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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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Harriet G. Williams and Jeanmarie R. Burke

A conditioned patellar tendon reflex paradigm was used to study the contributions of crossed spinal and supraspinal inputs to the output of the alpha motoneuron pool in children with and without developmental coordination disorders. The basic patellar tendon reflex response was exaggerated in children with developmental coordination disorders. Crossed spinal and supraspinal influences on the excitability of the alpha motoneuron pool were similar in both groups of children. However, there was evidence of exaggerated crossed spinal and supraspinal inputs onto the alpha motoneuron pool in individual children with developmental coordination disorder.

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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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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, Hiroaki Kanehisa and Tetsuo Fukunaga

The purposes of this study were to compare the elasticity of tendon and aponeurosis in human knee extensors and ankle plantar flexors in vivo and to examine whether the maximal strain of tendon was correlated to that of aponeurosis. The elongation of tendon and aponeurosis during isometric knee extension (n = 23) and ankle plantar flexion (n = 22), respectively, were determined using a real-time ultrasonic apparatus, while the participants performed ramp isometric contractions up to voluntary maximum. To calculate the strain values from the measured elongation, we measured the respective length of tendon and aponeurosis. For the knee extensors, the maximal strain of aponeurosis (12.1 ± 2.8%) was significantly greater than that of the patella tendon (8.3 ± 2.4%), p < 0.001. On the contrary, the maximal strain of Achilles tendon (5.9 ± 1.4%) was significantly greater than that of aponeurosis in ankle plantar flexors (2.7 ± 1.4%), p < 0.001. Furthermore, for both knee extensors and ankle plantar flexors there was no significant correlation between maximal strain of tendon and aponeurosis. These results would be important for understanding the different roles of tendon and aponeurosis during human movements and for more accurate muscle modeling.

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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.

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Kurt Manal, Justin D. Cowder and Thomas S. Buchanan

In this article, we outline a method for computing Achilles tendon moment arm. The moment arm is computed from data collected using two reliable measurement instruments: ultrasound and video-based motion capture. Ultrasound is used to measure the perpendicular distance from the surface of the skin to the midline of the tendon. Motion capture is used to determine the perpendicular distance from the bottom of the probe to the ankle joint center. The difference between these two measures is the Achilles tendon moment arm. Unlike other methods, which require an angular change in joint position to approximate the moment arm, the hybrid method can be used to compute the moment arm directly at a specific joint angle. As a result, the hybrid method involves fewer error-prone measurements and the moment arm can be computed at the limits of the joint range of motion. The method is easy to implement and uses modalities that are less costly and more accessible than MRI. Preliminary testing using a lamb shank as a surrogate for a human ankle revealed good accuracy (3.3% error). We believe the hybrid method outlined here can be used to measure subject-specific moment arms in vivo and thus will potentially benefit research projects investigating ankle mechanics.

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Michael F. Joseph, Jeffrey M. Anderson, Thomas H. Trojian and John Crowley


Achilles tendon rupture is often the result of a long-term degenerative process, frequently occurring asymptomatically.


To determine the prevalence of asymptomatic Achilles tendinopathy in an active, asymptomatic, young-adult population and to compare these findings across gender.


Convenience sample, cohort study.


Research laboratory


A sample of 52 (28 male, 24 female) healthy, active subjects were recruited from the student body at the University of Connecticut. Images of 104 Achilles tendons were made.


Ultrasound images made with a Phillips HD11 with a 15-MHz real-time linear-array transducer were collected on both the longitudinal and transverse axes of the Achilles tendon. Activity level was measured with the International Physical Activity Questionnaire Short Form (IPAQ-SF).

Main Outcome Measure:

Presence of ultrasound evidence of Achilles tendinopathy as agreed on by 2 blinded assessors highly skilled in ultrasonography.


More subjects were categorized as highly active (57.4%) on the IPAQ-SF than moderately active (42.6%). One female and one male subject were found to have ultrasound evidence of asymptomatic Achilles tendinopathy, equaling 3.8% prevalence in this study.


We found a low prevalence of asymptomatic Achilles tendinopathy in an active, young-adult population. Further work is necessary to identify an optimal group warranting ultrasound screening for asymptomatic tendinopathy.

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Rebekah D. Alcock, Gregory C. Shaw and Louise M. Burke

; Zdzieblik et al., 2015 ) and athletic populations (e.g., for the prevention and management of connective tissue injury; Baar, 2015 , 2017 ). Although whey protein has been shown to enhance patella tendon hypertrophy in young males when combined with a 12-week resistance exercise training program ( Farup