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Ishigaki T, Ishida T, Ino T, Okunuki T, Yokoyama H, Edama M. Relationship between compressive stiffness and tensile stiffness in the human Achilles tendon in vivo. J Bodyw Mov Ther 2025; 42:1073-1078. [PMID: 40325638 DOI: 10.1016/j.jbmt.2025.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 01/27/2025] [Accepted: 03/02/2025] [Indexed: 05/07/2025]
Abstract
BACKGROUND Tendon elongation is measured using ultrasound images during isometric ramp contractions in traditional measurement techniques for human tendon mechanical properties, and tendon tensile stiffness (TS) is calculated from the slope of specific force intervals in the tendon force-elongation curve. Recently, the compressive stiffness (CS) of tendons, measured using a myotonometer, has attracted attention as a new technique for investigating tendon mechanical properties in vivo. This study aimed to clarify the relationship between tensile and compressive Achilles tendon stiffness in vivo. METHODS Thirty young healthy adults (20.7 ± 18 years) participated in this study. TS was measured using B-mode ultrasonography and a dynamometer and calculated from the slope of the specific force intervals (25-45%, 30-70%, 50-100%, and 90-100% maximum voluntary contraction) in the tendon force-elongation curve. CS in the resting condition was measured at 3, 4, 5, 6, and 7 cm proximal to the calcaneus Achilles tendon insertion. The data obtained from each measurement region, as well as the average of those data, were used for further correlation analysis. The relationship between TS and CS was evaluated using Spearman rank correlation coefficient. RESULTS Correlation analysis demonstrated no relationship between TS and CS regardless of the force intervals in TS (r = - 0.019-0.251, P = 0.181-0.980). CONCLUSION The current results suggest that each measurement technique for the TS and CS evaluates different tendon mechanical properties. Researchers and clinicians should consider the characteristics of these two measurement techniques and select the appropriate method depending on the research purpose.
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Affiliation(s)
- Tomonobu Ishigaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata city, 950-3198, Niigata, Japan; Athlete Support Research Center, Niigata University of Health and Welfare, Niigata city, 950-3198, Niigata, Japan; Institute of Life Innovation Research Center, Toyo University, Kita-ku, Tokyo, 115-0053, Japan.
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, 060-0812, Hokkaido, Japan.
| | - Takumi Ino
- Faculty of Health Sciences, Hokkaido University of Science, Sapporo, 006-8585, Hokkaido, Japan.
| | - Takumi Okunuki
- Institute of Life Innovation Research Center, Toyo University, Kita-ku, Tokyo, 115-0053, Japan; Japan Society for the Promotion of Sciences, Chiyoda-ku, 102-0083, Tokyo, Japan.
| | - Hiroko Yokoyama
- Faculty of Health Sciences, Tohoku Fukushi University, Sendai, 981-0943, Miyagi, Japan.
| | - Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata city, 950-3198, Niigata, Japan; Athlete Support Research Center, Niigata University of Health and Welfare, Niigata city, 950-3198, Niigata, Japan.
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Volesky K, Novak J, Janek M, Katolicky J, Tufano JJ, Steffl M, Courel-Ibáñez J, Vetrovsky T. Assessing the Test-Retest Reliability of MyotonPRO for Measuring Achilles Tendon Stiffness. J Funct Morphol Kinesiol 2025; 10:83. [PMID: 40137335 PMCID: PMC11942912 DOI: 10.3390/jfmk10010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 02/21/2025] [Accepted: 02/26/2025] [Indexed: 03/27/2025] Open
Abstract
Objectives: This study evaluates the test-retest reliability and inter-rater reliability of the MyotonPRO for measuring Achilles tendon stiffness at two standardized sites over various time frames and settings. Methods: Eight healthy participants underwent assessments by three raters over six visits. Tendon stiffness was measured at proximal (mid-portion) and distal (insertional) regions of the Achilles tendon at various time frames (10-15 s, 10-15 min, 24 h, and 14 days apart). Measurements included participant repositioning and two activity stimuli (daily living and sport). Reliability was calculated using the intraclass correlation coefficient (ICC), its 95% confidence interval, coefficient of variation, standard error of measurement, and minimal detectable change. Results: Short-term reliability (10-15 min) was excellent, with an ICC of 0.956 (0.929-0.974). Between days reliability (24 h) was good, with an ICC of 0.889 (0.802-0.938). Between weeks reliability (2 weeks) was good with an ICC of 0.886 (0.811-0.931). Short-term reliability with the simulation of activity of daily living was good, with an ICC of 0.917 (0.875-0.945). Short-term reliability with the simulation of sport was good with an ICC of 0.933 (0.891-0.96). Between days reliability with the simulation of sport was good, with an ICC of 0.920 (0.859-0.955). Conclusions: When used in a standardized position, the MyotonPRO demonstrates reliable repeated measurements of Achilles tendon stiffness. This protocol provides a foundation for clinical research and rehabilitation by clarifying expected reliability across minutes, days, and weeks, thus aiding clinicians and researchers in monitoring tendon adaptations and making evidence-based decisions.
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Affiliation(s)
- Krystof Volesky
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic; (K.V.)
| | - Jan Novak
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic; (K.V.)
| | - Michael Janek
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic; (K.V.)
| | - Jakub Katolicky
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, University Hospital in Motol, Charles University, 150 06 Prague, Czech Republic
| | - James J. Tufano
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic; (K.V.)
| | - Michal Steffl
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic; (K.V.)
| | - Javier Courel-Ibáñez
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 520 71 Melilla, Spain
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic; (K.V.)
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Król P, Słomka KJ, Juras G, Marszałek W, Stania M. Post-mechanotherapy differences in postural control in patients with Achilles tendinopathy - A randomized controlled trial. Gait Posture 2024; 114:180-192. [PMID: 39353339 DOI: 10.1016/j.gaitpost.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/12/2024] [Accepted: 09/19/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Neuromuscular deficits affecting functional ability can occur in patients with Achilles tendinopathy during difficult balance activities. This study aimed to assess postural control in patients with Achilles tendinopathy after shockwave and sonotherapy, using advanced analytical methods, including rambling-trembling signal decomposition and sample entropy. RESEARCH QUESTION What are the differences in postural control between patients with Achilles tendinopathy after shockwave therapy, ultrasound therapy, and placebo ultrasound? METHODS Thirty-nine patients were included in the study, and randomly assigned to 3 groups, i.e., shockwave therapy, ultrasound therapy and placebo ultrasound. Postural sway was assessed during quiet standing with eyes open and closed, with two force platforms, one for the affected and the other for the non-affected limb, at baseline and at weeks 1 and 6 after treatment. Rambling-trembling trajectories and sample entropy were calculated for the antero-posterior and medio-lateral directions. RESULTS The parameters of trembling trajectory in both directions were significantly smaller for the affected compared to non-affected limb. The ultrasound group had significantly larger rambling-trembling trajectories in the antero-posterior and medio-lateral sway directions than the shockwave therapy group. Also, all patients had more difficulty controlling their postural sway while standing with eyes closed compared to eyes open. Sample entropy was not significantly affected by the therapy type, timepoint and limb condition. SIGNIFICANCE As opposed to sample entropy, rambling-trembling decomposition can complement or replace traditional linear measures of COP time series in functional assessment of the Achilles tendon.
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Affiliation(s)
- Piotr Król
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72A, Katowice 40-065, Poland
| | - Kajetan Jacek Słomka
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72A, Katowice 40-065, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72A, Katowice 40-065, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72A, Katowice 40-065, Poland
| | - Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72A, Katowice 40-065, Poland.
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Stania M, Słomka KJ, Juras G, Król T, Król P. Efficacy of shock wave therapy and ultrasound therapy in non-insertional Achilles tendinopathy: a randomised clinical trial. Front Neurol 2024; 15:1434983. [PMID: 39055323 PMCID: PMC11270751 DOI: 10.3389/fneur.2024.1434983] [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: 05/19/2024] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Objective Physiotherapists and physicians continue to seek effective conservative treatments for Achilles tendinopathy. This study aimed to subjectively and objectively determine the therapeutic efficacy of radial shock wave therapy (RSWT) and ultrasound therapy in non-insertional Achilles tendinopathy. Materials and methods Thirty-nine patients with non-insertional Achilles tendinopathy were randomly assigned to three experimental groups, i.e., RSWT (group A), ultrasound therapy (group B), and placebo ultrasound (group C) groups. Before the intervention and at weeks 1 and 6 after the treatment, the patients were assessed using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire and posturographic measurements of step initiation performed on the force platforms under two different conditions (non-perturbed transit and perturbed transit). Results Six weeks after therapy, all groups exhibited significantly increased VISA-A scores against the measurement at week 1 after therapy. The post-therapy percentage changes in VISA-A scores were significantly greater in group A compared to group B. The three-way ANOVA demonstrated that treatment type affected sway range in the frontal plane and mean velocity of the centre of foot pressure displacements in the sagittal and frontal planes during quiet standing before step initiation. The Bonferroni post-hoc test showed that the means of all those variables were significantly smaller for group A than for group B patients. The three-way ANOVA revealed an effect of the platform arrangement on transit time and double-support period. The Bonferroni post-hoc test revealed statistically longer transit time for the perturbed vs. non-perturbed trials; a reverse relationship was observed for the double-support period. Conclusion The VISA-A showed that RSWT was significantly more effective than sonotherapy for alleviation of pain intensity as well as function and activity improvement in patients with non-insertional Achilles tendinopathy. Therefore, RSWT therapy can be used in clinical practice by physiotherapists to alleviate the symptoms of non-insertional Achilles tendinopathy. Objective data registered by force platforms during quiet standing before and after step initiation did not prove useful for monitoring the progress of treatment applied to patients with non-insertional Achilles tendinopathy between consecutive therapy interventions.Clinical trial registration:https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617000860369, identifier (ACTRN12617000860369).
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Affiliation(s)
- Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Kajetan J. Słomka
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Tomasz Król
- Department of Kinesitherapy and Special Methods, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Piotr Król
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
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Hanimann J, Fitze DP, Götschi T, Fröhlich S, Frey WO, de Bruin ED, Sutter R, Spörri J. Changes in patellar tendon complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up. Front Physiol 2024; 15:1401632. [PMID: 39040077 PMCID: PMC11261000 DOI: 10.3389/fphys.2024.1401632] [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: 03/15/2024] [Accepted: 05/30/2024] [Indexed: 07/24/2024] Open
Abstract
Patellar tendon (PT) complaints are frequent in competitive alpine skiers and such complaints are characterized by a long-lasting affection. Since PTs are subject to maturation up to 1-2 years after growth spurt, this early career stage may be decisive for the further course of complaints. The aim of this study was to investigate the evolution of PT complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up. The PT complaints and SWV patterns of forty-seven skiers were analysed at baseline (i.e., immediately after their peak height growth at 13-15 years of age) and were re-analysed at 4-year follow-up. The PTs were scanned via three-dimensional SWE. Symptomatic skiers were identified based on pain sensation under loading and pressure-induced pain around the PT. The prevalence of PT complaints decreased from 29.8% at baseline to 12.8% at follow-up (Pearson's χ2 = 9.429; p = 0.002). SWV decreased from the baseline assessment to the follow-up in the proximal and distal regions (p < 0.05). SWV coefficient of variation (CV) in the distal and mid-portion regions was greater at baseline than at follow-up (p < 0.05). At the follow-up assessment, compared to "healthy" skiers, "healed" skiers who recovered from PT complaints had lower SWVs in the proximal region (p = 0.020) and greater SWV CVs in the proximal region (p = 0.028). Moreover, symptomatic skiers had significantly greater SWV CVs in the mid-portion region than did "healthy" subjects with no history of PT complaints (p = 0.020). The average SWV was negatively correlated with the SWV (proximal: r = -0.74, p < 0.001; mid-portion: r = -0.37 p = 0.011; and distal: r = -0.58, p < 0.001). The occurrence of PT complaints decreased over a 4-year post-growth spurt follow-up. "Healed" skiers who were symptomatic at baseline had an even greater average decrease in the proximal and mid-portion SWV than "healthy" skiers with no history of PT complaints. This may lead to the hypothesis that PT complaints in adolescent skiers are not self-eliminating towards the end of adolescence, as at least structural irregularities appear to persist for several years after the onset of initial symptoms. Furthermore, "healed" and symptomatic tendons exhibited increased SWV variability, supporting the hypothesis that SWV CV may provide additional valuable information on the mechanical properties of PTs affected by overuse-related complaints.
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Affiliation(s)
- Jonas Hanimann
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Daniel P. Fitze
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Tobias Götschi
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter O. Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
- Department of Health, OST—Eastern Swiss University of Applied Sciences, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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van Dam L, Terink R, van den Akker-Scheek I, Zwerver J. Intra- and inter-operator reliability of measuring compressive stiffness of the patellar tendon in volleyball players using a handheld digital palpation device. PLoS One 2024; 19:e0304743. [PMID: 38917106 PMCID: PMC11198853 DOI: 10.1371/journal.pone.0304743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
This observational study aimed to evaluate the intra- and inter-operator reliability of a digital palpation device in measuring compressive stiffness of the patellar tendon at different knee angles in talent and elite volleyball players. Second aim was to examine differences in reliability when measuring at different knee angles, between dominant and non-dominant knees, between sexes, and with age. Two operators measured stiffness at the midpoint of the patellar tendon in 45 Dutch volleyball players at 0°, 45° and 90° knee flexion, on both the dominant and non-dominant side. We found excellent intra-operator reliability (ICC>0.979). For inter-operator reliability, significant differences were found in stiffness measured between operators (p<0.007). The coefficient of variance significantly decreased with increasing knee flexion (2.27% at 0°, 1.65% at 45° and 1.20% at 90°, p<0.001). In conclusion, the device appeared to be reliable when measuring compressive stiffness of the patellar tendon in elite volleyball players, especially at 90° knee flexion. Inter-operator reliability appeared to be questionable. More standardized positioning and measurement protocols seem necessary.
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Affiliation(s)
- Lotte van Dam
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
- Department of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rieneke Terink
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes Zwerver
- Department of Sports Medicine, Sports Valley, Gelderse Vallei Hospital, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Dhankhar M, Guo Z, Kant A, Basir R, Joshi R, Heo SC, Mauck RL, Lakadamyali M, Shenoy VB. Revealing the Biophysics of Lamina-Associated Domain Formation by Integrating Theoretical Modeling and High-Resolution Imaging. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.24.600310. [PMID: 38979207 PMCID: PMC11230226 DOI: 10.1101/2024.06.24.600310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
The interactions between chromatin and the nuclear lamina orchestrate cell type-specific gene activity by forming lamina-associated domains (LADs) which preserve cellular characteristics through gene repression. However, unlike the interactions between chromatin segments, the strength of chromatin-lamina interactions and their dependence on cellular environment are not well understood. Here, we develop a theory to predict the size and shape of peripheral heterochromatin domains by considering the energetics of chromatin-chromatin interactions, the affinity between chromatin and the nuclear lamina and the kinetics of methylation and acetylation9in human mesenchymal stem cells (hMSCs). Through the analysis of super-resolution images of peripheral heterochromatin domains using this theoretical framework, we determine the nuclear lamina-wide distribution of chromatin-lamina affinities. We find that the extracted affinity is highly spatially heterogeneous and shows a bimodal distribution, indicating regions along the lamina with strong chromatin binding and those exhibiting vanishing chromatin affinity interspersed with some regions exhibiting a relatively diminished chromatin interactions, in line with the presence of structures such as nuclear pores. Exploring the role of environmental cues on peripheral chromatin, we find that LAD thickness increases when hMSCs are cultured on a softer substrate, in correlation with contractility-dependent translocation of histone deacetylase 3 (HDAC3) from the cytosol to the nucleus. In soft microenvironments, chromatin becomes sequestered at the nuclear lamina, likely due to the interactions of HDAC3 with the chromatin anchoring protein LAP2 β ,increasing chromatin-lamina affinity, as well as elevated levels of the intranuclear histone methylation. Our findings are further corroborated by pharmacological interventions that inhibit contractility, as well as by manipulating methylation levels using epigenetic drugs. Notably, in the context of tendinosis, a chronic condition characterized by collagen degeneration, we observed a similar increase in the thickness of peripheral chromatin akin to that of cells cultured on soft substrates consistent with theoretical predictions. Our findings underscore the pivotal role of the microenvironment in shaping genome organization and highlight its relevance in pathological conditions.
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Römer C, Czupajllo J, Wolfarth B, Sichting F, Legerlotz K. The Myometric Assessment of Achilles Tendon and Soleus Muscle Stiffness before and after a Standardized Exercise Test in Elite Female Volleyball and Handball Athletes-A Quasi-Experimental Study. J Clin Med 2024; 13:3243. [PMID: 38892954 PMCID: PMC11172482 DOI: 10.3390/jcm13113243] [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: 04/30/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The high prevalence of injuries in female athletes necessitates a course of action that not only enhances research in this field but also incorporates improved prevention programs and regular health monitoring of highly stressed structures such as tendons and muscles. Since myometry is already used by coaches and physiotherapists, it is important to investigate whether tissue stiffness varies in different types of sports, and whether such measures are affected by an acute training session. Methods: Myometric measurements of the Achilles tendon (AT) and soleus muscle (SM) were performed in the longitudinal plane and relaxed tendon position. In total, 38 healthy professional female athletes were examined, applying a quasi-experimental study design, with subgroup analysis performed for different sports. To investigate the stiffness of the AT and SM, 24 female handball and volleyball athletes performed a standardized maximal incremental performance test on a treadmill. In this subgroup, myometric measurements were taken before and after the exercise test. Results: The measurements showed no significant difference between the mean pre- (AT: 661.46 N/m; SM 441.48 N/m) and post-exercise stiffness (AT: 644.71 N/m; SM: 439.07 N/m). Subgroup analysis for different types of sports showed significantly lower AT and SM stiffness in swimming athletes compared to handball (p = 0.002), volleyball (p = 0.000) and hammer throw athletes (p = 0.008). Conclusions: Myometry can be performed on the same day as an acute training session in healthy female professional volleyball and handball athletes. Female swimmers have significantly lower AT and SM stiffness compared to female handball, volleyball and hammer throw athletes. These results show that the stiffness differences in the AT and SM can be assessed by myometry.
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Affiliation(s)
- Claudia Römer
- Department of Sports Medicine, Charité University Medicine Berlin, 10115 Berlin, Germany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité University Medicine Berlin, 10115 Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité University Medicine Berlin, 10115 Berlin, Germany
| | - Freddy Sichting
- Department of Human Movement Science, Chemnitz University of Technology, 09111 Chemnitz, Germany
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt University Berlin, 10115 Berlin, Germany
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Wegener F, Ritterbusch A, Saal C, Baumgart C, Hoppe MW. Myotonometry and extended field-of-view ultrasound imaging allow reliable quantification of patellar tendon stiffness and length at rest and during maximal load, whereas several restrictions exist for the Achilles tendon. Front Sports Act Living 2024; 6:1379506. [PMID: 38859890 PMCID: PMC11163091 DOI: 10.3389/fspor.2024.1379506] [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: 01/31/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Stiffness and length are well-established tendon parameters in sports and medicine. Myotonometry and ultrasound imaging are the commonly used methods to quantify these parameters. However, further studies are needed to clarify the reliability of these methods, especially when assessing maximally loaded tendons and when conducted by different experienced investigators. This study aimed to determine the intra- and interrater reliabilities of measuring the stiffness and length of the patellar tendon (PT) and Achilles tendon (AT) using the myotonometry method and the extended field-of-view ultrasound (EFOV-US) technique at rest and maximal load performed by different experienced investigators. Methods Twenty-seven participants were examined on three different days by one experienced investigator and one novice investigator. Primary outcomes were the intraclass correlation coefficient (ICC) and associated 95% confidence interval (95% CI), coefficient of variation (CV), standard error of measurement (SEM), and minimal detectable change (MDC) across the measurement days and investigators. Results For PT measurements at rest and maximal load, the estimated ICCs for stiffness and length were ≥.867 and ≥.970, respectively, with 95% CIs ranging from poor (.306) to excellent (.973) and good (.897) to excellent (.999). The CV, SEM, and MDC for PT stiffness and length were ≤5.2% and ≤2.0%, ≤39.3 N/m and ≤0.9 mm, and ≤108.9 N/m and ≤2.6 mm, respectively. For AT measurements, some restrictions were evident for stiffness at rest and both parameters at maximal load. However, regarding AT length at rest, the estimated ICC was ≥.996, with an excellent 95% CI (.987-.999). The CV, SEM, and MDC for AT length at rest were 2.8%, ≤1.1 mm, and ≤2.9 mm, respectively. Conclusion The estimated ICCs show good to excellent reliability for the myotonometry method and the EFOV-US technique for measuring PT stiffness and length at rest and maximal load for experienced and novice investigators. However, some restrictions are evident for the AT, especially for measurements at maximal load.
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Affiliation(s)
- Florian Wegener
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Arne Ritterbusch
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Christian Saal
- Movement and Training Science, Faculty of Sport Science, Leipzig University, Leipzig, Germany
| | - Christian Baumgart
- Department of Movement and Training Science, Faculty of Humanities and Social Sciences, University of Wuppertal, Wuppertal, Germany
| | - Matthias W. Hoppe
- Department of Exercise Science, Institute of Sport Science and Motology, Faculty of Educational Sciences, Philipps University of Marburg, Marburg, Germany
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Konar S, Leung S, Tay ML, Coleman B, Dalbeth N, Cornish J, Naot D, Musson DS. Novel In Vitro Platform for Studying the Cell Response to Healthy and Diseased Tendon Matrices. ACS Biomater Sci Eng 2024; 10:3293-3305. [PMID: 38666422 DOI: 10.1021/acsbiomaterials.4c00414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Current in vitro models poorly represent the healthy or diseased tendon microenvironment, limiting the translation of the findings to clinics. The present work aims to establish a physiologically relevant in vitro tendon platform that mimics biophysical aspects of a healthy and tendinopathic tendon matrix using a decellularized bovine tendon and to characterize tendon cells cultured using this platform. Bovine tendons were subjected to various decellularization techniques, with the efficacy of decellularization determined histologically. The biomechanical and architectural properties of the decellularized tendons were characterized using an atomic force microscope. Tendinopathy-mimicking matrices were prepared by treating the decellularized tendons with collagenase for 3 h or collagenase-chondroitinase (CC) for 1 h. The tendon tissue collected from healthy and tendinopathic patients was characterized using an atomic force microscope and compared to that of decellularized matrices. Healthy human tendon-derived cells (hTDCs) from the hamstring tendon were cultured on the decellularized matrices for 24 or 48 h, with cell morphology characterized using f-actin staining and gene expression characterized using real-time PCR. Tendon matrices prepared by freeze-thawing and 48 h nuclease treatment were fully decellularized, and the aligned structure and tendon stiffness (1.46 MPa) were maintained. Collagenase treatment prepared matrices with a disorganized architecture and reduced stiffness (0.75 MPa), mimicking chronic tendinopathy. Treatment with CC prepared matrices with a disorganized architecture without altering stiffness, mimicking early tendinopathy (1.52 MPa). hTDCs on a healthy tendon matrix were elongated, and the scleraxis (SCX) expression was maintained. On tendinopathic matrices, hTDCs had altered morphological characteristics and lower SCX expression. The expression of genes related to actin polymerization, matrix degradation and remodeling, and immune cell invasion were higher in hTDCs on tendinopathic matrices. Overall, the present study developed a physiological in vitro system to mimic healthy tendons and early and late tendinopathy, and it can be used to better understand tendon cell characteristics in healthy and diseased states.
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Affiliation(s)
- Subhajit Konar
- Department of Nutrition and Dietetics, University of Auckland, Auckland 1142, New Zealand
| | - Sophia Leung
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland 1142, New Zealand
| | - Mei Lin Tay
- Department of Surgery, University of Auckland, Auckland 1142, New Zealand
| | - Brendan Coleman
- Department of Orthopaedics, Middlemore Hospital, Auckland 1640, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland 1142, New Zealand
| | - Jillian Cornish
- Department of Medicine, University of Auckland, Auckland 1142, New Zealand
| | - Dorit Naot
- Department of Nutrition and Dietetics, University of Auckland, Auckland 1142, New Zealand
| | - David S Musson
- Department of Nutrition and Dietetics, University of Auckland, Auckland 1142, New Zealand
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11
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Albano D, Basile M, Gitto S, Messina C, Longo S, Fusco S, Snoj Z, Gianola S, Bargeri S, Castellini G, Sconfienza LM. Shear-wave elastography for the evaluation of tendinopathies: a systematic review and meta-analysis. LA RADIOLOGIA MEDICA 2024; 129:107-117. [PMID: 37907673 DOI: 10.1007/s11547-023-01732-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To compare pathologic and healthy tendons using shear-wave elastography (SWE). METHODS A systematic review with meta-analysis was done searching Pubmed and EMBASE up to September 2022. Prospective, retrospective and cross-sectional studies that used SWE in the assessment of pathologic tendons versus control were included. Our primary outcome were SWE velocity (m/s) and stiffness (kPa). Methodological quality was assessed by the methodological index for non-randomized studies (MINORS). We used the mean difference (MD) with corresponding 95% confidence intervals (CIs) to quantify effects between groups. We performed sensitivity analysis in case of high heterogeneity, after excluding poor quality studies according to MINORS assessment. We used Grades of Recommendation, Assessment, Development and Evaluation to evaluate the certainty of evidence (CoE). RESULTS Overall, 16 studies with 676 pathologic tendons (188 Achilles, 142 patellar, 96 supraspinatus, 250 mixed) and 723 control tendons (484 healthy; 239 contralateral tendon) were included. Five studies (31.3%) were judged as poor methodological quality. Shear-wave velocity and stiffness meta-analyses showed high heterogeneity. According to a sensitivity analysis, pathologic tendons had a lower shear wave velocity (MD of - 1.69 m/s; 95% CI 1.85; - 1.52; n = 274; I2 50%) compared to healthy tendons with very low CoE. Sensitivity analysis on stiffness still showed high heterogeneity. CONCLUSION Pathological tendons may have reduced SWE velocity compared to controls, but the evidence is very uncertain. Future robust high-quality longitudinal studies and clear technical indications on the use of this tool are needed. PROTOCOL PROSPERO identifier: CRD42023405410 CLINICAL RELEVANCE STATEMENT: SWE is a relatively recent modality that may increase sensitivity and diagnostic accuracy of conventional ultrasound imaging promoting early detection of tendinopathy. Non-negligible heterogeneity has been observed in included studies, so our findings may encourage the conduct of future high-quality longitudinal studies which can provide clear technical indications on the use of this promising tool in tendon imaging.
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Affiliation(s)
- Domenico Albano
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy.
| | - Mariachiara Basile
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Gitto
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Longo
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Fusco
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Ziga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine - Department of Radiology, University of Ljubljana, Ljubljana, Slovenia
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
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12
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van Dam L, Terink R, Mensink M, de Vos RJ, Zwerver J. The JUMPFOOD study: additional effect of hydrolyzed collagen and vitamin C to exercise treatment for patellar tendinopathy (jumper's knee) in athletes-study protocol for a double-blind randomized controlled trial. Trials 2023; 24:768. [PMID: 38017500 PMCID: PMC10685530 DOI: 10.1186/s13063-023-07783-2] [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: 04/24/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patellar tendinopathy (PT) is a common problem in jumping athletes. Management can be challenging and treatment outcome is not always successful. In combination with tendon loading exercises, hydrolyzed collagen/vitamin C supplementation appears to have a promising effect on the recovery of tendinopathy. The aim of this study is to evaluate whether the use of oral supplementation of hydrolyzed collagen and vitamin C in combination with progressive tendon loading exercises (PTLE) is superior to PTLE and placebo on VISA-P score (which rates pain, function, sports participation) after 24 weeks for athletes with PT. METHODS The JUMPFOOD study is a double-blinded, two-armed randomized controlled trial, in which the effectiveness of oral supplementation of hydrolyzed collagen/vitamin C combined with PTLE compared to PTLE with placebo on pain and recovery of function in athletes with PT will be investigated. Seventy-six athletes aged 16-40 years, with symptoms of PT for at least 12 weeks, who play sports at least once a week will be included. All participants will receive education, advice with regard to load management and a PTLE program according to the Dutch guidelines for anterior knee pain. In addition, the intervention group will receive daily 10 g hydrolyzed collagen and 40 mg vitamin C supplementation for 24 weeks whereas the control group receives 10 g maltodextrin placebo supplementation. Measurements will take place at baseline and at 12 and 24 weeks' follow-up. Primary outcome is the VISA-P score, which evaluates pain, function, and sports participation. For secondary outcome measures, data with regard to pain during functional tests, flexibility measurements, blood withdrawals, imaging characteristics of the tendon, and health questionnaires will be collected. During the follow-up period, participants will register sports participation, amount of training and tendon load, pain during sports, co-medication, and side-effects in a digital weekly diary. DISCUSSION The JUMPFOOD study is the first large RCT to study the effectiveness of hydrolyzed collagen/vitamin C supplementation in combination with the PTLE program in athletes with patellar tendinopathy. If supplementation of collagen/vitamin C appears to be effective, this treatment can be implemented in daily sports medicine practice to improve the treatment outcome of patients with PT. TRIAL REGISTRATION ClinicalTrials.gov NCT05407194. Registered on 7 June 2022.
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Affiliation(s)
- L van Dam
- Department of Sports Medicine, SportsValley, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), Wageningen, The Netherlands.
| | - R Terink
- Department of Sports Medicine, SportsValley, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - M Mensink
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), Wageningen, The Netherlands
| | - R J de Vos
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Zwerver
- Department of Sports Medicine, SportsValley, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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13
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Kurashina W, Takahashi T, Sasanuma H, Saitsu A, Takeshita K. Relationship Between Achilles Tendon Stiffness Using Myoton PRO and Translation Using a Tensile Testing Machine: A Biomechanical Study of a Porcine Model. Cureus 2023; 15:e49359. [PMID: 38146575 PMCID: PMC10749689 DOI: 10.7759/cureus.49359] [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] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Background Achilles tendinopathy is a common ankle disorder in both the general population and athletes. This condition can alter the mechanical characteristics of the Achilles tendon (AT) by decreasing tendon stiffness. Achilles tendinopathy is primarily treated conservatively; however, few monitoring tools exist for evaluating the condition of the AT. The Myoton PRO (Myoton AS, Tallinn, Estonia) device is a handheld tool used to evaluate tissue stiffness. However, no basic studies have examined the validity of Myoton PRO for assessing the AT. This study aimed to assess the validity of Myoton PRO using animal ATs and to examine its clinical applicability. Methods We used 28 fresh porcine ankles and evaluated AT stiffness at the calcaneus insertion site (AT0) and 2.0 cm above the calcaneus (AT2) using Myoton PRO. We also measured changes in the AT length using a tensile testing machine during the cyclic loading test. We investigated the correlation between dynamic stiffness and length change. Furthermore, we assessed the difference in stiffness between AT0 and AT2. Results The dynamic stiffness was 717.6 ± 183.1 N/m at AT0 and 467.4 ± 152.3 N/m at AT2. The change in length during the cyclic loading test was 1.8 ± 0.7 mm. The correlation between dynamic stiffness and length change was as follows: AT0, r=-0.61; AT2, r=-0.64 (P<0.001). The dynamic stiffness at AT0 was significantly greater than that at AT2 (P<0.001). Conclusions AT assessment using Myoton PRO has potential clinical utility as an indicator of tissue stiffness.
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Affiliation(s)
- Wataru Kurashina
- Graduate School of Medicine, Jichi Medical University, Shimotsuke, JPN
- Department of Rehabilitation, Tochigi Medical Center Shimotsuga, Tochigi, JPN
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, JPN
| | - Hideyuki Sasanuma
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, JPN
| | - Akihiro Saitsu
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, JPN
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14
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Stania M, Pawłowski M, Marszałek W, Juras G, Słomka KJ, Król P. A preliminary investigation into the impact of shock wave therapy and sonotherapy on postural control of stepping tasks in patients with Achilles tendinopathy. Front Neurol 2023; 14:1157335. [PMID: 37332988 PMCID: PMC10272772 DOI: 10.3389/fneur.2023.1157335] [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: 02/02/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The outcomes of physical therapy are commonly assessed with subjective scales and questionnaires. Hence, a continuous search to identify diagnostic tests that would facilitate objective assessment of symptom reduction in those patients with Achilles tendinopathy who undergo mechanotherapy. The main aim of this study was to evaluate and compare the effectiveness of shock wave and ultrasound treatments, using objective posturographic assessment during step-up and step-down initiation. Materials and methods The patients with non-insertional Achilles tendinopathy and pain lasting for more than 3 months were randomly assigned to one of the experimental groups, i.e., radial shock wave therapy (RSWT), ultrasound therapy, or placebo ultrasound. All groups also received deep friction massage as the primary therapy. The transitional locomotor task was performed with the affected and unaffected limb in random order, on two force platforms under two conditions (step-up and step-down). The recording of center of foot pressure displacements was divided into three phases: quiet standing before step-up/step-down, transit, and quiet standing until measurement completion. Pre-intervention measurements were performed and then short-term follow-ups at weeks 1 and 6 post-therapy. Results The three-way repeated measures ANOVA showed few statistically significant two-factor interactions between therapy type, time point of measurement and the type of the locomotor task. Significant increases in postural sway were observed in the entire study population throughout the follow-up period. Three-way ANOVAs revealed a group effect (shock wave vs. ultrasound) on almost all variables of the quiet standing phase prior to step-up/step-down initiation. Overall, postural stability before the step-up and step-down tasks appeared to be more efficient in patients who had undergone RSWT compared to the ultrasound group. Conclusion Objective posturographic assessment during step-up and step-down initiation did not demonstrate therapeutic superiority of any of the three therapeutic interventions used in patients with non-insertional Achilles tendinopathy.Clinical Trial Registration: The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12617000860369; registration date: 9.06.2017).
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15
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Vinhas A, Almeida AF, Rodrigues MT, Gomes ME. Prospects of magnetically based approaches addressing inflammation in tendon tissues. Adv Drug Deliv Rev 2023; 196:114815. [PMID: 37001644 DOI: 10.1016/j.addr.2023.114815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/24/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023]
Abstract
Tendon afflictions constitute a significant share of musculoskeletal diseases and represent a primary cause of incapacity worldwide. Unresolved/chronic inflammatory states have been associated with the onset and progression of tendon disorders, contributing to undesirable immune stimulation and detrimental tissue effects. Thus, targeting persistent inflammatory events could assist important developments to solve pathophysiological processes and innovative therapeutics to address impaired healing and accomplish complete tendon regeneration. This review overviews the impact of inflammation and inflammatory mediators in tendon niches, unveiling the importance of tendon cell populations and their signature features, and the influence of microenvironmental factors on inflamed and injured tendons. The demand for non-invasive instructive strategies to manage persistent inflammatory mediators, guide inflammatory pathways, and modulate cellular responses will also be approached by exploring the role of pulsed electromagnetic field (PEMF). PEMF alone or combined with more sophisticated systems triggered by magnetic fields will be considered in the design of successful therapies to control inflammation in tendinopathic conditions.
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16
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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: 39] [Impact Index Per Article: 19.5] [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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17
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Stania M, Juras G, Marszałek W, Król P. Analysis of pain intensity and postural control for assessing the efficacy of shock wave therapy and sonotherapy in Achilles tendinopathy - A randomized controlled trial. Clin Biomech (Bristol, Avon) 2023; 101:105830. [PMID: 36469960 DOI: 10.1016/j.clinbiomech.2022.105830] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/01/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND The troublesome symptoms of Achilles tendinopathy prompt patients to seek effective forms of conservative treatment. The main aim of the study was to determine the therapeutic efficacy of shock wave and ultrasound therapies for Achilles tendinopathy in reducing pain intensity. Treatment efficacy was also assessed using objective posturographic measurements. METHODS Thirty-nine patients patients were randomly allocated to one of three experimental groups that received shock wave therapy (group A), ultrasound therapy (group B) and placebo ultrasound (group C). Posturographic measurements and subjective assessment of pain intensity were taken prior to therapy and at weeks 1 and 6 of therapy completion. FINDINGS A comparison of percentage change in activity-related pain from baseline to 6 weeks post-therapy revealed a significantly greater pain reduction in group A compared to group B. The three-way ANOVA demonstated an effect of treatment type on all posturographic variables. The Bonferroni post-hoc test showed the means of all variables were significantly smaller for group A than group B. Limb condition also had an effect on the center-of-pressure trajectories in anteroposterior plane; the post-hoc test showed the mean values of the variables were significantly greater for the non-affected compared to affected limb. INTERPRETATION Shock wave therapy was significantly more effective than sonotherapy for alleviation of activity-related pain of Achilles tendinopathy. An association was also shown between shock wave therapy and more efficient postural control in patients with Achilles tendinopathy. The parameters of center-of-pressure trajectories in the sagittal plane were significantly greater for the non-affected compared to affected limb. The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12617000860369; registration date: 9.06.2017).
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Affiliation(s)
- Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72a, 40-065 Katowice, Poland.
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72a, 40-065 Katowice, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72a, 40-065 Katowice, Poland
| | - Piotr Król
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72a, 40-065 Katowice, Poland
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Synthetic Graft Augmentation Is Safe and Effective for the Repair of Acute Achilles Tendon Rupture in Patients With Preexisting Tendinopathy. Arthrosc Sports Med Rehabil 2022; 4:e2079-e2087. [PMID: 36579039 PMCID: PMC9791818 DOI: 10.1016/j.asmr.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To assess the safety and report the clinical outcomes of synthetic graft augmentation using polypropylene (PP) mesh in the repair of acute Achilles tendon (AT) rupture in patients with preexisting tendinopathy. Methods: Patients who underwent open repair for acute AT rupture at our institution between April 2017 and March 2019 were retrospectively identified. The inclusion criteria were acute AT rupture in patients with preexisting tendinopathy. All patients included in the study underwent acute repair augmented by an inlay PP mesh and had 30 months' follow-up. Patient characteristics, operative details, and outcomes were analyzed. Continuous data were described by mean, standard deviation, median, and range. The Wilcoxon signed rank test was used to analyze the change in patient-reported outcome measures. The significance level was set at a P-value of .05. Results Thirteen patients were included. There were 5 female and 8 male patients, withan average age of 52 years (range 49-56 years). No cases of rerupture or graft-related complications requiring additional treatment occurred during mean follow -up of 38 months. All patients reported good functional outcome, as shown from nonsignificant difference between the preinjury and 38-month postoperative Achilles Tendon Rupture Score (88.5 ± 2.2 vs 89.2 ± 2.2, P = .107) and the excellent postoperative American Orthopedic Foot and Ankle Society Ankle/Hindfoot Scale score (92.22 ± 2.2) at last follow-up. At the end of follow-up, all patients were able to perform single-legged heel rise as the noninvolved side. By average of 16 weeks, all patients returned to their preinjury activity level. Conclusions The use of inlay PP mesh to augment the repair of acute AT rupture in patients with preexisting tendinopathy appears to be safe and effective, allowing early return to preinjury activity level with favorable clinical outcomes. Level of Evidence Level IV, therapeutic case series.
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Lall PS, Alsubiheen AM, Aldaihan MM, Lee H. Differences in Medial and Lateral Gastrocnemius Stiffness after Exercise-Induced Muscle Fatigue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113891. [PMID: 36360770 PMCID: PMC9656849 DOI: 10.3390/ijerph192113891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 06/10/2023]
Abstract
Muscles are affected at the cellular level by exercised-induced fatigue, inducing changes in their stiffness. Examining muscle stiffness can improve the knowledge of various pathologic conditions, such as pain and injury. The objective of this study was to examine the stiffness of the medial gastrocnemius (MG) muscle and the lateral gastrocnemius (LG) muscle to determine the changes in stiffness, and to assess the differences in the stiffness between the MG and the LG, as affected by muscle fatigue measured using shear wave elastography (SWE) and a MyotonPRO after inducing muscle fatigue. A total of 35 healthy young adults participated in the study. The stiffness of the MG and the LG were assessed before and after a muscle fatigue protocol (MFP), which included three sets of 50 eccentric contractions of the calf muscles of the dominant leg, at rest, and at maximum voluntary contraction (MVC). The measurements were taken with SWE and the MyotonPRO simultaneously. Compared to baseline, the resting stiffness of the MG and the LG significantly increased immediately, 24 h, and 48 h after muscle fatigue (p < 0.05); however, during MVC, the stiffness of the MG decreased (p < 0.05) and that of the LG showed no change (p > 0.05). When the stiffness of the MG and the LG were compared before and after the MFP, changes in the stiffness of the MG were significantly greater than those in the LG (p < 0.05). This signifies that the MG was more affected by the exercise-induced muscle fatigue than was the LG. The assessment of musculoskeletal tissue and its characteristics, before and after eccentric exercise, is crucial in the prevention of overuse injuries associated with repeated exposure to both low and high levels of force.
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Affiliation(s)
- Prarthana Sanya Lall
- Graduate School, Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
| | - Abdulrahman M. Alsubiheen
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mishal M. Aldaihan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Hanuel Lee
- Graduate School, Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Korea
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Abián P, Bravo-Sánchez A, Jiménez F, Abián-Vicén J. CARACTERÍSTICAS DEL TENDÓN ROTULIANO Y DE AQUILES EN JUGADORES SENIOR DE BÁDMINTON. REVISTA INTERNACIONAL DE MEDICINA Y CIENCIAS DE LA ACTIVIDAD FÍSICA Y DEL DEPORTE 2022. [DOI: 10.15366/rimcafd2022.87.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Los objetivos del estudio fueron describir las propiedades estructurales y mecánicas de los tendones rotuliano y de Aquiles en jugadores senior (>35 años) de bádminton y detectar posibles asimetrías entre el lado dominante y no dominante. La muestra estuvo compuesta por 206 jugadores senior de bádminton (Edad: 52.2±9.6 años) que participaron en el campeonato de Europa Senior en 2018. Se evaluaron las propiedades estructurales (grosor, anchura y área de sección transversal) por medio de un ecógrafo Logiq® S8 y las propiedades mecánicas (elasticidad, tono, rigidez e índice de elastografía) con miotonometría y sonoelastografía de los tendones rotuliano y de Aquiles. Los resultados mostraron que fueron mayores el grosor (5.34±19.90%, p = 0.027) y la anchura (1.57±8.52%, p=0.036) en el tendón de Aquiles no dominante mientras que el tendón rotuliano dominante mostró unos valores mayores para el tono (2.09±12.96%, p=0.002) y para la rigidez (4.41±21.11%, p=0.002) respecto al no dominante.
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21
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Callow JH, Cresswell M, Damji F, Seto J, Hodgson AJ, Scott A. The Distal Free Achilles Tendon Is Longer in People with Tendinopathy than in Controls: A Retrospective Case-Control Study. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:6585980. [PMID: 38655157 PMCID: PMC11022772 DOI: 10.1155/2022/6585980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 04/26/2024]
Abstract
Objectives The free Achilles tendon is defined as the region of tendon distal to the soleus which is "unbuttressed," i.e., unsupported by muscular tissue. We reasoned that a relative lack of distal buttressing could place the tendon at a greater risk for developing Achilles tendinopathy. Therefore, our primary goal was to compare the free Achilles tendon length between those with midportion or insertional Achilles tendinopathy and healthy controls. Design This is a retrospective case-control study. Setting. Hospital in Vancouver, Canada. Participants. 66 cases with Achilles tendinopathy (25 insertional, 41 midportion) consecutively drawn from a hospital database within a 5-year period and matched to 66 controls (without tendinopathy) based on sex, age, and weight. Main outcome measures. Odds ratio of the risk of developing Achilles tendinopathy given the length of free tendon, defined anatomically on MRI, after adjustment for confounders. Results MRI-defined free Achilles tendon length is a statistically significant predictor of having midportion Achilles tendinopathy (odds ratio = 0.53, 95% confidence interval 1.13 to 2.07). Midportion Achilles tendinopathy cases had significantly longer free tendons (Mdn = 51.2 mm, IQR = 26.9 mm) compared to controls (Mdn = 40.8 mm, IQR = 20.0 mm), p = 0.007. However, there was no significant difference between the free Achilles tendon lengths in insertional AT cases (Mdn = 47.9 mm, IQR = 15.1 mm) and controls (Mdn = 39.2 mm, IQR = 17.9 mm), p = 0.158. Free Achilles tendon length was also correlated with the tendon thickness among those with Achilles tendinopathy, rτ = 0.25, and p = 0.003. Conclusions The MRI-defined length of the free Achilles tendon is positively associated with the risk of midportion Achilles tendinopathy. A relative lack of distal muscular buttressing of the Achilles tendon may therefore influence the development of tendinopathy.
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Affiliation(s)
- Joanne H. Callow
- Department of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Mark Cresswell
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Faraz Damji
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Joshua Seto
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada
| | - Antony J. Hodgson
- Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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22
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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: 9] [Impact Index Per Article: 3.0] [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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23
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Götschi T, Hanimann J, Schulz N, Huser S, Held V, Frey WO, Snedeker JG, Spörri J. Patellar Tendon Shear Wave Velocity Is Higher and has Different Regional Patterns in Elite Competitive Alpine Skiers than in Healthy Controls. Front Bioeng Biotechnol 2022; 10:858610. [PMID: 35757800 PMCID: PMC9218688 DOI: 10.3389/fbioe.2022.858610] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Competitive alpine skiers are exposed to enormous forces acting on their bodies–particularly on the knee joint and hence the patellar tendon - during both the off-season preparation and in-season competition phases. However, factors influencing patellar tendon adaptation and regional pattern differences between alpine skiers and healthy controls are not yet fully understood, but are essential for deriving effective screening approaches and preventative countermeasures. Thirty elite competitive alpine skiers, all members of the Swiss Alpine Ski Team, and 38 healthy age-matched controls were recruited. A set of two-dimensional shear wave elastography measurements of the PT was acquired and projected into three-dimensional space yielding a volumetric representation of the shear wave velocity profile of the patellar tendon. Multivariate linear models served to quantify differences between the two cohorts and effects of other confounding variables with respect to regional shear wave velocity. A significant (p < 0.001) intergroup difference was found between skiers (mean ± SD = 10.4 ± 1.32 m/s) and controls (mean ± SD = 8.9 ± 1.59 m/s). A significant sex difference was found within skiers (p = 0.024), but no such difference was found in the control group (p = 0.842). Regional SWV pattern alterations between skiers and controls were found for the distal region when compared to the mid-portion (p = 0.023). Competitive alpine skiers exhibit higher SWV in all PT regions than healthy controls, potentially caused by long-term adaptations to heavy tendon loading. The presence of sex-specific differences in PT SWV in skiers but not in controls indicates that sex effects have load-dependent dimensions. Alterations in regional SWV patterns between skiers and controls suggest that patellar tendon adaptation is region specific. In addition to the implementation of 3D SWE, deeper insights into long-term tendon adaptation and normative values for the purpose of preventative screening are provided.
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Affiliation(s)
- Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jonas Hanimann
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicole Schulz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Simon Huser
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Victoria Held
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Konar S, Bolam SM, Coleman B, Dalbeth N, McGlashan SR, Leung S, Cornish J, Naot D, Musson DS. Changes in Physiological Tendon Substrate Stiffness Have Moderate Effects on Tendon-Derived Cell Growth and Immune Cell Activation. Front Bioeng Biotechnol 2022; 10:800748. [PMID: 35295642 PMCID: PMC8918575 DOI: 10.3389/fbioe.2022.800748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/07/2022] [Indexed: 11/29/2022] Open
Abstract
Tendinopathy is characterised by pathological changes in tendon matrix composition, architecture, and stiffness, alterations in tendon resident cell characteristics, and fibrosis, with inflammation also emerging as an important factor in tendinopathy progression. The sequence of pathological changes in tendinopathy and the cellular effects of the deteriorating matrix are largely unknown. This study investigated the effects of substrate stiffness on tendon-derived cells (TDCs) and THP-1 macrophages using PDMS substrates representing physiological tendon stiffness (1.88 MPa), a stiff gel (3.17 MPa) and a soft gel (0.61 MPa). Human TDCs were cultured on the different gel substrates and on tissue culture plastic. Cell growth was determined by alamarBlue™ assay, cell morphology was analysed in f-actin labelled cells, and phenotypic markers were analysed by real-time PCR. We found that in comparison to TDCs growing on gels with physiological stiffness, cell growth increased on soft gels at 48 h (23%, p = 0.003). Cell morphology was similar on all three gels. SCX expression was slightly reduced on the soft gels (1.4-fold lower, p = 0.026) and COL1A1 expression increased on the stiff gels (2.2-fold, p = 0.041). Culturing THP-1 macrophages on soft gels induced increased expression of IL1B (2-fold, p = 0.018), and IL8 expression was inhibited on the stiffer gels (1.9-fold, p = 0.012). We also found that culturing TDCs on plastic increased cell growth, altered cell morphology, and inhibited the expression of SCX, SOX9, MMP3, and COL3. We conclude that TDCs and macrophages respond to changes in matrix stiffness. The magnitude of responses measured in TDCs were minor on the range of substrate stiffness tested by the gels. Changes in THP-1 macrophages suggested a more inflammatory phenotype on substrates with non-physiological stiffness. Although cell response to subtle variations in matrix stiffness was moderate, it is possible that these alterations may contribute to the onset and progression of tendinopathy.
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Affiliation(s)
- Subhajit Konar
- Department of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
| | - Scott M. Bolam
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedics, Middlemore Hospital, Auckland, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Sue R. McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Sophia Leung
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Jillian Cornish
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Dorit Naot
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - David S. Musson
- Department of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
- *Correspondence: David S. Musson,
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25
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Matthews W, Ellis R, Furness J, Hing WA. The clinical diagnosis of Achilles tendinopathy: a scoping review. PeerJ 2021; 9:e12166. [PMID: 34692248 PMCID: PMC8485842 DOI: 10.7717/peerj.12166] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. METHODOLOGY A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. RESULTS A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. CONCLUSIONS There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.
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Affiliation(s)
- Wesley Matthews
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - James Furness
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wayne A. Hing
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Gervasi M, Barbieri E, Capparucci I, Annibalini G, Sisti D, Amatori S, Carrabs V, Valli G, Donati Zeppa S, Rocchi MBL, Stocchi V, Sestili P. Treatment of Achilles Tendinopathy in Recreational Runners with Peritendinous Hyaluronic Acid Injections: A Viscoelastometric, Functional, and Biochemical Pilot Study. J Clin Med 2021; 10:jcm10071397. [PMID: 33807327 PMCID: PMC8037202 DOI: 10.3390/jcm10071397] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) affects ca. 10 million recreational runners in Europe; the practice of hyaluronic acid (HA) infiltration is being increasingly adopted. The aim of this pilot study was to monitor the effects of a three-local time-spaced injections regimen of HA in the treatment of AT in middle-aged runners combining for the first time viscoelastometric, biochemical, and functional methodologies with routine clinical examinations. METHODS Eight male runners (Age 49.3 ± 3.9), diagnosed for unilateral AT, were given three ultrasound (US) guided peritendinous HA injections at the baseline (T0) and every fifteenth day with a follow-up on the forty-fifth day (T1, T2, and T3). At all-time points patients were assessed for viscoelastic tone and stiffness, maximal voluntary isometric contraction (MVIC), and pain level (Likert scale 0-5). The peritendinous effusions of the injured tendon were collected at T0 and T2 to quantify the volume variations and the IL-1β and MMP-3 levels. RESULTS At T0 MVIC and pain score were significantly lower and higher, respectively, in injured tendons. The volume, IL-1β and MMP-3 levels decreased in the course of treatment and the clinical endpoints ameliorated over time. Tone, stiffness, and functional performance also varied significantly at T2 and T3, as compared to T0. CONCLUSIONS The sequential peritendinous injections of HA were effective in the amelioration of the clinical symptoms, as well as of the functional and viscoelastic state associated with AT. The determination of the viscoelastometric state may help to precisely evaluate the healing process in AT patients.
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Affiliation(s)
- Marco Gervasi
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
- Correspondence: ; Tel.: +39-072-230-3013
| | - Elena Barbieri
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
- Interuniversity Institute of Myology (IIM), 06121 Perugia, Italy
| | - Italo Capparucci
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Giosuè Annibalini
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Davide Sisti
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Stefano Amatori
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Vittoria Carrabs
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Giacomo Valli
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Sabrina Donati Zeppa
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Marco Bruno Luigi Rocchi
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Vilberto Stocchi
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
| | - Piero Sestili
- Department of Biomolecular Sciences, University Urbino Carlo Bo, via A. Saffi 2, 61029 Urbino, Italy; (E.B.); (I.C.); (G.A.); (D.S.); (S.A.); (V.C.); (G.V.); (S.D.Z.); (M.B.L.R.); (V.S.); (P.S.)
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Bussin E, Cairns B, Gerschman T, Fredericson M, Bovard J, Scott A. Topical diclofenac vs placebo for the treatment of chronic Achilles tendinopathy: A randomized controlled clinical trial. PLoS One 2021; 16:e0247663. [PMID: 33661967 PMCID: PMC7932128 DOI: 10.1371/journal.pone.0247663] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The application of topical diclofenac has been suggested as a possible treatment for Achilles tendinopathy. Our aim was to answer the question, is topical diclofenac more effective than placebo for the treatment of Achilles tendinopathy?. METHODS 67 participants with persistent midportion or insertional Achilles tendinopathy were randomly assigned to receive a 4 week course of 10% topical diclofenac (n = 32) or placebo (n = 35). The a priori primary outcome measure was change in severity of Achilles tendinopathy (VISA-A score) at 4 and 12 weeks. Secondary outcome measures included numeric pain rating, and patient-reported change in symptoms using a 7 point scale, from substantially worse to substantially better. Pressure pain threshold (N) and transverse tendon stiffness (N/m) were measured over the site of maximum Achilles tendon pathology at baseline and 4 weeks. RESULTS There were no statistically or clinically significant differences between the diclofenac and placebo groups in any of the primary or secondary outcome measures at any timepoint. Average VISA-A score improved in both groups (p<0.0001), but the improvements were marginal: at 4 weeks, the improvements in VISA-A were 9 (SD 11) in the diclofenac group and 8 (SD 12) in the placebo group, and at 12 weeks the improvements were 9 (SD 16) and 11 (SD13) respectively-these average changes are smaller than the minimum clinically important difference of the VISA-A. CONCLUSION The regular application of topical diclofenac for Achilles tendinopathy over a 4 week period was not associated with superior clinical outcomes to that achieved with placebo.
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Affiliation(s)
- Erin Bussin
- Fortius Sports Medicine, Burnaby, British Columbia, Canada
| | - Brian Cairns
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Tommy Gerschman
- Department of Pediatrics, University of British Colombia, Vancouver, Canada
| | - Michael Fredericson
- Department of Orthpaedic Surgery, Stanford University, Stanford, California, United States of America
| | - Jim Bovard
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- * E-mail:
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Götschi T, Schulz N, Snedeker JG, Hanimann J, Franchi MV, Spörri J. Three-Dimensional Mapping of Shear Wave Velocity in Human Tendon: A Proof of Concept Study. SENSORS 2021; 21:s21051655. [PMID: 33673664 PMCID: PMC7957754 DOI: 10.3390/s21051655] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/25/2022]
Abstract
Ultrasound-based shear wave elastography (SWE) provides the means to quantify tissue mechanical properties in vivo and has proven valuable in detecting degenerative processes in tendons. Its current mode of use is for two-dimensional rendering measurements, which are highly position-dependent. We therefore propose an approach to create a volumetric reconstruction of the mechano-acoustic properties of a structure of interest based on optically tracking the ultrasound probe during free-hand measurement sweeps. In the current work, we aimed (1) to assess the technical feasibility of the three-dimensional mapping of unidirectional shear wave velocity (SWV), (2) to evaluate the possible artefacts associated with hand-held image acquisition, (3) to investigate the reproducibility of the proposed technique, and (4) to study the potential of this method in detecting local adaptations in a longitudinal study setting. Operative and technical feasibility as well as potential artefacts associated with hand-held image acquisition were studied on a synthetic phantom containing discrete targets of known mechanical properties. Measurement reproducibility was assessed based on inter-day and inter-reader scans of the patellar, Achilles, and supraspinatus tendon of ten healthy volunteers and was compared to traditional two-dimensional image acquisition. The potential of this method in detecting local adaptations was studied by testing the effect of short-term voluntary isometric loading history on SWV along the tendon long axis. The suggested approach was technically feasible and reproducible, with a moderate to very good reliability and a standard error of measurement in the range of 0.300-0.591 m/s for the three assessed tendons at the two test-retest modalities. We found a consistent variation in SWV along the longitudinal axis of each tendon, and isometric loading resulted in regional increases in SWV in the patellar and Achilles tendons. The proposed method outperforms traditional two-dimensional measurement with regards to reproducibility and may prove valuable in the objective assessment of pathological tendon changes.
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Affiliation(s)
- Tobias Götschi
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland;
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland;
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (J.H.); (M.V.F.); (J.S.)
- Correspondence: ; Tel.: +41-44-386-11-11
| | - Nicole Schulz
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland;
| | - Jess G. Snedeker
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland;
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland;
| | - Jonas Hanimann
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (J.H.); (M.V.F.); (J.S.)
| | - Martino V. Franchi
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (J.H.); (M.V.F.); (J.S.)
- Institute of Physiology, Department of Biomedical Sciences, University of Padova, 35121 Padova, Italy
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (J.H.); (M.V.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Masi AT, Andonian B, van der Heijde D. Biomechanical Factors May Be the Main Contributor to Entheseal Changes in Normal Adults. J Rheumatol 2020; 48:618-619. [PMID: 33262296 DOI: 10.3899/jrheum.201296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Alfonse T Masi
- University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA;
| | - Brian Andonian
- Division of Rheumatology and Immunology, Duke University Medical Center, Durham, North Carolina, USA
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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: 0.4] [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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Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review. ACTA ACUST UNITED AC 2020; 56:medicina56080378. [PMID: 32731400 PMCID: PMC7466193 DOI: 10.3390/medicina56080378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/21/2022]
Abstract
Tendinopathy is a common disease that affects athletes, causing pain and dysfunction to the afflicted tendon. A clinical diagnose is usually combined with imaging and, among all the existing techniques, ultrasound is widely adopted. The aim of this review is to sum up the existing evidence on ultrasound as an imaging tool and guide for treatments in lower limbs tendinopathy. Using three different databases—PubMed, MEDLINE and CENTRAL—a literature search has been performed in May 2020 combining MeSH terms and free terms with Boolean operators. Authors independently selected studies, conducted quality assessment, and extracted results. Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages. The main parameters considered by ultrasound imaging are tendon thickness, hypoechogenicity of tendon structure and neovascularization of the tendon bound tissue. Ultrasound-guide is also used in many tendinopathy treatments and the available studies gave encouraging results, even if further studies are needed in this field.
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Schneebeli A, Falla D, Clijsen R, Barbero M. Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study. BMJ Open Sport Exerc Med 2020; 6:e000726. [PMID: 32153987 PMCID: PMC7047478 DOI: 10.1136/bmjsem-2019-000726] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 12/11/2022] Open
Abstract
Objective This study evaluates the intra-rater and inter-rater reliability of the MyotonPRO and its construct validity for the assessment of Achilles tendon stiffness. Design Reliability and construct validity study. Methods Forty healthy participants were assessed using the MyotonPRO by two raters on two different occasions. Tendon was evaluated in three different positions (relaxed, 0° plantarflexion and standing) and during different isometric contractions (range 0–3 kg). Reliability was calculated using intraclass correlation coefficient (ICC and 95% CI) standard error of measurement and minimal detectable change. Construct validity was evaluated between the different positions and the different contraction intensities using Friedman test. Results Intra-rater reliability was very high ICC2,k 0.87–0.98. The reliability of the 0.5 kg contraction was moderate with an ICC2,k of 0.59. Inter-rater reliability ranged from high to very high with an ICC2,k of 0.76–0.86. The reliability of the 0.5 kg, 1 kg contraction and the standing position was moderate with an ICC2,k of 0.55, 0.54 and 0.56 respectively. Inter-session reliability ranged from high to very high with an ICC2,k of 0.70–0.89. The reliability of the 0.5 kg contraction was moderate with an ICC2,k of 0.54. Construct validity was demonstrated between different contraction levels and different positions. Conclusion MyotonPRO is a reliable tool for the evaluation of Achilles tendon stiffness during different contraction levels and in different positions. Construct validity was supported by changes of tendon stiffness during the explored conditions. MyotonPRO can be implemented, as a ready to use device, in the evaluation of tendon tissue mechanical properties.
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Affiliation(s)
- Alessandro Schneebeli
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland.,Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise Rehabilitation Sciences, College of Life Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise Rehabilitation Sciences, College of Life Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Ron Clijsen
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland.,University College Physiotherapy, Thim van der Laan AG, Landquart, Switzerland
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
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Myotendinous asymmetries derived from the prolonged practice of badminton in professional players. PLoS One 2019; 14:e0222190. [PMID: 31504052 PMCID: PMC6736299 DOI: 10.1371/journal.pone.0222190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/25/2019] [Indexed: 12/23/2022] Open
Abstract
Background The continued practice of a sport linked to the unilateral predominance of the dominant side can provoke chronic asymmetric adaptations in the myotendinous structure and mechanical properties. Objectives: The main purpose was to determine whether asymmetry between the preferred and non-preferred lower limb is present in the lower limb tendon structure, muscle architecture and stiffness values of professional badminton players. Methods Sixteen male professional badminton players (age = 24.1 ± 6.7 years; body height = 177.90 ± 7.53 cm) participated in this study. The muscle architecture of the vastus lateralis (VL), medial gastrocnemius (MG) and lateral gastrocnemius (LG) and the structure of patellar and Achilles tendons were measured in the dominant and non-dominant lower limb with ultrasonography. Stiffness was also measured at the same points with a hand-held MyotonPro. Significant differences between the dominant and non-dominant lower limb were determined using Student’s t test for related samples. Results Bilateral differences were observed for thickness, width and cross-sectional area (CSA) in both tendons showing higher values for the dominant side: patellar tendon CSA (2.02 ± 0.64 vs. 1.51 ± 0.42 cm2; p < 0.05) and Achilles tendon CSA (1.12 ± 0.18 vs. 0.92 ± 0.28 cm2; p < 0.05). No significant differences were observed in muscle architecture and myotonic variables between the dominant and non-dominant lower limb. Conclusions The prolonged practice of badminton caused asymmetries in the CSA, width and thickness of the patellar and Achilles tendon between the dominant and non-dominant lower limbs. No bilateral differences were found in the muscle architecture of VL, MG and LG or in the stiffness of any muscle or tendon analyzed.
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