Patellar Tendon Shear Wave Velocity Is Higher and has Different Regional Patterns in Elite Competitive Alpine Skiers than in Healthy Controls

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.

Three-dimensional mapping of ultrasound-derived skeletal muscle shear wave velocity

“…To enable intra-and inter-individual comparisons of the local SWV, the retrieved volume can be mapped into an abstracted representation of the muscle of study in reference to selected geometrical and anatomical features. A similar approach has already been shown to be technically feasible, reproducible and clinically significant in previous studies for tendons (Götschi et al, 2021;Götschi et al, 2022a;Götschi et al, 2022b). However, it is not clear a priori whether this is directly transferable to muscle tissue, particularly given the much larger volumes of interest.…”

Challenging the assumption of uniformity in patellar tendon structure: Regional patellar tendon morphology and mechanical properties in vivo

“…A recent study suggested that young males may have different mechanical properties in the patellar tendon assessed by shear wave elastography when compared with young females 15 . To our knowledge, however, no study has evaluated the in vivo morphology and mechanical properties of the patellar tendon segmented mediolaterally into three regions in young males and females.…”

“…A recent study suggested that young males may have different mechanical properties in the patellar tendon assessed by shear wave elastography when compared with young females. 15 To our knowledge, however, no study has evaluated the in vivo morphology and mechanical properties of the patellar tendon segmented mediolaterally into three regions in young males and females. The purpose of this study was to compare the thickness, length, viscosity, and shear modulus of the medial, central, and lateral regions of healthy patellar tendons of young males and females in vivo.…”

Patellar Tendon Elasticity and Temperature Following after a 448 Kilohertz Radiofrequency Intervention on Active Healthy Subjects: An Open Controlled Clinical Trial

“…The patellar tendon is a linear structure composed of a superficial and a deep layer that runs in parallel from the patella to the tibia without direct muscle insertions [ 1 ]. It is capable of supporting large volumes of weight and is one of the tendons responsible for providing stability and extension of the knee [ 2 , 3 ]. Due to its morphology and adaptive properties, the tendon exhibits the capacity to respond to both intrinsic and extrinsic stimuli.…”

“…Due to its morphology and adaptive properties, the tendon exhibits the capacity to respond to both intrinsic and extrinsic stimuli. The patellar tendon can undergo thickening and remodeling due to the pull that occurs by repeated forces [ 2 ].…”