Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading: Implications for Achilles tendinopathy

Pringels, Lauren; Bossche, Luc Vanden; Wezenbeek, Evi; Burssens, Arne; Vermue, Hannes; Victor, Jan; Chevalier, Amélie

doi:10.1111/sms.14285

Cited by 6 publications

(8 citation statements)

References 43 publications

(138 reference statements)

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“…A customized validated test setup was used as an activity simulator, which had the great advantage of preserving the anatomical connection of the gastrocnemius muscle to the knee (Figure 1). 4 This allows a more physiological tensile load of this biarticular muscle on the AT during plantarflexion or dorsiflexion of the ankle. The specimen's foot was inserted in the ankle‐foot holder and fixed with three pins.…”

Section: Methodsmentioning

confidence: 99%

“…The reliability of this transducer for measuring interstitial tissue pressure has been tested and is considered a gold standard 17 . The same technique has already been successfully used in human tissue for the dynamic measurement of intratendinous, intraneural, intradiscal, and intramuscular pressure 4,18–20 . Under ultrasound guidance, an experienced sonographer placed the pressure sensor in the midportion region of the AT, namely 25 mm proximal to the posterosuperior calcaneal border, where tendinopathy typically occurs 21 .…”

Section: Methodsmentioning

confidence: 99%

“…17 The same technique has already been successfully used in human tissue for the dynamic measurement of intratendinous, intraneural, intradiscal, and intramuscular pressure. 4,[18][19][20] Under ultrasound guidance, an experienced sonographer placed the pressure sensor in the midportion region of the AT, namely 25 mm proximal to the posterosuperior calcaneal border, where tendinopathy typically occurs. 21 A GE Logic S8 ultrasound system (GE Healthcare) with a high-resolution linear ML6-15 transducer was used for ultrasonographic imaging.…”

Section: Intratendinous Pressure Determinationmentioning

confidence: 99%

“…Traditionally, it was assumed that the nature of this overload was purely tensile. However, it has recently been revealed that the AT is also exposed to compressive loads, which can occur both externally through impingement and internally through torsion 3–5 . The latter is explained by the unique structural characteristic of the AT, which consists of three twisted subtendons corresponding to each part of the triceps surae muscle 6–8 .…”

Section: Introductionmentioning

confidence: 99%

“…However, it has recently been revealed that the AT is also exposed to compressive loads, which can occur both externally through impingement and internally through torsion. [3][4][5] The latter is explained by the unique structural characteristic of the AT, which consists of three twisted subtendons corresponding to each part of the triceps surae muscle. [6][7][8] Proximally, the fascicles of the subtendons initially run vertically, according to the position of their corresponding muscle bellies.…”

Section: Introductionmentioning

confidence: 99%

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Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Pringels,

Stouthandel,

Van Hoof

et al. 2023

Scandinavian Med Sci Sports

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Torsion of the Achilles tendon (AT) enhances tensile strength, but a high degree of torsion might also be a risk factor for Achilles tendinopathy, due to greater internal compression exerted during tensile loading. However, evidence supporting the grounds for this assumption is lacking. Hence, we aimed to investigate the impact of AT torsion type on intratendinous pressure. Eighteen human fresh frozen cadaveric legs were mounted in a testing rig and a miniature pressure catheter was placed through ultrasound‐guided insertion in the midportion region of the AT. Intratendinous pressure was measured during a simulated straight‐knee calf stretch and eccentric heel drop. The AT was then carefully dissected and classified into Type I (least), Type II (moderate), and Type III (extreme) torsion. Of the ATs examined, nine were found to have Type I torsion (50%), nine Type II (50%), and none Type III. It was found that the intratendinous pressure of the AT increased exponentially with ankle dorsiflexion during both exercises (p < 0.001) and that this increase was greater in ATs with Type II torsion than Type I torsion (p < 0.05). This study provides the first biomechanical data to support the hypothesis that in athletes with a high degree of torsion in the AT, the midportion area will experience more internal compression during exercise, for example, calf stretching and eccentric heel drops. Whether this phenomenon is also associated with an elevated risk for Achilles tendinopathy needs further prospective investigation.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Intratendinous Pressure Determinationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Pringels,

Stouthandel,

Van Hoof

et al. 2023

Scandinavian Med Sci Sports

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Elevated fluid and glycosaminoglycan content in the Achilles tendon contribute to higher intratendinous pressures: Implications for Achilles tendinopathy

Pringels,

Van Valckenborgh,

Segers

et al. 2024

Journal of Sport and Health Science

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Effect of interstitial fluid pressure on shear wave elastography: an experimental and computational study

Cihan,

Holko,

Wei

et al. 2024

Phys. Med. Biol.

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Objective. An elevated Interstitial Fluid Pressure (IFP) can lead to strain-induced stiffening of poroelastic biological tissues. As Shear Wave Elastography (SWE) measures functional tissue stiffness based on the propagation speed of acoustically induced shear waves, the Shear Wave Velocity (SWV) can be used as an indirect measurement of the IFP. The underlying biomechanical principle for this stiffening behavior with pressurization is however not well understood, and we therefore studied how IFP affects SWV through SWE experiments and numerical modeling.Approach. For model set-up and verification, SWE experiments were performed while dynamically modulating IFP in a chicken breast. To identify the confounding factors of the SWV-IFP relationship, we manipulated the material model (linear poroelastic vs. porohyperelastic), deformation assumptions (geometric linearity vs. nonlinearity), and boundary conditions (constrained vs. unconstrained) in a finite element model mimicking the SWE experiments.Main results. The experiments demonstrated a statistically significant positive correlation between the SWV and IFP. The model was able to reproduce a similar SWV-IFP relationship by considering an unconstrained porohyperelastic tissue. Material nonlinearity was identified as the primary factor contributing to this relationship, whereas geometric nonlinearity played a smaller role. The experiments also highlighted the importance of the dynamic nature of the pressurization procedure, as indicated by a different observed SWV-IFP for pressure buildup and relaxation, but its clinical relevance needs to be further investigated.Significance. The developed model provides an adaptable framework for SWE of poroelastic tissues and paves the way towards non-invasive measurements of IFP.

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Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading: Implications for Achilles tendinopathy

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 6 publications

References 43 publications

Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

Elevated fluid and glycosaminoglycan content in the Achilles tendon contribute to higher intratendinous pressures: Implications for Achilles tendinopathy

Effect of interstitial fluid pressure on shear wave elastography: an experimental and computational study

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