Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Review with Meta-analysis

Obst, Steven; Heales, Luke; Schrader, Benjamin L.; Davis, Scott; Dodd, Keely A.; Holzberger, Cory J.; Beavis, Louis B.; Barrett, Rod

doi:10.1007/s40279-018-0956-7

Cited by 60 publications

(63 citation statements)

References 84 publications

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“…The Achilles tendon (AT) is one of the most commonly injured structures in the lower limb, both in athletes and the general population 1 2. Tendinopathy of AT can alter the mechanical, material and morphological properties of the tendon structure with a decrease of stiffness and young modulus and an increase of tendon cross-sectional area and diameter 3 4…”

Section: Introductionmentioning

confidence: 99%

Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study

Schneebeli

Falla

Clijsen

et al. 2020

BMJ Open Sport Exerc Med

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ObjectiveThis study evaluates the intra-rater and inter-rater reliability of the MyotonPRO and its construct validity for the assessment of Achilles tendon stiffness.DesignReliability and construct validity study.MethodsForty 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.ResultsIntra-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.ConclusionMyotonPRO 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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Section: Introductionmentioning

confidence: 99%

Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study

Schneebeli

Falla

Clijsen

et al. 2020

BMJ Open Sport Exerc Med

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“…Achilles tendinopathy is an overuse injury that reduces the integrity of the tendon . This manifests as fusiform thickening of the tendon and reduced mechanical properties . Pain during loading activities and functional impairments accompany these structural changes and lead patients to seek treatment.…”

Section: Introductionmentioning

confidence: 99%

Immediate effect of photobiomodulation therapy on Achilles tendon morphology and mechanical properties: An exploratory study

2019

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Objectives: Evaluate the immediate (within 4 hours) effects of laser-induced photobiomodulation (PBM) therapy on Achilles tendon morphology and mechanical properties in healthy and pathologic tendons. Materials and methods: Twenty people with healthy Achilles tendons and twelve people with Achilles tendinopathy participated. One Achilles tendon received PBM treatment following an established protocol, and the contralateral side received a placebo treatment. Achilles tendon morphology and mechanical properties were evaluated bilaterally with ultrasound imaging and continuous shear wave elastography immediately before treatment, immediately after treatment, then 2 and 4 hours after treatment. Results: There were no immediate effects of PBM on tendon morphology or mechanical properties when comparing the PBM-treated side and placebo-treated side within each cohort. Additionally, the effects of PBM did not differ between healthy and pathologic Achilles tendons. Conclusion: When treated with a laser-induced PBM treatment, healthy and pathologic Achilles tendons do not have immediate (within 4 hours) changes in tendon morphology or mechanical properties. These findings suggest that PBM therapy can be administered before other clinical treatments or high-load activities. K E Y W O R D Selastography, laser therapy, material properties, tendinitis, tendinopathy, ultrasound | 165 CORRIGAN et Al.

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“…For a tendon of a given length, a lower stiffness would result in greater tendon strain under the same external load. A further adaptation in Achilles tendinopathy is tendon thickening, which increases the tendon cross-sectional area (CSA) by 20-66% (Arya and Kulig, 2010;Helland et al, 2013;Leung and Griffith, 2008;Nuri et al, 2017bNuri et al, , 2018Obst et al, 2018). Tendon thickening may therefore be an adaptation that at least partially compensates for the reduction in tendon stiffness, thereby protecting the tendon from high strains.…”

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confidence: 99%

Influence of altered geometry and material properties on tissue stress distribution under load in tendinopathic Achilles tendons – A subject-specific finite element analysis

Shim

Hansen

Newsham-West

et al. 2019

Journal of Biomechanics

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Achilles tendon material properties and geometry are altered in Achilles tendinopathy. The purpose of this study was to determine the relative contributions of altered material properties and geometry to free Achilles tendon stress distribution during a sub-maximal contraction in tendinopathic relative to healthy tendons. Tendinopathic (n=8) and healthy tendons (n=8) were imaged at rest and during a sub-maximal voluntary isometric contraction using threedimensional freehand ultrasound. Images were manually segmented and used to create subject-specific finite element models. The resting cross-sectional area of the free tendon was on average 31% greater for the tendinopathic compared to healthy tendons. Material properties for each tendon were determined using a numerical parameter optimisation approach that minimised the difference in experimentally measured longitudinal strain and the strain predicted by the finite element model under submaximal loading conditions for each tendon. The mean Young's modulus for tendinopathic tendons was 53% lower than the corresponding control value. Finite element analyses revealed that tendinopathic tendons experience 24% less stress under the same submaximal external loading conditions compared to healthy tendons. The lower tendon stress in tendinopathy was due to a greater influence of tendon cross-sectional area, which alone reduced tendon stress by 30%, compared to a lower Young's modulus, which alone increased tendon stress by 8%. These findings suggest that the greater tendon cross-sectional area observed in tendinopathy compensates for the substantially lower Young's modulus, thereby protecting pathological tendon against excessive stress.Achilles tendinopathy is a common tendon injury which is prevalent in, but not exclusive to, athletic populations (Kongsgaard et al., 2005;Rolf and Movin, 1997). Up to 25% of affected patients will eventually require operative treatment and 20% of those undergo further surgery (Alfredson, 2003). Achilles tendinopathy is most commonly located in the mid-portion of the free tendon, 2-6 cm from the calcaneal insertion (Astrom and Rausing, 1995;Maffulli et al., 2004;Rolf and Movin, 1997) and is characterised by collagen bundle disruption, hyper-cellularity, hyper-vascularity and altered collagen, glycosaminoglycan and fluid content (Khan et al., 1999). Tendinopathy has also been reported to cause a reduction in tendon mechanical and material properties (Arya and Kulig, 2010;Helland et al., 2013). For the Achilles tendon, stiffness was reduced by 20% and Young's modulus by 50% relative to healthy tendons (Arya and Kulig, 2010). For a tendon of a given length, a lower stiffness would result in greater tendon strain under the same external load. A further adaptation in Achilles tendinopathy is tendon thickening, which increases the tendon cross-sectional area (CSA) by 20-66% (Arya and Kulig, 2010;Helland et al., 2013;Leung and Griffith, 2008;Nuri et al., 2017bNuri et al., , 2018Obst et al., 2018). Tendon thickening may therefore be an adaptation...

show abstract

Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Review with Meta-analysis

Cited by 60 publications

References 84 publications

Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study

Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study

Immediate effect of photobiomodulation therapy on Achilles tendon morphology and mechanical properties: An exploratory study

Influence of altered geometry and material properties on tissue stress distribution under load in tendinopathic Achilles tendons – A subject-specific finite element analysis

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