASCs) to bioengineer our composite living fibers. We found that the hASCs in our fibers showed high elongation and cytoskeleton anisotropic organization, typical of tenocytes. Moreover, acting as biological cues, platelet-derived EVs boosted the hASCs' tenogenic commitment, prevented phenotypic drift, enhanced the deposition of the tendon-like extracellular matrix, and induced lower collagen matrix contraction. In conclusion, our living fibers provided an in vitro system for tendon tissue engineering, allowing us to study not only the tendon microenvironment but also the influence of biochemical cues on stem cell behavior. More importantly, we showed that platelet-derived EVs are a promising biochemical tool for tissue engineering and regenerative medicine applications that are worthy of further exploration, as paracrine signaling might potentiate tendon repair and regeneration.
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Affiliation(s)
- Ana L. Graça
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- ICVS/3B’s–PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
| | - Rui M. A. Domingues
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- ICVS/3B’s–PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
| | - Manuel Gomez-Florit
- Health Research Institute of the Balearic Islands (IdISBa), 07010 Palma, Spain
- Correspondence: (M.G.-F.); (M.E.G.)
| | - Manuela E. Gomes
- 3B’s Research Group, I3Bs—Research Institute on Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, 4805-017 Guimarães, Portugal
- ICVS/3B’s–PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
- Correspondence: (M.G.-F.); (M.E.G.)
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14
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Heo SJ, Thakur S, Chen X, Loebel C, Xia B, McBeath R, Burdick JA, Shenoy VB, Mauck RL, Lakadamyali M. Aberrant chromatin reorganization in cells from diseased fibrous connective tissue in response to altered chemomechanical cues. Nat Biomed Eng 2023; 7:177-191. [PMID: 35996026 PMCID: PMC10053755 DOI: 10.1038/s41551-022-00910-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 06/14/2022] [Indexed: 11/09/2022]
Abstract
Changes in the micro-environment of fibrous connective tissue can lead to alterations in the phenotypes of tissue-resident cells, yet the underlying mechanisms are poorly understood. Here, by visualizing the dynamics of histone spatial reorganization in tenocytes and mesenchymal stromal cells from fibrous tissue of human donors via super-resolution microscopy, we show that physiological and pathological chemomechanical cues can directly regulate the spatial nanoscale organization and density of chromatin in these tissue-resident cell populations. Specifically, changes in substrate stiffness, altered oxygen tension and the presence of inflammatory signals drive chromatin relocalization and compaction into the nuclear boundary, mediated by the activity of the histone methyltransferase EZH2 and an intact cytoskeleton. In healthy cells, chemomechanically triggered changes in the spatial organization and density of chromatin are reversible and can be attenuated by dynamically stiffening the substrate. In diseased human cells, however, the link between mechanical or chemical inputs and chromatin remodelling is abrogated. Our findings suggest that aberrant chromatin organization in fibrous connective tissue may be a hallmark of disease progression that could be leveraged for therapeutic intervention.
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Affiliation(s)
- Su-Jin Heo
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA, USA
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Shreyasi Thakur
- Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xingyu Chen
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Materials Science Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Claudia Loebel
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Boao Xia
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Rowena McBeath
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jason A Burdick
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA, USA
- BioFrontiers Institute and Department of Chemical and Biological Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Vivek B Shenoy
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Materials Science Engineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert L Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA.
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA, USA.
- Translational Musculoskeletal Research Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
| | - Melike Lakadamyali
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Epigenetics Institute, University of Pennsylvania, Philadelphia, PA, USA.
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15
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Lee J, Bridge JE, Clark DR, Stewart CE, Erskine RM. Collagen supplementation augments changes in patellar tendon properties in female soccer players. Front Physiol 2023; 14:1089971. [PMID: 36776971 PMCID: PMC9910607 DOI: 10.3389/fphys.2023.1089971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
We investigated the effect of collagen hydrolysate supplementation on changes in patellar tendon (PT) properties after 10 weeks' training in female soccer players from a Football Association Women's Super League Under 21 s squad. We pair-matched n = 17 players (age: 17 ± 0.9 years; height: 1.66 ± 0.06 m; mass: 58.8 ± 8.1 kg) for baseline knee extension (KE) maximum isometric voluntary contraction (MIVC) torque, age, height, and body mass, and randomly assigned them to collagen (COL) or placebo (PLA) groups (COL n = 8, PLA n = 9). Participants consumed 30 g collagen hydrolysate supplementation or energy-matched PLA (36.5 g maltodextrin, 8.4 g fructose) and plus both groups consumed 500 mg vitamin C, after each training session, which comprised bodyweight strength-, plyometric- and/or pitch-based exercise 3 days/week for 10 weeks in-season. We assessed KE MIVC torque, vastus lateralis muscle thickness and PT properties using isokinetic dynamometry and ultrasonography before and after 10 weeks' soccer training. KE MIVC torque, muscle thickness and tendon cross-sectional area did not change after training in either group. However, COL increased PT stiffness [COL, +18.0 ± 12.2% (d = 1.11) vs. PLA, +5.1 ± 10.4% (d = 0.23), p = 0.049] and Young's modulus [COL, +17.3 ± 11.9% (d = 1.21) vs. PLA, +4.8 ± 10.3% (d = 0.23), p = 0.035] more than PLA. Thus, 10 weeks' in-season soccer training with COL increased PT mechanical and material properties more than soccer training alone in high-level female soccer players. Future studies should investigate if collagen hydrolysate supplementation can improve specific aspects of female soccer performance requiring rapid transference of force, and if it can help mitigate injury risk in this under-researched population.
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Affiliation(s)
- Joonsung Lee
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Josh E. Bridge
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David R. Clark
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Claire E. Stewart
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Robert M. Erskine
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom,Institute of Sport, Exercise and Health, University College London, London, United Kingdom,*Correspondence: Robert M. Erskine,
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16
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Guthrie BM, King EL, Patwardhan S, Wei Q, Sikdar S, Chitnis PV, Jones MT. Relationships between surrogate measures of mechanical and psychophysiological load, patellar tendon adaptations, and neuromuscular performance in NCAA division I men's volleyball athletes. Front Sports Act Living 2023; 5:1065470. [PMID: 36909358 PMCID: PMC9992433 DOI: 10.3389/fspor.2023.1065470] [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: 10/09/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Patellar tendon adaptations occur in response to mechanical load. Appropriate loading is necessary to elicit positive adaptations with increased risk of injury and decreased performance likely if loading exceeds the capacity of the tendon. The aim of the current study was to examine intra-individual associations between workloads and patellar tendon properties and neuromuscular performance in collegiate volleyball athletes. Methods National Collegiate Athletics Association Division I men's volleyball athletes (n = 16, age: 20.33 ± 1.15 years, height: 193.50 ± 6.50 cm, body mass: 84.32 ± 7.99 kg, bodyfat%: 13.18 ± 4.72%) competing across 9 weeks of in-season competition participated. Daily measurements of external workloads (i.e., jump count) and internal workloads [i.e., session rating of perceived exertion (sRPE)] were recorded. Weekly measurements included neuromuscular performance assessments (i.e., countermovement jump, drop jump), and ultrasound images of the patellar tendon to evaluate structural adaptations. Repeated measures correlations (r-rm) assessed intra-individual associations among performance and patellar tendon metrics. Results Workload measures exhibited significant negative small to moderate (r-rm =-0.26-0.31) associations with neuromuscular performance, negative (r-rm = -0.21-0.30), and positive (r-rm = 0.20-0.32) small to moderate associations with patellar tendon properties. Discussion Monitoring change in tendon composition and performance adaptations alongside workloads may inform evidence-based frameworks toward managing and reducing the risk of the development of patellar tendinopathy in collegiate men's volleyball athletes.
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Affiliation(s)
- Brian M Guthrie
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA, United States
| | - Erica L King
- Department of Bioengineering, George Mason University, Fairfax, VA, United States.,Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Shriniwas Patwardhan
- Department of Bioengineering, George Mason University, Fairfax, VA, United States.,Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Qi Wei
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax, VA, United States.,Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Parag V Chitnis
- Department of Bioengineering, George Mason University, Fairfax, VA, United States.,Center for Adaptive Systems of Brain-Body Interactions, George Mason University, Fairfax, VA, United States
| | - Margaret T Jones
- Patriot Performance Laboratory, Frank Pettrone Center for Sports Performance, George Mason University, Fairfax, VA, United States.,Sport, Recreation, and Tourism Management, George Mason University, Fairfax, VA, United States
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17
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ÇAKIR PEKÖZ B, YILDIRIM A. Aşil tendonu gerinim oranı ile mitral anulus kalsifikasyonu varlığı arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1132997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Aşil tendonu (AT)- ultrasonografisi (US) ve gerinim elastografisi (SE) ile elde edilen AT- kalınlığı (T) ve AT- gerinim oranının (SR) mitral kapak kalsifikasyonlu (MAC) hastaları belirlemedeki önemini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya ekokardiyografi sonrası MAC tanısı alan 100 hasta (65 kadın, 35 erkek ve ortalama yaş 64.7 ± 12.1) ve kardiyovasküler risk faktörü benzer olan 50 kontrol (32 kadın, 18 erkek ve ortalama yaş 63.2 ± 12.8) alındı. Laboratuvar incelemeler ve AT US yapıldı. AT-T ve AT-SR hesaplandı.
Bulgular: MAC olan hastalarda AT-T ve AT-SR belirgin olarak yüksek olduğu bulundu. Logistic regresyon analizinde, AT-T ve AT-SR değerlerinin MAC olma riskini bağımsız olarak belirlediği bulundu. Bu analize göre AT-T (her 1 mm) ve AT-SR (her 0.1)’nin MAC olma riskini sırası ile %69.9 ve %12.7 oranlarında artırdığı saptandı. AT-T ve AT-SR değerlerinin MAC olan hastaları belirlemesi açısından ROC analizi yapıldığında, ROC eğri altında kalan alanın sırası ile 0.684 ve 0.819 belirlendi. Aynı analizde, AT-SR için sınır değer 1.25 olarak alındığında %94.1 sensitivite ve %76.2 spesivite ile MAC varlığını belirlediği tespit edildi.
Sonuç: AT SE incelemesinde saptanan AT-SR, MAC olan hastaları önceden belirlemede kullanılabilecek basit, ucuz, tekrarlanabilir ve non-invaziv bir parametredir. Bu durum MAC ve AT-SR artışının benzer fizyopatolojik mekanizma ile meydana gelebilmesinin bir sonucu olabilir.
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Affiliation(s)
- Burçak ÇAKIR PEKÖZ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Arafat YILDIRIM
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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18
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Merry K, Napier C, Waugh CM, Scott A. Foundational Principles and Adaptation of the Healthy and Pathological Achilles Tendon in Response to Resistance Exercise: A Narrative Review and Clinical Implications. J Clin Med 2022; 11:4722. [PMID: 36012960 PMCID: PMC9410084 DOI: 10.3390/jcm11164722] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Therapeutic exercise is widely considered a first line fundamental treatment option for managing tendinopathies. As the Achilles tendon is critical for locomotion, chronic Achilles tendinopathy can have a substantial impact on an individual's ability to work and on their participation in physical activity or sport and overall quality of life. The recalcitrant nature of Achilles tendinopathy coupled with substantial variation in clinician-prescribed therapeutic exercises may contribute to suboptimal outcomes. Further, loading the Achilles tendon with sufficiently high loads to elicit positive tendon adaptation (and therefore promote symptom alleviation) is challenging, and few works have explored tissue loading optimization for individuals with tendinopathy. The mechanism of therapeutic benefit that exercise therapy exerts on Achilles tendinopathy is also a subject of ongoing debate. Resultingly, many factors that may contribute to an optimal therapeutic exercise protocol for Achilles tendinopathy are not well described. The aim of this narrative review is to explore the principles of tendon remodeling under resistance-based exercise in both healthy and pathologic tissues, and to review the biomechanical principles of Achilles tendon loading mechanics which may impact an optimized therapeutic exercise prescription for Achilles tendinopathy.
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Affiliation(s)
- Kohle Merry
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Christopher Napier
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Charlie M. Waugh
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
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Thornton LH, Dick TJM, Bennett MB, Clemente CJ. Understanding Australia’s unique hopping species: a comparative review of the musculoskeletal system and locomotor biomechanics in Macropodoidea. AUST J ZOOL 2022. [DOI: 10.1071/zo21048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Kangaroos and other macropodoids stand out among mammals for their unusual hopping locomotion and body shape. This review examines the scaling of hind- and forelimb bones, and the primary ankle extensor muscles and tendons. We find that the scaling of the musculoskeletal system is sensitive to the phylogenetic context. Tibia length increases with positive allometry among most macropodoids, but negative allometry in eastern grey kangaroos and isometry in red kangaroos. Femur length decreases with stronger negative allometry in eastern grey and red kangaroos than among other macropodoids. Muscle masses scale with negative allometry in western grey kangaroos and with isometry in red kangaroos, compared to positive allometry in other macropodoids. We further summarise the work on the hopping gait, energetics in macropodoids, and stresses in the musculoskeletal system in an evolutionary context, to determine what trade-offs may limit locomotor performance in macropodoids. When large kangaroos hop, they do not increase oxygen consumption with speed, unlike most mammals, including small hopping species. We conclude that there is not enough information to isolate the biomechanical factors that make large kangaroos so energy efficient. We identify key areas for further research to fill these gaps.
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20
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Young BL, Sheppard ED, Phillips S, Stubbs TM, He JK, Moon A, Pinto MC, McGwin G, Brabston EW, Gilbert SR, Ponce BA. Caffeine intake does not appear to impair tendon-to-bone healing strength in a rat rotator cuff repair model. JSES Int 2022; 6:463-467. [PMID: 35572424 PMCID: PMC9091803 DOI: 10.1016/j.jseint.2021.12.011] [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] [Indexed: 11/13/2022] Open
Abstract
Background Tendon-to-bone (TtB) healing is essential for successful rotator cuff repair (RCR). This study aimed to investigate if caffeine intake impaired TtB healing in a rat RCR model. Methods Seventy-two rats were randomized into a caffeinated group or a noncaffeinated group. Specimens received one week of oral caffeine solution or normal saline before RCR. All rats then underwent bilateral RCR. Caffeination or saline gavages continued until rats were sacrificed at 2, 4, and 8 weeks postoperatively. Load-to-failure (primary outcomes measure), maximum stress, and stiffness of the TtB interface were measured for one shoulder of each specimen. Six random shoulders from each group underwent histological assessment of TtB healing. Results Load-to-failure and maximum stress of RCR did not appear to differ between groups at any time point. No difference in RCR stiffness was found between groups at 2 and 4 weeks; however, stiffness in the caffeinated group did appear to lower at 8 weeks (P = .04). Conclusion Perioperative caffeine intake did not appear to affect load-to-failure strength of RCR in an animal model. Although our secondary outcome measures of maximum stress and stiffness also did not appear to be influenced by perioperative caffeine intake, there did appear to be a trend toward decreased RCR stiffness at 8 weeks postoperatively in specimens that received caffeine.
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Affiliation(s)
- Bradley L. Young
- Atrium Health Musculoskeletal Institute, Carolinas Medical Center, Charlotte, NC, USA
| | - Evan D. Sheppard
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham AL, USA
| | - Sierra Phillips
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham AL, USA
| | - Trevor M. Stubbs
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham AL, USA
| | - Jun Kit He
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham AL, USA
| | - Andrew Moon
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham AL, USA
| | - Martim C. Pinto
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham AL, USA
| | - Gerald McGwin
- School of Public Health, Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Shawn R. Gilbert
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham AL, USA
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21
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Calejo I, Reis RL, Domingues RMA, Gomes ME. Texturing Hierarchical Tissues by Gradient Assembling of Microengineered Platelet-Lysates Activated Fibers. Adv Healthc Mater 2022; 11:e2102076. [PMID: 34927396 DOI: 10.1002/adhm.202102076] [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: 09/28/2021] [Revised: 11/14/2021] [Indexed: 11/07/2022]
Abstract
The heterogeneity of hierarchical tissues requires designing multipart engineered constructs as suitable tissue replacements. Herein, the incorporation of platelet lysate (PL) within an electrospun fiber core is proposed aiming for the fabrication of functionally graded 3D scaffolds for heterotypic tissues regeneration, such as tendon-to-bone interfaces. First, anisotropic yarns (A-Yarns) and isotropic threads with nanohydroxyapatite (I-Threads/PL@nHAp) are fabricated to recreate the tendon- and bone-microstructures and both incorporated with PL using emulsion electrospinning for a sustained and local delivery of growth factors, cytokines, and chemokines. Biological performance using human adipose-derived stem cells demonstrates that A-Yarns/PL induce a higher expression of scleraxis, a tenogenic-marker, while in I-Threads/PL@nHAp, higher alkaline phosphatase activity and matrix mineralization suggest an osteogenic commitment without the need for biochemical supplementation compared to controls. As a proof-of-concept, functional 3D gradient scaffolds are fabricated using a weaving technique, resulting in 3D textured hierarchical constructs with gradients in composition and topography. Additionally, the precise delivery of bioactive cues together with in situ biophysical features guide the commitment into a phenotypic gradient exhibiting chondrogenic and osteochondrogenic profiles in the interface of scaffolds. Overall, a promising patch solution for the regeneration of tendon-to-bone tissue interface through the fabrication of PL-functional 3D gradient constructs is demonstrated.
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Affiliation(s)
- Isabel Calejo
- 3B's Research Group i3Bs – Research Institute on Biomaterials, Biodegradables and Biomimetics University of Minho Barco Guimarães 4805‐017 Portugal
| | - Rui L. Reis
- 3B's Research Group i3Bs – Research Institute on Biomaterials, Biodegradables and Biomimetics University of Minho Barco Guimarães 4805‐017 Portugal
| | - Rui M. A. Domingues
- 3B's Research Group i3Bs – Research Institute on Biomaterials, Biodegradables and Biomimetics University of Minho Barco Guimarães 4805‐017 Portugal
| | - Manuela E. Gomes
- 3B's Research Group i3Bs – Research Institute on Biomaterials, Biodegradables and Biomimetics University of Minho Barco Guimarães 4805‐017 Portugal
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22
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Klinge PM, Srivastava V, McElroy A, Leary OP, Ahmed Z, Donahue JE, Brinker T, De Vloo P, Gokaslan ZL. Diseased filum terminale as a cause of tethered cord syndrome in Ehlers Danlos syndrome: histopathology, biomechanics, clinical presentation, and outcome of filum excision. World Neurosurg 2022; 162:e492-e502. [DOI: 10.1016/j.wneu.2022.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
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23
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Chae S, Choi YJ, Cho DW. Mechanically and biologically promoted cell-laden constructs generated using tissue-specific bioinks for tendon/ligament tissue engineering applications. Biofabrication 2022; 14. [PMID: 35086074 DOI: 10.1088/1758-5090/ac4fb6] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/27/2022] [Indexed: 11/11/2022]
Abstract
Tendon and ligament tissues provide stability and mobility crucial for musculoskeletal function, but are particularly prone to injury. Owing to poor innate healing capacity, the regeneration of mature and functional tendon/ligament (T/L) poses a formidable clinical challenge. Advanced bioengineering strategies to develop biomimetic tissue implants are highly desired for the treatment of T/L injuries. Here, we presented a cell-based tissue engineering strategy to generate cell-laden tissue constructs comprising stem cells and tissue-specific bioinks using 3D cell-printing technology. We implemented an in vitro preconditioning approach to guide semi-organized T/L-like formation before the in vivo application of cell-printed implants. During in vitro maturation, tissue-specific decellularized extracellular matrix-based cellular constructs facilitated long-term in vitro culture with high cell viability and promoted tenogenesis with enhanced cellular/structural anisotropy. Moreover, we demonstrated improved cell survival/retention upon in vivo implantation of pre-matured constructs in nude mice with de novo tendon formation and improved mechanical strength. Although in vivo mechanical properties of the cell-printed implants were lower than those of human T/L tissues, the results of this study may have significant implications for future cell-based therapies in tendon and ligament regeneration and translational medicine.
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Affiliation(s)
- Suhun Chae
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Kyungbuk 790-784, Gyeongsangbuk-do, Pohang, Gyeongsangbuk-do, 37679, Korea (the Republic of)
| | - Yeong-Jin Choi
- Department of Advanced Biomaterials Research, Korea Institute of Materials Science, 797, Changwon-daero, Seongsan-gu, Gyeongsangnam-do, Changwon, 51508, Korea (the Republic of)
| | - Dong-Woo Cho
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Kyungbuk 790-784, KOREA, Pohang, 37673, Korea (the Republic of)
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24
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Christensen BA, Lin DC, Schwaner MJ, McGowan CP. Elastic energy storage across speeds during steady-state hopping of desert kangaroo rats (Dipodomys deserti). J Exp Biol 2022; 225:273978. [PMID: 35019972 DOI: 10.1242/jeb.242954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/30/2021] [Indexed: 11/20/2022]
Abstract
Small bipedal hoppers, including kangaroo rats, are thought to not benefit from substantial elastic energy storage and return during hopping. However, recent species-specific material properties research suggests that, despite relative thickness, the ankle extensor tendons of these small hoppers are considerably more compliant than had been assumed. With faster locomotor speeds demanding higher forces, a lower tendon stiffness suggests greater tendon deformation and thus a greater potential for elastic energy storage and return with increasing speed. Using the elastic modulus values specific to kangaroo rat tendons, we sought to determine how much elastic energy is stored and returned during hopping across a range of speeds. In vivo techniques were used to record tendon force in the ankle extensors during steady-speed hopping. Our data support the hypothesis that the ankle extensor tendons of kangaroo rats store and return elastic energy in relation to hopping speed, storing more at faster speeds. Despite storing comparatively less elastic energy than larger hoppers, this relationship between speed and energy storage offer novel evidence of a functionally similar energy storage mechanism, operating irrespective of body size or tendon thickness, across the distal muscle-tendon units of both small and large bipedal hoppers.
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Affiliation(s)
- Brooke A Christensen
- Department of Biological Sciences, University of Idaho, Moscow ID, USA.,Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine CA, USA
| | - David C Lin
- Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman WA, USA.,Department of Integrative Physiology and Neuroscience, Washington State University, Pullman WA, USA.,Washington Center for Muscle Biology, Washington State University, Pullman WA, USA
| | - M Janneke Schwaner
- Department of Biological Sciences, University of Idaho, Moscow ID, USA.,Department of Ecology and Evolutionary Biology, University of California, Irvine, Irvine CA, USA
| | - Craig P McGowan
- Department of Biological Sciences, University of Idaho, Moscow ID, USA.,Washington Center for Muscle Biology, Washington State University, Pullman WA, USA.,Keck School of Medicine of the University of Southern California, Los Angeles CA, USA
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25
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Pentidis N, Mersmann F, Bohm S, Schroll A, Giannakou E, Aggelousis N, Arampatzis A. Development of Muscle-Tendon Adaptation in Preadolescent Gymnasts and Untrained Peers: A 12-Month Longitudinal Study. Med Sci Sports Exerc 2021; 53:2565-2576. [PMID: 34649260 DOI: 10.1249/mss.0000000000002742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The current study investigated the effects of long-term athletic training on the development of the triceps surae muscle-tendon unit in preadolescence. METHODS Eleven preadolescent untrained children and a group of 21 artistic gymnastics athletes of similar age (9 ± 1.7 yr) and maturity (Tanner stages I and II) participated in the study. The measurements were conducted every 3 months for 1 yr, and training volume and duration of the athletes were documented. Plantar flexor muscle strength, Achilles tendon stiffness, maximum tendon strain, and gastrocnemius medialis morphometrics were measured by integrating kinematics, ultrasonography, and dynamometry. A linear mixed-effects model was used to analyze the investigated parameters. RESULTS We found greater muscle strength (P < 0.001) in athletes compared with nonathletes but no differences in Achilles tendon stiffness (P = 0.252), indicating a training-induced imbalanced adaptation of muscle strength and tendon stiffness in preadolescent athletes. Although pennation angle (P = 0.490), thickness (P = 0.917), and fascicle length (P = 0.667) did not differ between groups, we found higher fluctuations in pennation angle and muscle strength over 1 yr in athletes. The imbalanced adaptation of muscle strength and tendon stiffness together with greater fluctuations of muscle strength resulted in greater tendon strain fluctuations over 1 yr (P = 0.017) and a higher frequency of athletes with high-level tendon strain (≥9%) compared with nonathletes. CONCLUSIONS The findings indicate an increased mechanical demand for the tendon in preadolescent athletes that could have implications for the risk of tendon overuse injury. Therefore, we recommend the implementation of individual training approaches to preserve a balanced adaptation within the triceps surae muscle-tendon unit in preadolescent athletes.
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Affiliation(s)
| | | | | | | | - Erasmia Giannakou
- Department of Physical Education and Sports Science, Democritus University of Thrace, Komotini, GREECE
| | - Nickos Aggelousis
- Department of Physical Education and Sports Science, Democritus University of Thrace, Komotini, GREECE
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26
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Collagen and Vitamin C Supplementation Increases Lower Limb Rate of Force Development. Int J Sport Nutr Exerc Metab 2021; 32:65-73. [PMID: 34808597 DOI: 10.1123/ijsnem.2020-0313] [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: 10/14/2020] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exercise and vitamin C-enriched collagen supplementation increase collagen synthesis, potentially increasing matrix density, stiffness, and force transfer. PURPOSE To determine whether vitamin C-enriched collagen (hydrolyzed collagen [HC] + C) supplementation improves rate of force development (RFD) alongside a strength training program. METHODS Using a double-blinded parallel design, over 3 weeks, healthy male athletes (n = 50, 18-25 years) were randomly assigned to the intervention (HC + C; 20 g HC + 50 mg vitamin C) or placebo (20 g maltodextrin). Supplements were ingested daily 60 min prior to training. Athletes completed the same targeted maximal muscle power training program. Maximal isometric squats, countermovement jumps, and squat jumps were performed on a force plate at the same time each testing day (baseline, Tests 1, 2, and 3) to measure RFD and maximal force development. Mixed-model analysis of variance compared performance variables across the study timeline, whereas t tests were used to compare the change between baseline and Test 3. RESULTS Over 3 weeks, maximal RFD in the HC + C group returned to baseline, whereas the placebo group remained depressed (p = .18). While both groups showed a decrease in RFD through Test 2, only the treatment group recovered RFD to baseline by Test 3 (p = .036). In the HC + C group, change in countermovement jumps eccentric deceleration impulse (p = .008) and eccentric deceleration RFD (p = .04) was improved. A strong trend was observed for lower limb stiffness assessed in the countermovement jumps (p = .08). No difference was observed in maximal force or squat jump parameters. CONCLUSION The HC + C supplementation improved RFD in the squat and countermovement jump alongside training.
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27
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Turhan AU, Açıl S, Gül O, Öner K, Okutan AE, Ayas MS. Treatment of knee osteochondritis dissecans with autologous tendon transplantation: Clinical and radiological results. World J Orthop 2021; 12:867-876. [PMID: 34888147 PMCID: PMC8613687 DOI: 10.5312/wjo.v12.i11.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/28/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Defect treatment with tendon autograft in osteochondral lesions has been published in the literature with an experimental study in dogs. To demonstrate that it is possible to treat knee osteochondral lesions with the technique of autologous tendon transplantation.
AIM To evaluate the clinical and radiological results of patients with knee osteochondral lesions who were treated with autologous tendon transplantation.
METHODS Twenty patients (22 knees) with osteochondritis dissecans (OCD) lesions involving the knee were treated with autologous tendon transplantation between 2005-2018. All lesions were International Cartilage Repair Society grade IV. All patients were evaluated clinically at final follow-up with knee injury and osteoarthritis outcome score (KOOS); and radiologically with magnetic resonance observation and cartilage repair tissue (MOCART) and Kellgren-Lawrence (KL) classification.
RESULTS A total of 20 patients (22 knees) with a mean age of 25.5± 6.8 years were included. The average defect size was 4.2 ± 2.1 cm2, and the average defect depth was 0.9 ± 0.4 cm. Total KOOS score was preoperatively 29.4 ± 5.5 and was later found to be 81.5 ± 5.9 after an average of 68.7 ± 37.7 mo follow-up. The mean MOCART score was 56.2 ± 10.7. Preoperatively, all of the patients had KL grades of 0–1; during the follow-up period, 80% of the patients showed no radiological progress of osteoarthritis. Patients with less than 4 cm2 lesion had statistically significantly better overall KOOS than patients whose more than 4 cm2 lesion, particularly in sport and quality of life subscales.
CONCLUSION The autologous tendon transplantation is a single-step, safe, simple, cost-effective method for the treatment of knee OCD with satisfactory clinical and radiological outcomes, particularly in patients with less than 4 cm2 lesion.
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Affiliation(s)
- Ahmet Uğur Turhan
- Department of Orthopedics and Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon 61080, Turkey
| | - Sezgin Açıl
- Department of Orthopedics and Traumatology, Tirebolu State Hospital, Giresun 28100, Turkey
| | - Orkun Gül
- Department of Orthopedics and Traumatology, Medical Park Trabzon Hospital, Trabzon 61080, Turkey
| | - Kerim Öner
- Department of Orthopedics and Traumatology, Karadeniz Technical University Faculty of Medicine, Trabzon 61080, Turkey
| | - Ahmet Emin Okutan
- Department of Orthopedics and Traumatology, Samsun Training and Research Hospital, Samsun 55100, Turkey
| | - Muhammet Salih Ayas
- Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum 25070, Turkey
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28
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Mossor AM, Austin BL, Avey-Arroyo JA, Butcher MT. A Horse of a Different Color?: Tensile Strength and Elasticity of Sloth Flexor Tendons. Integr Org Biol 2021; 2:obaa032. [PMID: 33796818 DOI: 10.1093/iob/obaa032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tendons must be able to withstand the tensile forces generated by muscles to provide support while avoiding failure. The properties of tendons in mammal limbs must therefore be appropriate to accommodate a range of locomotor habits and posture. Tendon collagen composition provides resistance to loading that contributes to tissue strength which could, however, be modified to not exclusively confer large strength and stiffness for elastic energy storage/recovery. For example, sloths are nearly obligate suspenders and cannot run, and due to their combined low metabolic rate, body temperature, and rate of digestion, they have an extreme need to conserve energy. It is possible that sloths have a tendon "suspensory apparatus" functionally analogous to that in upright ungulates, thus allowing for largely passive support of their body weight below-branch, while concurrently minimizing muscle contractile energy expenditure. The digital flexor tendons from the fore- and hindlimbs of two-toed (Choloepus hoffmanni) and three-toed (Bradypus variegatus) sloths were loaded in tension until failure to test this hypothesis. Overall, tensile strength and elastic (Young's) modulus of sloth tendons were low, and these material properties were remarkably similar to those of equine suspensory "ligaments." The results also help explain previous findings in sloths showing relatively low levels of muscle activation in the digital flexors during postural suspension and suspensory walking.
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Affiliation(s)
- A M Mossor
- Department of Biological Sciences, Youngstown State University, Youngstown, OH USA
| | - B L Austin
- Department of Biological Sciences, Youngstown State University, Youngstown, OH USA
| | | | - M T Butcher
- Department of Biological Sciences, Youngstown State University, Youngstown, OH USA
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29
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Knaus KR, Blemker SS. 3D Models Reveal the Influence of Achilles Subtendon Twist on Strain and Energy Storage. Front Bioeng Biotechnol 2021; 9:539135. [PMID: 33614608 PMCID: PMC7892897 DOI: 10.3389/fbioe.2021.539135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 01/15/2021] [Indexed: 01/29/2023] Open
Abstract
The Achilles tendon (AT) has complex function in walking, exchanging energy due to loading by the triceps surae muscles. AT structure comprises three subtendons which exhibit variable twist among themselves and between individuals. Our goal was to create 3D finite element (FE) models to explore AT structure-function relationships. By simulating subtendon loading in FE models with different twisted geometries, we investigated how anatomical variation in twisted tendon geometry impacts fascicle lengths, strains, and energy storage. Three tendon FE models, built with elliptical cross sections based on average cadaver measurements, were divided into subtendons with varied geometric twist (low, medium, and high) and equal proportions. Tendon was modeled as transversely isotropic with fascicle directions defined using Laplacian flow simulations, producing fascicle twist. Prescribed forces, representing AT loading during walking, were applied to proximal subtendon ends, with distal ends fixed, and tuned to produce equal tendon elongation in each case, consistent with ultrasound measurements. Subtendon fascicle lengths were greater than free tendon lengths in all models by 1-3.2 mm, and were longer with greater subtendon twist with differences of 1.2-1.9 mm from low to high twist. Subtendon along-fiber strains were lower with greater twist with differences of 1.4-2.6%, and all were less than free tendon longitudinal strain by 2-5.5%. Energy stored in the AT was also lower with greater twist with differences of 1.8-2.4 J. With greater subtendon twist, similar elongation of the AT results in lower tissue strains and forces, so that longitudinal stiffness of the AT is effectively decreased, demonstrating how tendon structure influences mechanical behavior.
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Affiliation(s)
- Katherine R Knaus
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
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30
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Knaus KR, Ebrahimi A, Martin JA, Loegering IF, Thelen DG, Blemker SS. Achilles Tendon Morphology Is Related to Triceps Surae Muscle Size and Peak Plantarflexion Torques During Walking in Young but Not Older Adults. Front Sports Act Living 2020; 2:88. [PMID: 33345079 PMCID: PMC7739823 DOI: 10.3389/fspor.2020.00088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/04/2020] [Indexed: 12/25/2022] Open
Abstract
The interaction of the triceps surae muscles and the Achilles tendon is critical in producing the ankle plantarflexion torque required for human walking. Deficits in plantarflexor output are a hallmark of reduced mobility in older adults and are likely associated with changes in the triceps surae muscles that occur with age. Structural differences between young and older adults have been observed in the Achilles tendon and in the triceps surae muscles. However, less is known about how age-related differences in muscle and tendon morphology correspond with each other and, furthermore, how those morphology differences correlate with age-related deficits in function. The goal of this work was to investigate whether there is a correlation between age-related differences in triceps surae muscle size and Achilles tendon cross-sectional area (CSA) and whether either is predictive of ankle plantarflexion torque during walking. We used magnetic resonance imaging (MRI) to measure triceps surae muscle volumes and tendon CSAs in young (n = 14, age: 26 ± 4 years) and older (n = 7, age: 66 ± 5 years) adults, and we determined peak plantarflexion torques during treadmill walking. We found that individual muscle volumes as a percentage of the total triceps surae volume did not differ between young and older adults, though muscle volumes per body size (normalized by the product of height and mass) were smaller in older adults. Achilles tendon CSA was correlated with body size and muscle volumes in young adults but not in older adults. The ratio of tendon CSA to total triceps surae muscle volume was significantly greater in older adults. Peak ankle plantarflexion torque during walking correlated with body size and triceps surae volume in young and older adults but was correlated with tendon CSA only in the young adults. Structure–function relationships that seem to exist between the Achilles tendon and the triceps surae muscles in young adults are no longer evident in all older adults. Understanding mechanisms that determine altered Achilles tendon CSA in older adults may provide insight into age-related changes in function.
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Affiliation(s)
- Katherine R Knaus
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Anahid Ebrahimi
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Jack A Martin
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States.,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, United States
| | - Isaac F Loegering
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, United States.,Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, United States.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Silvia S Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States.,Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, United States
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31
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Del Signore F, De Dominicis S, Mastromatteo G, Simeoni F, Scapolo PA, Tamburro R, Vignoli M. Sonoelastography of Normal Canine Common Calcaneal Tendon: Preliminary Results. Vet Comp Orthop Traumatol 2020; 34:200-205. [PMID: 33302314 DOI: 10.1055/s-0040-1721660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Shear wave elastography (SWE) is a feasible and newly developed ultrasonographic technique which is able to assess elasticity of tissues. The aim of this work was to assess the feasibility of SWE on the normal canine common calcaneal tendon (CCT) evaluating the intra-operator repeatability and reproducibility of single measurements and stiffness of different anatomic CCT portions was examined. Tendons were first evaluated with B-mode ultrasound with a linear probe 8.5 to 10 MHz in longitudinal section with slight flexed tarsocrural joint and a gel-pad. Common calcaneal tendon was divided into three different anatomical regions. Shear wave elastography was performed in each region by two operators and quantitative evaluation (m/s and kPa) was performed on the most representative images. Region of interest (0.15 cm) was settled. Intraclass correlation coefficient (ICC) results were classified using the following scale: 0.00 to 0.20 = poor; 0.20 to 0.40 = fair; 0.40 to 075 = good; >0.75 = excellent. Ten adult dogs were enrolled. Intra-operator ICC values were >0.75 for both operators in every tendon portion. Inter-operator SWE ICC values for m/s measurements were 0.3, 0.61 and 0.61 for the enthesis, intermediate portion and the myotendinous junction respectively; for kPa measurements, values were respectively 0.3, 0.7 and 0.81. The three CCT portions were significantly different in stiffness (p-value < 0.001 for both m/s and kPa measurements). These preliminary results provide evidence that SWE is potentially appliable to assess mechanical properties of canine CCT affected by tendinopathies.
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Affiliation(s)
- Francesca Del Signore
- Department of Medicine, Faculty of Veterinary Medicine, University of Teramo, Piano D'Accio, Teramo, Italy
| | - Stefania De Dominicis
- Department of Medicine, Faculty of Veterinary Medicine, University of Teramo, Piano D'Accio, Teramo, Italy
| | - Giovanni Mastromatteo
- Department of Medicine, Faculty of Veterinary Medicine, University of Teramo, Piano D'Accio, Teramo, Italy
| | - Francesco Simeoni
- Department of Medicine, Faculty of Veterinary Medicine, University of Teramo, Piano D'Accio, Teramo, Italy
| | - Pier Augusto Scapolo
- Department of Medicine, Faculty of Veterinary Medicine, University of Teramo, Piano D'Accio, Teramo, Italy
| | - Roberto Tamburro
- Department of Medicine, Faculty of Veterinary Medicine, University of Teramo, Piano D'Accio, Teramo, Italy
| | - Massimo Vignoli
- Department of Medicine, Faculty of Veterinary Medicine, University of Teramo, Piano D'Accio, Teramo, Italy
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32
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Minafra P, Alviti F, Giovagnorio R, Cantisani V, Mazzoni G. Shear Wave Elastographic Study of the Myotendinous Junction of the Medial Gastrocnemius: Normal Patterns and Dynamic Evaluation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2195-2200. [PMID: 32391612 DOI: 10.1002/jum.15330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/25/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The myotendinous junction (MTJ) represents a specialized anatomic region through which the contractile strength is transmitted from the muscle to the tendon. The integrity of this region is essential to permit force transmission and to optimize energy expenditure during walking, running, and globally for human movement. We evaluated the MTJ with shear wave elastography to assess its elasticity variation during a functional test. METHODS Forty professional soccer players were enrolled in the study. Shear wave elastography was performed at the level of the medial gastrocnemius MTJ both in a resting position and during a standing calf rise position to assess functional contraction. RESULTS All 40 participants were male, aged between 18 and 38 years (mean age, 25 years). The results of the elastographic study showed mean stiffness values ± SD of 4.19 ± 0.86 m/s for the right medial gastrocnemius and 4.20 ± 0.87 m/s for the left medial gastrocnemius with the muscle relaxed. During contraction, the stiffness values were 8.33 ± 0.5 m/s for the right medial gastrocnemius and 8.30 ± 0.48 m/s for the left medial gastrocnemius. CONCLUSIONS Our study showed an increase of stiffness at the level of the MTJ during muscle contraction. This result is in line with the physiologic stiffening of the MTJ to resist the high level of force applied during muscle contraction. Shear wave elastography could be a useful method to assess the characteristics of the MTJ under both physiologic and pathologic conditions.
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Affiliation(s)
- Paolo Minafra
- Società Polisportiva Ars et Labor Football Club, Ferrara, Italy
| | - Federica Alviti
- Department of Anatomy, Histology, Forensic Medicine, and Orthopedics, Board of Physical Medicine and Rehabilitation
| | | | - Vito Cantisani
- Department of Radiology, Sapienza University of Rome, Rome, Italy
| | - Gianni Mazzoni
- Centro Studi Attività Motorie e Sportive, University of Ferrara, Ferrara, Italy
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Sichting F, Kram NC. Phantom material testing indicates that the mechanical properties, geometrical dimensions, and tensional state of tendons affect oscillation-based measurements. Physiol Meas 2020; 41:095010. [PMID: 33021964 DOI: 10.1088/1361-6579/abb4b3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE There is an increasing interest in the application of oscillation-based measurement techniques to evaluate the mechanical stiffness of healthy and diseased tendons. These techniques measure the stiffness of a tendon indirectly by registering the oscillation response of a tendon to an external mechanical impulse. Although these measurement techniques seem to be comparatively easy and time-saving, their applicability is implicitly limited by their indirect measurement principle. APPROACH In this study, we aim to find evidence that the oscillation response of a tendon to an external mechanical impulse is not only affected by the stiffness of a tendon but also by the tendons' cross-sectional area (CSA), length, and tension. Therefore, we reviewed the current literature on oscillation-based techniques that measure in vivo tendon properties. Further, a phantom material was used to mimic the nature of tendons and to test the impact of four factors on oscillation-based measurements. MAIN RESULTS Our results indicate that the mechanical properties, geometrical dimensions (length and CSA), and tensional state affect oscillation-based measures. Surprisingly, most studies on tendon behavior often exclusively associate their oscillation-based measurements with the mechanical stiffness of a tendon. SIGNIFICANCE While this narrow perspective bears the risk of misinterpretation or false implications, a broader understanding of oscillation-based measurements has the potential to shed new light on the interaction of muscles and tendons in vivo.
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Affiliation(s)
- Freddy Sichting
- Department of Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
| | - Nicolai C Kram
- Department of Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
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Li X, Chen H, Xie S, Wang N, Wu S, Duan Y, Zhang M, Shui L. Fabrication of Photo-Crosslinkable Poly(Trimethylene Carbonate)/Polycaprolactone Nanofibrous Scaffolds for Tendon Regeneration. Int J Nanomedicine 2020; 15:6373-6383. [PMID: 32904686 PMCID: PMC7457647 DOI: 10.2147/ijn.s246966] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The treatment of tendon injuries remains a challenging problem in clinical due to their slow and insufficient natural healing process. Scaffold-based tissue engineering provides a promising strategy to facilitate tendon healing and regeneration. However, many tissue engineering scaffolds have failed due to their poor and unstable mechanical properties. To address this, we fabricated nanofibrous polycaprolactone/methacrylated poly(trimethylene carbonate) (PCL/PTMC-MA) composite scaffolds via electrospinning. MATERIALS AND METHODS PTMC-MA was characterized by nuclear magnetic resonance. Fiber morphology of composite scaffolds was evaluated using scanning electron microscopy. The monotonic tensile test was performed for determining the mechanical properties of composite scaffolds. Cell viability and collagen deposition were assessed via PrestoBlue assay and enzyme-linked immunosorbent assay, respectively. RESULTS These PCL/PTMC-MA composite scaffolds had an increase in mechanical properties as PTMC-MA content increase. After photo-crosslinking, they showed further enhanced mechanical properties including creep resistance, which was superior to pure PCL scaffolds. It is worth noting that photo-crosslinked PCL/PTMC-MA (1:3) composite scaffolds had a Young's modulus of 31.13 ± 1.30 MPa and Max stress at break of 23.80 ± 3.44 MPa that were comparable with the mechanical properties of native tendon (Young's modulus 20-1200 MPa, max stress at break 5-100 MPa). In addition, biological experiments demonstrated that PCL/PTMC-MA composite scaffolds were biocompatible for cell adhesion, proliferation, and differentiation.
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Affiliation(s)
- Xing Li
- National Center for International Research on Green Optoelectronics, South China Normal University, Guangzhou510006, People’s Republic of China
- Guangdong Provincial Key Laboratory of Optical Information Materials and Technology, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou510006, People’s Republic of China
| | - Honglin Chen
- Institute for Life Science, School of Medicine, South China University of Technology, Guangzhou510006, People’s Republic of China
| | - Shuting Xie
- National Center for International Research on Green Optoelectronics, South China Normal University, Guangzhou510006, People’s Republic of China
- Guangdong Provincial Key Laboratory of Optical Information Materials and Technology, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou510006, People’s Republic of China
| | - Ning Wang
- Institute for Life Science, School of Medicine, South China University of Technology, Guangzhou510006, People’s Republic of China
| | - Sujuan Wu
- National Center for International Research on Green Optoelectronics, South China Normal University, Guangzhou510006, People’s Republic of China
- Guangdong Provincial Key Laboratory of Optical Information Materials and Technology, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou510006, People’s Republic of China
| | - Yuyou Duan
- Institute for Life Science, School of Medicine, South China University of Technology, Guangzhou510006, People’s Republic of China
| | - Minmin Zhang
- School of Information and Optoelectronic Science and Engineering, South China Normal University, Guangzhou510006, People’s Republic of China
| | - Lingling Shui
- National Center for International Research on Green Optoelectronics, South China Normal University, Guangzhou510006, People’s Republic of China
- Guangdong Provincial Key Laboratory of Optical Information Materials and Technology, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou510006, People’s Republic of China
- School of Information and Optoelectronic Science and Engineering, South China Normal University, Guangzhou510006, People’s Republic of China
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35
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Xu Y, Yuan P, Wang R, Wang D, Liu J, Zhou H. Effects of Foot Strike Techniques on Running Biomechanics: A Systematic Review and Meta-analysis. Sports Health 2020; 13:71-77. [PMID: 32813597 DOI: 10.1177/1941738120934715] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CONTENT Distance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect biomechanical variables related to RRI risks. OBJECTIVE To determine the effects of foot strike techniques on running biomechanics. DATA SOURCES The databases of Web of Science, PubMed, EMBASE, and EBSCO were searched from database inception through November 2018. STUDY SELECTION The initial electronic search found 723 studies. Of these, 26 studies with a total of 472 participants were eligible for inclusion in this meta-analysis. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Means, standard deviations, and sample sizes were extracted from the eligible studies, and the standard mean differences (SMDs) were obtained for biomechanical variables between forefoot strike (FFS) and rearfoot strike (RFS) groups using a random-effects model. RESULTS FFS showed significantly smaller magnitude (SMD, -1.84; 95% CI, -2.29 to -1.38; P < 0.001) and loading rate (mean: SMD, -2.1; 95% CI, -3.18 to -1.01; P < 0.001; peak: SMD, -1.77; 95% CI, -2.21 to -1.33; P < 0.001) of impact force, ankle stiffness (SMD, -1.69; 95% CI, -2.46 to -0.92; P < 0.001), knee extension moment (SMD, -0.64; 95% CI, -0.98 to -0.3; P < 0.001), knee eccentric power (SMD, -2.03; 95% CI, -2.51 to -1.54; P < 0.001), knee negative work (SMD, -1.56; 95% CI, -2.11 to -1.00; P < 0.001), and patellofemoral joint stress (peak: SMD, -0.71; 95% CI, -1.28 to -0.14; P = 0.01; integral: SMD, -0.63; 95% CI, -1.11 to -0.15; P = 0.01) compared with RFS. However, FFS significantly increased ankle plantarflexion moment (SMD, 1.31; 95% CI, 0.66 to 1.96; P < 0.001), eccentric power (SMD, 1.63; 95% CI, 1.18 to 2.08;P < 0.001), negative work (SMD, 2.60; 95% CI, 1.02 to 4.18; P = 0.001), and axial contact force (SMD, 1.26; 95% CI, 0.93 to 1.6; P < 0.001) compared with RFS. CONCLUSION Running with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.
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Affiliation(s)
- Yilin Xu
- Sports Biomechanics Laboratory, Jiangsu Research Institute of Sports Science, Nanjing, Jiangsu, China
| | - Peng Yuan
- Sports Biomechanics Laboratory, Jiangsu Research Institute of Sports Science, Nanjing, Jiangsu, China
| | - Ran Wang
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China
| | - Dan Wang
- School of Physical Education and Sport Training, Shanghai University of Sport, Shanghai, China
| | - Jia Liu
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Hui Zhou
- School of Automation, Nanjing University of Science and Technology, Nanjing, Jiangsu, China
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36
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Arampatzis A, Mersmann F, Bohm S. Individualized Muscle-Tendon Assessment and Training. Front Physiol 2020; 11:723. [PMID: 32670094 PMCID: PMC7332733 DOI: 10.3389/fphys.2020.00723] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/02/2020] [Indexed: 01/27/2023] Open
Abstract
The interaction of muscle and tendon is of major importance for movement performance and a balanced development of muscle strength and tendon stiffness could protect athletes from overuse injury. However, muscle and tendon do not necessarily adapt in a uniform manner during a training process. The development of a diagnostic routine to assess both the strength capacity of muscle and the mechanical properties of tendons would enable the detection of muscle-tendon imbalances, indicate if the training should target muscle strength or tendon stiffness development and allow for the precise prescription of training loads to optimize tendon adaptation. This perspective article discusses a framework of individualized muscle-tendon assessment and training and outlines a methodological approach for the patellar tendon.
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Affiliation(s)
- 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
| | - 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
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37
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Veiga GN, Biewener AA, Fuller A, van de Ven TMFN, McGowan CP, Panaino W, Snelling EP. Functional morphology of the ankle extensor muscle-tendon units in the springhare Pedetes capensis shows convergent evolution with macropods for bipedal hopping locomotion. J Anat 2020; 237:568-578. [PMID: 32584456 DOI: 10.1111/joa.13214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/20/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
This study assesses the functional morphology of the ankle extensor muscle-tendon units of the springhare Pedetes capensis, an African bipedal hopping rodent, to test for convergent evolution with the Australian bipedal hopping macropods. We dissect and measure the gastrocnemius, soleus, plantaris, and flexor digitorum longus in 10 adult springhares and compare them against similar-sized macropods using phylogenetically informed scaling analyses. We show that springhares align reasonably well with macropod predictions, being statistically indistinguishable with respect to the ankle extensor mean weighted muscle moment arm (1.63 vs. 1.65 cm, respectively), total muscle mass (41.1 vs. 29.2 g), total muscle physiological cross-sectional area (22.9 vs. 19.3 cm2 ), mean peak tendon stress (26.2 vs. 35.2 MPa), mean tendon safety factor (4.7 vs. 3.6), and total tendon strain energy return capacity (1.81 vs. 1.82 J). However, total tendon cross-sectional area is significantly larger in springhares than predicted for a similar-sized macropod (0.26 vs. 0.17 cm2 , respectively), primarily due to a greater plantaris tendon thickness (0.084 vs. 0.048 cm2 ), and secondarily because the soleus muscle-tendon unit is present in springhares but is vestigial in macropods. The overall similarities between springhares and macropods indicate that evolution has favored comparable lower hindlimb body plans for bipedal hopping locomotion in the two groups of mammals that last shared a common ancestor ~160 million years ago. The springhare's relatively thick plantaris tendon may facilitate rapid transfer of force from muscle to skeleton, enabling fast and accelerative hopping, which could help to outpace and outmaneuver predators.
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Affiliation(s)
- Gabriela N Veiga
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew A Biewener
- Concord Field Station, Department of Organismic and Evolutionary Biology, Faculty of Arts and Sciences, Harvard University, Bedford, MA, USA
| | - Andrea Fuller
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paraclinical Sciences, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
| | - Tanja M F N van de Ven
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Craig P McGowan
- Department of Biological Sciences, College of Science, University of Idaho, Moscow, ID, USA
| | - Wendy Panaino
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Edward P Snelling
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Anatomy and Physiology, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa.,Centre for Veterinary Wildlife Studies, Faculty of Veterinary Science, University of Pretoria, Onderstepoort, South Africa
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38
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Magerle R, Dehnert M, Voigt D, Bernstein A. Nanomechanical 3D Depth Profiling of Collagen Fibrils in Native Tendon. Anal Chem 2020; 92:8741-8749. [PMID: 32484331 DOI: 10.1021/acs.analchem.9b05582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Connective tissue displays a large compositional and structural complexity that involves multiple length scales. In particular, on the molecular and the nanometer level, the elementary processes that determine the biomechanics of collagen fibrils in connective tissues are still poorly understood. Here, we use atomic force microscopy (AFM) to determine the three-dimensional (3D) depth profiles of the local nanomechanical properties of collagen fibrils and their embedding interfibrillar matrix in native (unfixed), hydrated Achilles tendon of sheep and chickens. AFM imaging in air with controlled humidity preserves the tissue's water content, allowing the assembly of collagen fibrils to be imaged in high resolution beneath an approximately 5-10 nm thick layer of the fluid components of the interfibrillar matrix. We collect pointwise force-distance (FD) data and amplitude-phase-distance (APD) data, from which we construct 3D depth profiles of the local tip-sample interaction forces. The 3D images reveal the nanomechanical morphology of unfixed, hydrated collagen fibrils in native tendon with a 0.1 nm depth resolution and a 10 nm lateral resolution. We observe a diversity in the nanomechanical properties among individual collagen fibrils in their adhesive and in their repulsive, viscoelastic mechanical response as well as among the contact points between adjacent collagen fibrils. This sheds new light on the role of interfibrillar bonds and the mechanical properties of the interfibrillar matrix in the biomechanics of tendon.
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Affiliation(s)
- Robert Magerle
- Fakultät für Naturwissenschaften, Technische Universität Chemnitz, 09107 Chemnitz, Germany
| | - Martin Dehnert
- Fakultät für Naturwissenschaften, Technische Universität Chemnitz, 09107 Chemnitz, Germany
| | - Diana Voigt
- Fakultät für Naturwissenschaften, Technische Universität Chemnitz, 09107 Chemnitz, Germany
| | - Anke Bernstein
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center-Albert-Ludwigs-University of Freiburg and Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
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39
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Gachon B, Fritel X, Pierre F, Nordez A. In vivo assessment of the elastic properties of women's pelvic floor during pregnancy using shear wave elastography: design and protocol of the ELASTOPELV study. BMC Musculoskelet Disord 2020; 21:305. [PMID: 32414362 PMCID: PMC7229576 DOI: 10.1186/s12891-020-03333-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 05/07/2020] [Indexed: 12/23/2022] Open
Abstract
Background Animal studies have reported an increase in pelvic floor muscle stiffness during pregnancy, which might be a protective process against perineal trauma at delivery. Our main objective is to describe the changes in the elastic properties of the pelvic floor muscles (levator ani, external anal sphincter) during human pregnancy using shear wave elastography (SWE) technology. Secondary objectives are as follows: i) to look for specific changes of the pelvic floor muscles compared to peripheral muscles; ii) to determine whether an association between the elastic properties of the levator ani and perineal clinical and B-mode ultrasound measures exists; and iii) to provide explorative data about an association between pelvic floor muscle characteristics and the risk of perineal tears. Methods Our prospective monocentric study will involve three visits (14–18, 24–28, and 34–38 weeks of pregnancy) and include nulliparous women older than 18 years, with a normal pregnancy and a body mass index (BMI) lower than 35 kg.m− 2. Each visit will consist of a clinical pelvic floor assessment (using the Pelvic Organ Prolapse Quantification system), an ultrasound perineal measure of the anteroposterior hiatal diameter and SWE assessment of the levator ani and the external anal sphincter muscles (at rest, during the Valsalva maneuver and during pelvic floor contraction), and SWE assessment of both the biceps brachii and the gastrocnemius medialis (at rest, extension and contraction). We will collect data about the mode of delivery and the occurrence of perineal tears. We will investigate changes in continuous variables collected using the Friedman test. We will look for an association between the elastic properties of the levator ani muscle and clinical / ultrasound measures using a Spearman test at each trimester. We will investigate the association between the elastic properties of the pelvic floor muscles and perineal tear occurrence using a multivariate analysis with logistic regression. Discussion This study will provide original in vivo human data about the biomechanical changes of pregnant women’s pelvic floor. The results may lead to an individualized risk assessment of perineal trauma at childbirth. Trial registration This study was registered on https://clinicaltrials.gov on July 26, 2018 (NCT03602196).
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Affiliation(s)
- Bertrand Gachon
- Department of obstetrics and gynecology, Poitiers university hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France. .,Nantes Université, Movement - Interactions - Performance, MIP, EA 4334, F-44000, Nantes, France. .,Poitiers University, INSERM, Poitiers university hospital, CIC 1402, Poitiers, France.
| | - Xavier Fritel
- Department of obstetrics and gynecology, Poitiers university hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France.,Poitiers University, INSERM, Poitiers university hospital, CIC 1402, Poitiers, France.,INSERM, Center for Research in Epidemiology and Population Health (CESP), U1018, Gender, Sexuality and Health Team, University Paris-Sud, UMRS 1018, Orsay, France
| | - Fabrice Pierre
- Department of obstetrics and gynecology, Poitiers university hospital, 2 rue de la Miletrie CS90577, 86021, Poitiers Cedex, France
| | - Antoine Nordez
- Nantes Université, Movement - Interactions - Performance, MIP, EA 4334, F-44000, Nantes, France.,Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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40
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Burla F, Dussi S, Martinez-Torres C, Tauber J, van der Gucht J, Koenderink GH. Connectivity and plasticity determine collagen network fracture. Proc Natl Acad Sci U S A 2020; 117:8326-8334. [PMID: 32238564 PMCID: PMC7165426 DOI: 10.1073/pnas.1920062117] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Collagen forms the structural scaffold of connective tissues in all mammals. Tissues are remarkably resistant against mechanical deformations because collagen molecules hierarchically self-assemble in fibrous networks that stiffen with increasing strain. Nevertheless, collagen networks do fracture when tissues are overloaded or subject to pathological conditions such as aneurysms. Prior studies of the role of collagen in tissue fracture have mainly focused on tendons, which contain highly aligned bundles of collagen. By contrast, little is known about fracture of the orientationally more disordered collagen networks present in many other tissues such as skin and cartilage. Here, we combine shear rheology of reconstituted collagen networks with computer simulations to investigate the primary determinants of fracture in disordered collagen networks. We show that the fracture strain is controlled by the coordination number of the network junctions, with less connected networks fracturing at larger strains. The hierarchical structure of collagen fine-tunes the fracture strain by providing structural plasticity at the network and fiber level. Our findings imply that low connectivity and plasticity provide protective mechanisms against network fracture that can optimize the strength of biological tissues.
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Affiliation(s)
- Federica Burla
- Biological Soft Matter Group, Department of Living Matter, AMOLF, 1098 XG Amsterdam, The Netherlands
| | - Simone Dussi
- Physical Chemistry and Soft Matter, Wageningen University and Research, 6708 WE Wageningen, The Netherlands
| | - Cristina Martinez-Torres
- Biological Soft Matter Group, Department of Living Matter, AMOLF, 1098 XG Amsterdam, The Netherlands
- Department of Bionanoscience, Kavli Institute of Nanoscience Delft, Delft University of Technology, 2629 HZ Delft, The Netherlands
| | - Justin Tauber
- Physical Chemistry and Soft Matter, Wageningen University and Research, 6708 WE Wageningen, The Netherlands
| | - Jasper van der Gucht
- Physical Chemistry and Soft Matter, Wageningen University and Research, 6708 WE Wageningen, The Netherlands;
| | - Gijsje H Koenderink
- Biological Soft Matter Group, Department of Living Matter, AMOLF, 1098 XG Amsterdam, The Netherlands;
- Department of Bionanoscience, Kavli Institute of Nanoscience Delft, Delft University of Technology, 2629 HZ Delft, The Netherlands
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41
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Atkinson F, Evans R, Guest JE, Bavin EP, Cacador D, Holland C, Guest DJ. Cyclical strain improves artificial equine tendon constructs in vitro. J Tissue Eng Regen Med 2020; 14:690-700. [PMID: 32181983 DOI: 10.1002/term.3030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/10/2020] [Accepted: 03/05/2020] [Indexed: 01/10/2023]
Abstract
Tendon injuries are a common cause of morbidity in humans. They also occur frequently in horses, and the horse provides a relevant, large animal model in which to test novel therapies. To develop novel cell therapies that can aid tendon regeneration and reduce subsequent reinjury rates, the mechanisms that control tendon tissue regeneration and matrix remodelling need to be better understood. Although a range of chemical cues have been explored (growth factors, media etc.), the influence of the mechanical environment on tendon cell culture has yet to be fully elucidated. To mimic the in vivo environment, in this study, we have utilised a novel and affordable, custom-made bioreactor to apply a cyclical strain to tendon-like constructs generated in three-dimensional (3D) culture by equine tenocytes. Dynamic shear analysis (DSA), dynamic scanning calorimetry (DSC) and Fourier-transform infrared (FTIR) spectroscopy were used to determine the mechanical and chemical properties of the resulting tendon-like constructs. Our results demonstrate that equine tenocytes exposed to a 10% cyclical strain have an increased amount of collagen gel contraction after 7 and 8 days of culture compared with cells cultured in 3D in the absence of external strain. While all the tendon-like constructs have a very similar chemical composition to native tendon, the application of strain improves their mechanical properties. We envisage that these results will contribute towards the development of improved biomimetic artificial tendon models for the development of novel strategies for equine regenerative therapies.
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Affiliation(s)
- Francesca Atkinson
- Animal Health Trust, Suffolk, UK.,Department of Materials Science and Engineering, University of Sheffield, Sheffield, UK
| | | | | | | | | | - Christopher Holland
- Department of Materials Science and Engineering, University of Sheffield, Sheffield, UK
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42
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Silva M, Ferreira FN, Alves NM, Paiva MC. Biodegradable polymer nanocomposites for ligament/tendon tissue engineering. J Nanobiotechnology 2020; 18:23. [PMID: 32000800 PMCID: PMC6993465 DOI: 10.1186/s12951-019-0556-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/05/2019] [Indexed: 02/07/2023] Open
Abstract
Ligaments and tendons are fibrous tissues with poor vascularity and limited regeneration capacity. Currently, a ligament/tendon injury often require a surgical procedure using auto- or allografts that present some limitations. These inadequacies combined with the significant economic and health impact have prompted the development of tissue engineering approaches. Several natural and synthetic biodegradable polymers as well as composites, blends and hybrids based on such materials have been used to produce tendon and ligament scaffolds. Given the complex structure of native tissues, the production of fiber-based scaffolds has been the preferred option for tendon/ligament tissue engineering. Electrospinning and several textile methods such as twisting, braiding and knitting have been used to produce these scaffolds. This review focuses on the developments achieved in the preparation of tendon/ligament scaffolds based on different biodegradable polymers. Several examples are overviewed and their processing methodologies, as well as their biological and mechanical performances, are discussed.
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Affiliation(s)
- Magda Silva
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, 4805-017, Guimarães, Portugal
- ICVS/3B's, Associate PT Government Laboratory, Braga/Guimarães, Portugal
- Department of Polymer Engineering, Institute for Polymers and Composites/i3N, University of Minho, 4800-058, Guimarães, Portugal
- 2C2T-Centre of Textile Science and Technology, University of Minho, 4800-058, Guimarães, Portugal
| | - Fernando N Ferreira
- 2C2T-Centre of Textile Science and Technology, University of Minho, 4800-058, Guimarães, Portugal
| | - Natália M Alves
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, 4805-017, Guimarães, Portugal.
- ICVS/3B's, Associate PT Government Laboratory, Braga/Guimarães, Portugal.
| | - Maria C Paiva
- Department of Polymer Engineering, Institute for Polymers and Composites/i3N, University of Minho, 4800-058, Guimarães, Portugal.
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43
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Lim WL, Liau LL, Ng MH, Chowdhury SR, Law JX. Current Progress in Tendon and Ligament Tissue Engineering. Tissue Eng Regen Med 2019; 16:549-571. [PMID: 31824819 PMCID: PMC6879704 DOI: 10.1007/s13770-019-00196-w] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/07/2019] [Accepted: 05/22/2019] [Indexed: 02/08/2023] Open
Abstract
Background Tendon and ligament injuries accounted for 30% of all musculoskeletal consultations with 4 million new incidences worldwide each year and thus imposed a significant burden to the society and the economy. Damaged tendon and ligament can severely affect the normal body movement and might lead to many complications if not treated promptly and adequately. Current conventional treatment through surgical repair and tissue graft are ineffective with a high rate of recurrence. Methods In this review, we first discussed the anatomy, physiology and pathophysiology of tendon and ligament injuries and its current treatment. Secondly, we explored the current role of tendon and ligament tissue engineering, describing its recent advances. After that, we also described stem cell and cell secreted product approaches in tendon and ligament injuries. Lastly, we examined the role of the bioreactor and mechanical loading in in vitro maturation of engineered tendon and ligament. Results Tissue engineering offers various alternative ways of treatment from biological tissue constructs to stem cell therapy and cell secreted products. Bioreactor with mechanical stimulation is instrumental in preparing mature engineered tendon and ligament substitutes in vitro. Conclusions Tissue engineering showed great promise in replacing the damaged tendon and ligament. However, more study is needed to develop ideal engineered tendon and ligament.
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Affiliation(s)
- Wei Lee Lim
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Ling Ling Liau
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, JalanYaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Min Hwei Ng
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Shiplu Roy Chowdhury
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Jia Xian Law
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
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44
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Abstract
Tendons link muscle to bone and transfer forces necessary for normal movement. Tendon injuries can be debilitating and their intrinsic healing potential is limited. These challenges have motivated the development of model systems to study the factors that regulate tendon formation and tendon injury. Recent advances in understanding of embryonic and postnatal tendon formation have inspired approaches that aimed to mimic key aspects of tendon development. Model systems have also been developed to explore factors that regulate tendon injury and healing. We highlight current model systems that explore developmentally inspired cellular, mechanical, and biochemical factors in tendon formation and tenogenic stem cell differentiation. Next, we discuss in vivo, in vitro, ex vivo, and computational models of tendon injury that examine how mechanical loading and biochemical factors contribute to tendon pathologies and healing. These tendon development and injury models show promise for identifying the factors guiding tendon formation and tendon pathologies, and will ultimately improve regenerative tissue engineering strategies and clinical outcomes.
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Affiliation(s)
- Sophia K Theodossiou
- Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, Moscow, ID 83844, USA
| | - Nathan R Schiele
- Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, Moscow, ID 83844, USA
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45
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Rey-Vinolas S, Castaño O, Ruiz-Macarrilla L, Llorens X, Mora JM, Engel E, Mateos-Timoneda MA. Development of a novel automatable fabrication method based on electrospinning co electrospraying for rotator cuff augmentation patches. PLoS One 2019; 14:e0224661. [PMID: 31725745 PMCID: PMC6855444 DOI: 10.1371/journal.pone.0224661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 10/18/2019] [Indexed: 01/02/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder diseases. Rotator cuff augmentation (RCA) is trying to solve the high retear failure percentage after the surgery procedures (20-90%). The ideal augmentation patch must provide a temporal mechanical support during the healing process. In this work, we proposed a simple method for the fabrication of synthetic RCA patches. This method combines the use of electrospraying to produce poly-L-lactic-co-ε-caprolactone (PLC) films in an organogel form and electrospinning to produce poly(lactic) acid (PLA) nanofibers. The device consists in a combination of layers, creating a multilayered construct, enabling the possibility of tuning its mechanical properties and thickness. Besides, both techniques are simple to escalate for industrial production. A complete characterization has been performed to optimize the involved number of layers and production time of PLC films and PLA nanofibers fabrication, obtaining a final optimal configuration for RCA devices. Structural, mechanical and suture properties were evaluated. Also, the possibility of surface functionalization to improve the bioactivity of the scaffold was studied, adding aligned electrospun PLA nanofibers on the surface of the device to mimic the natural tendon topography. Surface modification was characterized by culturing adult normal human dermal fibroblasts. Lack of toxicity was detected for material presented, and cell alignment shape orientation guided by aligned fibers, mimicking tendon structure, was obtained. Cell proliferation and protein production were also evaluated.
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Affiliation(s)
- Sergi Rey-Vinolas
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Oscar Castaño
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Serra Hunter Fellow, Electronics and Biomedical Engineering Department, University of Barcelona (UB), Barcelona, Spain
- Bioelectronics Unit and Nanobioengineering Lab., Institute for Nanoscience and Nanotechnology of the University of Barcelona (IN2UB), Barcelona, Spain
| | | | - Xavier Llorens
- Fundació Joan Costa Roma, Consorci Sanitari de Terrassa, Terrassa, Spain
- Servei de C.O.T., Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - José M. Mora
- Fundació Joan Costa Roma, Consorci Sanitari de Terrassa, Terrassa, Spain
- Servei de C.O.T., Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Elisabeth Engel
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Department of Materials Science and Metallurgical Engineering, EEBE campus, Technical University of Catalonia (UPC), Barcelona, Spain
| | - Miguel A. Mateos-Timoneda
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Department of Materials Science and Metallurgical Engineering, EEBE campus, Technical University of Catalonia (UPC), Barcelona, Spain
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46
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Tissue biomechanical behavior should be considered in the risk assessment of perineal trauma at childbirth. Arch Gynecol Obstet 2019; 300:1821-1826. [PMID: 31720778 DOI: 10.1007/s00404-019-05369-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/30/2019] [Indexed: 12/31/2022]
Abstract
Perineal trauma at childbirth is associated with strong negative impacts on a woman's health but remains unpredictable. Pregnancy induces several changes in biomechanical behavior in humans as in animals, namely, an increase in ligamentous laxity and an increase in vaginal distensibility. Pelvic floor muscles in rats are reported to exhibit specific behaviors during pregnancy. Increases in both stiffness and the number of sarcomeres in series are observed and might process that protect against perineal trauma at childbirth. Some data in humans have shown that the risk of perineal trauma is highly linked to the intrinsic characteristics of the tissue, suggesting the potential benefit of incorporating intrinsic biomechanical characteristics in the risk prediction for perineal trauma. Shear wave elastography might be a useful noninvasive tool to investigate the elastic properties of these tissues in pregnant women in vivo, with the goal of implementing these properties as a predictive strategy.
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47
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Concepts of the Distal Medial Patellar Restraints: Medial Patellotibial Ligament and Medial Patellomeniscal Ligament. Sports Med Arthrosc Rev 2019; 27:143-149. [PMID: 31688532 DOI: 10.1097/jsa.0000000000000269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The important medial patellar ligamentous restraints to lateral dislocation are the proximal group (the medial quadriceps tendon femoral ligament and the medial patellofemoral ligament) and the distal group [medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML)]. The MPTL patellar insertion is at inferomedial border of patella and tibial insertion is in the anteromedial tibia. The MPML originates in the inferomedial patella, right proximal to the MPTL, inserting in the medial meniscus. On the basis of anatomy and biomechanical studies, the MPTL and MPML are more important in 2 moments during knee range of motion: terminal extension, when it directly counteracts quadriceps contraction. In a systematic review on MPTL reconstructions 19 articles were included detailing the clinical outcomes of 403 knees. All were case series. Overall, good and excellent outcomes were achieved in >75% of cohorts in most studies and redislocations were <10%, with or without the association of the medial patellofemoral ligament. The MPTL is a relevant additional tool to proximal restraint reconstruction in select patient profiles; however, more definitive clinical studies are necessary to better define surgical indications.
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48
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Tomás AR, Gonçalves AI, Paz E, Freitas P, Domingues RMA, Gomes ME. Magneto-mechanical actuation of magnetic responsive fibrous scaffolds boosts tenogenesis of human adipose stem cells. NANOSCALE 2019; 11:18255-18271. [PMID: 31566629 DOI: 10.1039/c9nr04355a] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Tendons are highly specialized load-bearing tissues with very limited healing capacity. Given their mechanosensitive nature, the combination of tendon mimetic scaffolds with remote mechanical actuation could synergistically contribute to the fabrication of improved tissue engineered alternatives for the functional regeneration of tendons. Here, hybrids of cellulose nanocrystals decorated with magnetic nanoparticles were produced to simultaneously reinforce and confer magnetic responsiveness to tendon mimetic hierarchical fibrous scaffolds, resulting in a system that enables remote stimulation of cells in vitro and, potentially, in vivo after construct transplantation. The biological performance and functionality of these scaffolds were evaluated using human adipose stem cells (hASCs) cultured under or in the absence of magnetic actuation. It was demonstrated that magneto-mechanical stimulation of hASCs promotes higher degrees of cell cytoskeleton anisotropic organization and steers the mechanosensitive YAP/TAZ signaling pathway. As feedback, stimulated cells show increased expression of tendon-related markers, as well as a pro-healing profile in genes related to their inflammatory secretome. Overall, these results support the use of the proposed magnetic responsive fibrous scaffolds as remote biointegrated actuators that can synergistically boost hASC tenogenesis through mechanosensing mechanisms and may modulate their pro-healing paracrine signaling, thus collectively contributing to the improvement of the regenerative potential of engineered tendon grafts.
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Affiliation(s)
- Ana R Tomás
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia Zona Industrial da Gandra, Barco, Guimarães 4805-017, Portugal.
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49
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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: 23] [Impact Index Per Article: 4.6] [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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50
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Mersmann F, Pentidis N, Tsai MS, Schroll A, Arampatzis A. Patellar Tendon Strain Associates to Tendon Structural Abnormalities in Adolescent Athletes. Front Physiol 2019; 10:963. [PMID: 31427983 PMCID: PMC6687848 DOI: 10.3389/fphys.2019.00963] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/11/2019] [Indexed: 12/28/2022] Open
Abstract
High mechanical strain is thought to be one of the main factors for the risk of tendon injury, as it determines the mechanical demand placed upon the tendon by the working muscle. The present study investigates the association of tendon mechanical properties including force, stress and strain, and measures of tendon micromorphology and neovascularization, which are thought to be indicative of tendinopathy in an adolescent high-risk group for overuse injury. In 16 adolescent elite basketball athletes (14–15 years of age) we determined the mechanical properties of the patellar tendon by combining inverse dynamics with magnetic resonance and ultrasound imaging. Tendon micromorphology was determined based on a spatial frequency analysis of sagittal plane ultrasound images and neovascularization was quantified as color Doppler area. There was a significant inverse relationship between tendon strain and peak spatial frequency (PSF) in the proximal tendon region (r = −0.652, p = 0.006), indicating locally disorganized collagen fascicles in tendons that are subjected to high strain. No such associations were present at the distal tendon site and no significant correlations were observed between tendon force or stress and tendon PSF as well as between tendon loading and vascularity. Our results suggest that high levels of tendon strain might associate to a micromorphological deterioration of the collagenous network in the proximal patellar tendon, which is also the most frequent site affected by tendinopathy. Neovascularization of the tendon on the other hand seems not to be directly related to the magnitude of tendon loading and might be a physiological response to a high frequency of training in this group. Those findings have important implications for our understanding of the etiology of tendinopathy and for the development of diagnostical tools for the assessment of injury risk.
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Affiliation(s)
- 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
| | - Nikolaos Pentidis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Meng-Shiuan Tsai
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Arno Schroll
- 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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