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Eric Winters, Steven Doty and Sean Newell

Objective:

To explore changes in bovine Achilles-tendon elasticity relative to 3 thermal conditions.

Design and Setting:

Posttest-only design with assignment by convenience. Manufactured-apparatus-clamped excised tendon, delivered tensile stress, and provided strain measures. Stress was increased at 1-minute intervals. Strain was observed for each level of stress. Before testing, cold-group tendons were submerged in cold water for 20 minutes. Heat-group tendons were tested in the presence of an ultraviolet lamp. A third group of tendons was tested at room temperature.

Subjects:

Frozen bovine Achilles tendons provided by a meat-rendering factory and segmented into 3 longitudinal strips.

Measurements:

Stress and strain were sequentially measured. Elastic region was identified, elastic-region Young's modulus determined, and elastic limit calculated.

Results:

Young's modulus for cold was 0.956 gigapascal (GPa; ± 0.0621); room temperature, 0.753 GPa (± 0.0624); and heat group, 0.487 GPa (± 0.0407). Significant differences were identified between each of the 3 conditions.

Conclusions:

A direct relationship was observed between imposed thermal energy and tendon elasticity. Thermal energy does not affect the elastic limit.

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Keitaro Kubo, Toshihiro Ikebukuro, Hideaki Yata, Minoru Tomita and Masaji Okada

The purpose of this study was to investigate muscle and tendon properties in highly trained sprinters and their relations to running performance. Fifteen sprinters and 15 untrained subjects participated in this study. Muscle thickness and tendon stiffness of knee extensors and plantar flexors were measured. Sprinter muscle thickness was significantly greater than that of the untrained subjects for plantar flexors, but not for knee extensors (except for the medial side). Sprinter tendon stiffness was significantly lower than that of the untrained subjects for knee extensors, but not for plantar flexors. The best official record of a 100-m race was significantly correlated to the muscle thickness of the medial side for knee extensors. In conclusion, the tendon structures of highly trained sprinters are more compliant than those of untrained subjects for knee extensors, but not for plantar flexors. Furthermore, a thicker medial side of knee extensors was associated with greater sprinting performance.

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Graham E. Caldwell

The effects of relative tendon/fiber proportion and tendon elasticity on the force output of the Hill muscle model (a contractile component [CC] in series with an elastic element [SEC]) were examined through computer simulation. Three versions of the Hill model were constructed. Model 1 examined the effect of relative tendon/fiber proportion on CC kinematics and kinetics during an isometric twitch, while Model 2 compared the effect of changes in tendon compliance. These models revealed force profile differences related to alterations in CC velocity, although the reasons underlying the variation in CC kinematics were different. The relative tendon/fiber proportion and tendon compliance differences were examined in combination in Model 3. Test simulations revealed response differences among the three model versions, and therefore verified Alexander and Ker's (1990) contention that the morphology of muscle is related to design criteria. It is suggested that the implementation of generalized muscle models to represent specific units of the musculoskeletal system should be done carefully and that the implementation process itself warrants further study.

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Tom A. Ranger, Wendy M. Braybon, Craig R. Purdam and Jill L. Cook

Context:

Lateral epicondylalgia, pain at the lateral elbow, is commonly associated with extensor carpi radialis brevis tendinopathy. The radial head, which abuts the extensor tendons and is elliptical in shape, may affect the extensor tendons during pronation of the forearm. Cadaverous studies have shown that the radial head may act as a cam in pronation, to offer a mechanical advantage to the common extensor tendon and to mitigate load on the origin of the extensor carpi radialis brevis tendon.

Objective:

To determine the effect of radial-head position on the wrist-extensor tendons in vivo.

Design:

Repeated-measures design.

Setting:

Laboratory.

Participants:

22 participants (12 male, 2 left-handed).

Main Outcome Measures:

Distance (mm) from subcutaneous fascia to radial head measured by ultrasound.

Results:

The radial head in supination was significantly deeper than either pronation or midprone, indicating a smaller cam effect in supination.

Conclusion:

The authors recommend that the effect of radial-head position and its relationship to the area of tendon pathology be considered clinically in the rehabilitation of patients suffering from lateral epicondylalgia.

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Thomas Cattagni, Clément Billet, Christophe Cornu and Marc Jubeau

Context: Prolonged tendon vibration may induce muscle fatigue, as assessed by a decrease in maximal force production. It remains unknown, however, whether the decrease in muscle strength after prolonged Achilles tendon vibration is related to the vibration frequency. Objective: To assess the maximal capacity of plantar-flexor (PF) neuromuscular function before and after prolonged Achilles tendon vibration at low and high frequencies generated using a portable device. Design: Pre- and posttest intervention with control.Setting: University laboratory. Participants: 10 healthy men age 22.6 ± 4.0 y. Intervention: Each subject participated in 3 experimental sessions that were randomly distributed and separated by 1 wk. During each experimental session, 1 of the following vibration protocols was applied for 30 min: 40-Hz vibration, 100-Hz vibration, or no vibration (control protocol). Main Outcome Measures: Maximal-voluntary-contraction torque, voluntary activation level, twitch torque, maximal electromyographic activity, and maximal M-wave of PF muscles (measured before and after each vibration or control protocol).Results: Statistical analysis exhibited no significant effect of vibration protocol on the measured variables. Conclusions: The current study demonstrates that 30 min of Achilles tendon vibration at a low or high frequency using a portable stimulator did not affect the neuromuscular performance of the PF muscles. These results emphasize the limits of tendon vibration, whatever the frequency applied, for inducing neuromuscular fatigue.

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Isabelle Schöffl, Frank Einwag, Wolf Strecker, Friedrich Hennig and Volker Schöffl

Flexor tendon pulley ruptures are the most common injury in rock climbers. Therapeutic standards usually include a prolonged use of taping applied as a replacement for the lost pulley in a circular fashion at the base of the proximal phalanx. Our biomechanical considerations, however, suggest a new taping method, the H-tape. The purpose of the study is to evaluate whether this new taping method can effectively change the course of the flexor tendon and therefore reduce the tendon–bone distance. In order to compare the effects of different taping methods described in the literature with the newly developed taping method, we performed standardized ultrasound examinations of 8 subjects with singular A2 pulley rupture and multiple pulley ruptures of A2 and A3 pulleys and determined the respective tendon–bone distance for the different taping methods, versus without tape at a preset position on the proximal phalanx. In a second approach, we evaluated the effect of the new taping method on the strength of the injured finger using a force platform on 12 subjects with different pulley ruptures with injuries older than 1 year. The new taping method decreased the tendon–bone distance in the injured finger significantly by 16%, whereas the other taping methods did not. The strength development was significantly better with the new tape for the crimp grip position (+13%), but there was no significant improvement for the hanging position. We recommend taping with the newly presented taping technique after pulley rupture.

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Keitaro Kubo, Takanori Teshima, Norikazu Hirose and Naoya Tsunoda

The purpose of this study was to compare the morphological and mechanical properties of the human patellar tendon among elementary school children (prepubertal), junior high school students (pubertal), and adults. Twenty-one elementary school children, 18 junior high school students, and 22 adults participated in this study. The maximal strain, stiffness, Young’s modulus, hysteresis, and cross-sectional area of the patellar tendon were measured using ultrasonography. No significant difference was observed in the relative length (to thigh length) or cross-sectional area (to body mass2/3) of the patellar tendon among the three groups. Stiffness and Young’s modulus were significantly lower in elementary school children than in the other groups, while no significant differences were observed between junior high school students and adults. No significant differences were observed in maximal strain or hysteresis among the three groups. These results suggest that the material property (Young’s modulus) of the patellar tendons of elementary school children was lower than that of the other groups, whereas that of junior high school students was already similar to that of adults. In addition, no significant differences were observed in the extensibility (maximal strain) or viscosity (hysteresis) of the patellar tendon among the three groups.

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Heidi Krueger and Shannon David

Clinical Scenario:

There are 2 approaches available for surgical repair of the Achilles tendon: open or percutaneous. However, there is controversy over which repair is superior.

Focused Clinical Question:

Which type of surgery is better in providing the best overall patient outcome, open or percutaneous repair, in physically active men and women with acute Achilles tendon ruptures?

Summary of Search, “Best Evidence” Appraised, and Key Findings:

The literature was searched for studies of level 3 evidence or higher that investigated the effectiveness of open repair versus percutaneous repair on acute Achilles tendon ruptures in physically active men and women. The literature search resulted in 3 studies for possible inclusion. All 3 good-quality studies were included.

Clinical Bottom Line:

There is supporting evidence to indicate that percutaneous repair is the best option for Achilles tendon surgery when it comes to the physically active population. Percutaneous repair has faster surgery times, less risk of complications, and faster recovery times over having an open repair, although it is acknowledged that every patient has a different situation and best individual option may vary patient to patient.

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Keitaro Kubo, Toshihiro Ikebukuro, Hideaki Yata, Naoya Tsunoda and Hiroaki Kanehisa

The purpose of this study was to compare the effects of resistance training on muscle and tendon properties between knee extensors and plantar flexors in vivo. Twenty healthy young men voluntarily participated in this study. The subjects were randomly divided into two training groups: knee extension group (n = 10) and plantar flexion group (n = 10). They performed five sets of exercises with a 1-min rest between sets, which consisted of unilateral knee extension for the knee extension group and plantar flexion for the plantar flexion group at 80% of 1 repetition maximum with 10 repetitions per set (4 days/wk, 12 wk). Before and after training, muscle strength, neural activation level (by interpolated twitch), muscle volume (by magnetic resonance imaging), and tendon stiffness (by ultrasonography) were measured. There were no differences in the training-induced increases in muscle strength, activation level, muscle volume, and tendon stiffness between knee extensors and plantar flexors. These results suggested that if the used protocol of training (i.e., intensity, repetition, etc.) were the same, there were no differences in the training-induced changes in muscle and tendon properties between knee extensors and plantar flexors.

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Laurence Houghton, Brian Dawson and Jonas Rubenson

Effects of prolonged running on Achilles tendon properties were assessed after a 60 min treadmill run and 140 min intermittent shuttle running (simulated cricket batting innings). Before and after exercise, 11 participants performed ramp-up plantar flexions to maximum-voluntary-contraction before gradual relaxation. Muscle-tendon-junction displacement was measured with ultrasonography. Tendon force was estimated using dynamometry and a musculoskeletal model. Gradients of the ramp-up force-displacement curves fitted between 0–40% and 50–90% of the preexercise maximal force determined stiffness in the low- and high-force-range, respectively. Hysteresis was determined using the ramp-up and relaxation force-displacement curves and elastic energy storage from the area under the ramp-up curve. In simulated batting, correlations between tendon properties and shuttle times were also assessed. After both protocols, Achilles tendon force decreased (4% to 5%, P < .050), but there were no changes in stiffness, hysteresis, or elastic energy. In simulated batting, Achilles tendon force and stiffness were both correlated to mean turn and mean sprint times (r = −0.719 to −0.830, P < .050). Neither protocol resulted in fatigue-related changes in tendon properties, but higher tendon stiffness and plantar flexion force were related to faster turn and sprint times, possibly by improving force transmission and control of movement when decelerating and accelerating.