<scp>MR</scp>‐based <i>in vivo</i> follow‐up study of <scp>A</scp>chilles tendon volume and hydration state after ankle‐loading activity

Grosse, Ulrich; Syha, Roland; Gatidis, Sergios; Grözinger, Gerd; Martirosian, Petros; Partovi, Sasan; Nikolaou, Konstantin; Robbin, Mark; Schick, Fritz; Springer, Fabian

doi:10.1111/sms.12550

Cited by 14 publications

(17 citation statements)

References 38 publications

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“…Grosse et al. (19) showed that T2* values are decreased by prior physical activity. In the present study, the patients were inactive during the initial scan (∼40 min) and for approximately 45 min between the scans; consequently, the increase in T2* could reflect a slightly higher free water content after a period of inactivity.…”

Section: Discussionmentioning

confidence: 99%

UTE T2* mapping of tendinopathic patellar tendons: an MRI reproducibility study

et al. 2020

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Background There is currently a lack of imaging modalities that can be used as a sensitive measure in tendinopathy. Recent findings suggest the applicability of ultra-short echo time (UTE) magnetic resonance imaging (MRI) T2* mapping in tendons, but the reproducibility remains unknown. Purpose To evaluate test–retest reproducibility of UTE MRI T2* mapping of tendinopathic patellar tendons and to evaluate the intra- and inter-observer reproducibility of the measurement. Material and Methods Fifteen patients with chronic patellar tendinopathy were evaluated with UTE MRI twice in a 3.0-T scanner on the same day. Manual segmentation of the patellar tendon was performed by two blinded investigators and automated T2*map reconstruction was performed in custom-made software. Results There was a significant and numerically small difference in test–retest T2* values (T2*meandiff = 0.06 ± 0.07 ms ≈ 3.7%; P = 0.006) with an ICC = 0.91 (95% confidence interval [CI] 0.58–0.98; typical error of 3.0%). The intra- and inter-observer reproducibility showed no significant bias ( P = 0.493 and P = 0.052), and generally substantial reproducibility was demonstrated for T2* (intra-observer ICC = 0.99; 95% CI 0.98–1.00 and inter-observer ICC = 0.99; 95% CI 0.96–1.00, and typical error 1.3% and 1.3%, respectively). Conclusion These data demonstrate a small bias between repeated measurements for UTE T2*, but with a very low associated mean difference (3.7%) between the two tests. The high ICC values and low typical error % demonstrate reproducibility of repeated T2*-mapping sessions. Further, the method showed substantial intra- and inter-observer reproducibility for T2* values proving feasibility for use of UTE T2* mapping in research and clinical practice.

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Section: Discussionmentioning

confidence: 99%

UTE T2* mapping of tendinopathic patellar tendons: an MRI reproducibility study

et al. 2020

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“…Isolated conditioning of the free tendon, as observed in the current study is likely due to some combination of differences in tendon structure, composition, and loading between free AT and aponeurosis. Factors such as complex fascicle/fiber orientation (Szaro et al., ; Edama et al., ), fascicle/fiber sliding as a result of elastic behavior of interfascicular matrix (Slane & Thelen, ; Thorpe et al., ), high collagen fiber crimp angle (Magnusson et al., ) as well as fluid redistribution under load (Syha et al., ; Grosse et al., ) have been reported to contribute to the unique mechanical behavior of the free AT. The free tendon is also longitudinally tensioned by forces from all three triceps surae muscles, whereas the aponeurosis experiences transverse strain due to soleus muscle bulging (Iwanuma et al., ; Farris et al., ; Bojsen‐Møller & Magnusson, ).…”

Section: Discussionmentioning

confidence: 99%

“…Studies have consistently highlighted the non‐uniform nature of AT mechanical properties between the free AT and aponeurosis, with the free AT demonstrating greater compliance compared to the aponeurosis during mechanical testing both before (Finni et al., ; Magnusson et al., ; Farris et al., ) and following exercise‐induced fatigue loading (Lichtwark et al., ; Obst et al., ). The free AT also experiences torsion of tendon fascicles (Szaro et al., ; Edama et al., ), and has a high fiber crimp angle (Magnusson et al., ), and substantial fluid content (Syha et al., ; Grosse et al., ). It is therefore possible that the number of conditioning contractions required to reach steady‐state longitudinal strain may differ between the free AT and whole AT.…”

mentioning

confidence: 99%

Regional three‐dimensional deformation of human Achilles tendon during conditioning

Nuri

Obst

Newsham-West

et al. 2016

Scandinavian Med Sci Sports

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Our understanding of in vivo Achilles tendon (AT) conditioning is limited to two-dimensional ultrasound measures of longitudinal deformation of the whole tendon. This study investigated the regional three-dimensional (3D) deformation of the AT during conditioning. Eighteen ATs were scanned using 3D freehand ultrasound during 10 successive 25 s submaximal (50%) voluntary isometric plantarflexion contractions. Longitudinal strain was assessed for the whole AT, aponeurosis, and free AT and transverse strain was assessed for the proximal-, mid-, and distal-portions of the free AT. Longitudinal conditioning of the whole AT was primarily driven by creep response of the free AT and transverse conditioning was greatest for the mid-portion of the free AT. Whole and free AT longitudinal strain increased up to the third contraction and were accompanied by a corresponding reduction in free AT cross-sectional area (CSA) strain in proximal-, mid-, and distal-portions. No significant changes in aponeurosis strain or tendon volume were detected between contractions. These findings suggest that conditioning alters free AT shape, with increased tendon length attained at the expense of reduction in free AT CSA. Although AT experiences different amounts of strain in different regions, the number of contractions required to reach steady-state strain during conditioning is uniform throughout the tendon.

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“…The proximal AT therefore does not appear to be vulnerable to strain-related injuries during repeated loading in MAT. Differences in tendon anatomical structure [fascicle/fibre orientation (Szaro et al, 2009), fluid content (Grosse et al, 2016) and crimp angle (Magnusson et al, 2002)], the magnitude and direction of the load exerted, and loading distribution pattern (Iwanuma et al, 2011;Farris et al, 2013;Reeves and Cooper, 2017) between proximal AT and free AT have been proposed as possible mechanisms underpinning the isolated creep behaviour of the free AT during repeated loading (Nuri et al, 2016).…”

Section: Contralateral Tendinopathymentioning

confidence: 99%

The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound

Nuri

Obst

Newsham-West

et al. 2017

Journal of Experimental Biology

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Mid-portion Achilles tendinopathy (MAT) alters the normal three-dimensional (3D) morphology of the Achilles tendon (AT) at rest and under a single tensile load. However, how MAT changes the 3D morphology of the AT during repeated loading remains unclear. This study compared the AT longitudinal, transverse and volume strains during repeated loading of the tendinopathic AT with those of the contralateral tendon in people with unilateral MAT. Ten adults with unilateral MAT performed 10 successive 25 s submaximal (50%) voluntary isometric plantarflexion contractions with both legs. Freehand 3D ultrasound scans were recorded and used to measure whole AT, free AT and proximal AT longitudinal strains and free AT cross-sectional area (CSA) and volume strains. The free AT experienced higher longitudinal and CSA strain and reached steady state following a greater number of contractions (five contractions) in the tendinopathic AT compared with the contralateral tendon (three contractions). Further, free tendon CSA and volume strain were greater in the tendinopathic AT than in the contralateral tendon from the first contraction, whereas free AT longitudinal strain was not greater than that of the contralateral tendon until the fourth contraction. Volume loss from the tendon core therefore preceded the greater longitudinal strain in the tendinopathic AT. Overall, these findings suggest that the tendinopathic free AT experiences an exaggerated longitudinal and transverse strain response under repeated loading that is underpinned by an altered interaction between solid and fluid tendon matrix components. These alterations are indicative of accentuated poroelasticity and an altered local stress-strain environment within the tendinopathic free tendon matrix, which could affect tendon remodelling via mechanobiological pathways.

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MR‐based in vivo follow‐up study of Achilles tendon volume and hydration state after ankle‐loading activity

Cited by 14 publications

References 38 publications

UTE T2* mapping of tendinopathic patellar tendons: an MRI reproducibility study

UTE T2* mapping of tendinopathic patellar tendons: an MRI reproducibility study

Regional three‐dimensional deformation of human Achilles tendon during conditioning

The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound

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