Alpine Skiing With total knee ArthroPlasty (ASWAP): effect on tendon properties

Abstract

Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på www.wiley.com: http://dx.doi. org/10.1111/sms.12457 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. AbstractThe aim of this study was to investigate the effect of alpine skiing on patellar tendon properties in patients with total knee arthroplasty (TKA). Thirty-one adults (70.4 ± 4.7 years) with unilateral TKA were recruited 2.7 ± 0.9 years after surgery and assigned to an intervention (IG) or a control group (CG). The IG underwent a 12-week guided skiing program (Kösters et al., 2015). Tendon stiffness, Young's modulus and cross-sectional area (CSA) were measured before and after the intervention. In both groups, mean tendon CSA was 28% (P < 0.001) larger in the operated (OP) than in the non-operated (NOP) leg at baseline, without any difference in other tendon properties. After training, stiffness increased in the IG by 5.8% and 15.8%, respectively, in the OP and NOP legs. Likewise, mean CSA increased in the IG by 2.9% in the OP and 3.8% in the NOP leg, whereas no significant changes were found for the Young´s modulus. None of the tendon parameters changed in the CG. Results indicate that patellar tendon structure and/or loading pattern are altered following TKA, but this tissue seems to retain its adaptation capacity. Further, alpine skiing appears to offer a suitable rehabilitation strategie for TKA patients.

Quantitative Analysis of Patellar Tendon After Total Knee Arthroplasty Using Echo Intensity: A Nonrandomized Controlled Trial of Alpine Skiing

“…Details concerning experimental setup, device calibrations, and measurement method can be found in our previous studies [5,27]. Briefly, knee muscle torque and tendon properties were assessed using a dynamometer (IsoMed 2000; D&R Ferstl GmbH, Hemau, Germany).…”

“…Maximum isometric torque of the knee flexors and extensors was measured at a knee angle of 90 (0 corresponding to full extension) [17]. Patellar tendon stiffness was measured by quantifying tendon elongation during ramped maximal voluntary isometric contractions (MVIC) of knee extension at a constant loading rate (110 N$m/s) with the help of visual feedback [5]. An ultrasound system (MyLab ClassC; Esaote, Genoa, Italy) with a 46mm linear transducer (LA523) and a frequency range of 10-15 MHz was used in B-mode for all imaging.…”

“…Its mechanical, material, and morphological properties have been quantified using ultrasound imaging in many studies [2e4]. Yet, a previous experiment by our group has shown a significant increase in patellar tendon cross-sectional area (CSA: þ28%) after TKA compared to the nonoperated leg [5]. During tendinous remodeling, increases in stiffness were systematically observed within the first few weeks of training [6], but tissue hypertrophy of this scale was only detectable in elite sports of high unilateral loading (eg, fencers and badminton players) after years of training and competition [7].…”

Endoprothetischer Gelenkersatz und Sport

“…Einfluss von Krafttraining auf die Kniegelenksmuskulatur bei liegender ProtheseRegelmäßiges Krafttraining (2-mal pro Woche über 13 Wochen) bei älteren Damen mit Kniegelenksarthrose und mit Kniegelenksprothesen kann geeignet sein, um ein Niveau der Muskelkraft, der Balance und der funktionellen Stabilität wieder herzustellen, welches dem eines Kontrollkollektivs ohne Kniegelenkspathologie vergleichbar ist[31,32].Petterson et al haben beschrieben, dass nach Knie TEP durch ein progressives Krafttraining innerhalb der ersten 4 Wochen zunächst die Normalisierung der willkürlichen Aktivierung des M. quadriceps wesentlich zur Maximalkraft beiträgt, bevor dann im Verlauf die physiologische Bedeutung des Muskelquerschnitts für die maximale Kraftentfaltung wieder zum Tragen kommt (12 und 52 Wochen post-OP) [33]. Einfluss von alpinem Skisport auf Knieendoprothesen Müller et al haben nach Knieprothesenimplantation den Effekt eines 12-wöchigen Alpin-Ski-Trainings auf multiple Aspekte untersucht und in Form einer Serie von Supplements publiziert: Es wurden positive Effekte auf das allgemeine Wohlbefinden der Patienten, die Kniefunktion und das Schmerzempfinden, auf die Patellarsehne, auf das Gangbild einschließlich seitengleicher Gewichtsverteilung, auf den Muskelquerschnitt des M. quadriceps (M. rectus femoris), auf die Adaptation der Typ I Muskelfasern, auf den Glukosestoffwechsel sowie auf die Kontraktionskraft von Kniestreckern und -beugern berichtet[34][35][36][37][38][39][40]. Nach drei Saisons Alpin-Ski mit jeweils 80 Skitagen wurde in einer Gruppe von 16 Patienten keine erhöhte Rate von PE-Abrieb, Osteolysen oder Implantatlockerungen konstatiert[41].…”

Good news for skiers with total knee arthroplasty

“…Although the patellar tendon cross‐sectional area (CSA) was larger in the operated leg than in the non‐operated leg at baseline, no differences between legs were observed in tensile stiffness and Young's modulus at baseline. After the intervention, tensile stiffness and CSA were increased in patellar tendons (Kösters et al., ). Biomarkers indicating neuromuscular junction degeneration and muscle atrophy were increased in these patients and were not ameliorated after the intervention (Narici et al., ).…”