Transmission-Mode Ultrasound for Monitoring the Instantaneous Elastic Modulus of the Achilles Tendon During Unilateral Submaximal Vertical Hopping

Ultrasound-tensiometry: A new method for measuring differential loading within a tendon during movement

BACKGROUND

Tendons transmit tensile load from muscles to the skeleton. Differential loading across a tendon can occur, especially when it contains subtendons originating from distinct muscles. Tendon shear wave speed has previously been shown to reflect local tensile stress. Hence, a tool that measures spatial variations in wave speed may reflect differential loading within a tendon during human movement.

RESEARCH QUESTION

Do wave speeds measured via high-framerate ultrasound-based tensiometry correspond with differential loading across a tendon?

METHODS

Ultrasound-tensiometry uses an external mechanical actuator to induce waves and high-framerate plane wave ultrasound imaging (20 kHz) to track tissue displacements arising from wave propagation within a tendon. Local tissue displacements are temporally and spatially filtered to remove high-frequency noise and reflected waves. A Radon transform of the spatio-temporal displacement data is used to compute the shear wave speed across the tendon. We evaluated ultrasound-tensiometry's ability to measure differential loading across a tendon using in silico, ex vivo and in vivo approaches. The in silico approach used a finite element model to simulate wave propagation along two adjacent subtendons undergoing differential loading. The ex vivo experiment measured wave speed in adjacent porcine flexor subtendons subjected to differential loading. In vivo, we tracked wave speed across the Achilles tendon while a participant performed calf stretches to differentially load the subtendons, and while walking on a treadmill at 1.5 m/s.

RESULTS

Wave speeds modulated with local tendon stress under both in silico and ex vivo conditions, with higher wave speeds observed in subtendons subjected to higher loads (6-16 m/s higher at 1.5× load differential). Spatial variations in in vivo Achilles tendon wave speeds were consistent with differential subtendon loading arising from distinct muscle loads (maximum range: 0-137 m/s, resolution: 0.1 mm×0.2 mm, precision: ±0.2 m/s).

SIGNIFICANCE

High-framerate ultrasound-tensiometry tracks spatial variations in tendon wave speed, which may be useful to investigate local tissue loading and to delineate individual muscle contributions to movement.

The Biomechanics of Musculoskeletal Tissues during Activities of Daily Living: Dynamic Assessment Using Quantitative Transmission-Mode Ultrasound Techniques

The measurement of musculoskeletal tissue properties and loading patterns during physical activity is important for understanding the adaptation mechanisms of tissues such as bone, tendon, and muscle tissues, particularly with injury and repair. Although the properties and loading of these connective tissues have been quantified using direct measurement techniques, these methods are highly invasive and often prevent or interfere with normal activity patterns. Indirect biomechanical methods, such as estimates based on electromyography, ultrasound, and inverse dynamics, are used more widely but are known to yield different parameter values than direct measurements. Through a series of literature searches of electronic databases, including Pubmed, Embase, Web of Science, and IEEE Explore, this paper reviews current methods used for the in vivo measurement of human musculoskeletal tissue and describes the operating principals, application, and emerging research findings gained from the use of quantitative transmission-mode ultrasound measurement techniques to non-invasively characterize human bone, tendon, and muscle properties at rest and during activities of daily living. In contrast to standard ultrasound imaging approaches, these techniques assess the interaction between ultrasound compression waves and connective tissues to provide quantifiable parameters associated with the structure, instantaneous elastic modulus, and density of tissues. By taking advantage of the physical relationship between the axial velocity of ultrasound compression waves and the instantaneous modulus of the propagation material, these techniques can also be used to estimate the in vivo loading environment of relatively superficial soft connective tissues during sports and activities of daily living. This paper highlights key findings from clinical studies in which quantitative transmission-mode ultrasound has been used to measure the properties and loading of bone, tendon, and muscle tissue during common physical activities in healthy and pathological populations.

Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery

The objective of this study was to assess the effectiveness of, and the correlation between, an average of 42 supervised physiotherapy (SVPh) visits for the vertical ground reaction forces component (vGRF) using ankle hops during two- and one-legged vertical hops (TLH and OLH, respectively), six months after the surgical suturing of the Achilles tendon using the open method (SSATOM) via Keesler’s technique. Hypothesis: Six months of supervised physiotherapy with a higher number of visits (SPHNVs) was positively correlated with higher vGRF values during TLH and OLH. Group I comprised male patients (n = 23) after SSATOM (SVPh x = 42 visits), and Group II comprised males (n = 23) without Achilles tendon injuries. In the study groups, vGRF was measured during TLH and OLH in the landing phase using two force plates. The vGRF was normalized to the body mass. The limb symmetry index (LSI) of vGRF values was calculated. The ranges of motion of the foot and circumferences of the ankle joint and shin were measured. Then, 10 m unassisted walking, the Thompson test, and pain were assessed. A parametric test for dependent and independent samples, ANOVA and Tukey’s test for between-group comparisons, and linear Pearson’s correlation coefficient calculations were performed. Group I revealed significantly lower vGRF values during TLH and OLH for the operated limb and LSI values compared with the right and left legs in Group II (p ≤ 0.001). A larger number of visits correlates with higher vGRF values for the operated limb during TLH (r = 0.503; p = 0.014) and OLH (r = 0.505; p = 0.014). An average of 42 SVPh visits in 6 months was insufficient to obtain similar values of relative vGRF and their LSI during TLH and OLH, but the hypothesis was confirmed that SPHNVs correlate with higher relative vGRF values during TLH and OLH in the landing phase.