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Achilles Tendon Mechanical But Not Morphological Properties Change with Rehabilitation in Patients with Chronic Midportion Achilles Tendinopathy.
Medicine & Science in Sports & Exercise ( IF 4.1 ) Pub Date : 2024-11-18 , DOI: 10.1249/mss.0000000000003606
Ine Mylle,Alessia Funaro,Laura Lecompte,Marion Crouzier,Stijn Bogaerts,Benedicte Vanwanseele

PURPOSE Achilles tendinopathy (AT) is associated with altered tendon's morphological and mechanical properties, yet it is unclear whether these properties are reversed upon mechanical loading to promote tendon healing. This study aims to determine the extent to which pathological tendon's morphological and mechanical properties adapt throughout a 12-week eccentric rehabilitation protocol. METHODS Forty participants with midportion AT were recruited and participated in a 12-week eccentric rehabilitation program. Function and symptoms were recorded through the Victorian Institute of Sports Assessment-Achilles (VISA-A) and hopping. The tendon's morphological (i.e. volume, midportion cross-sectional area (CSA) and anteroposterior (AP) diameter) and mechanical (i.e. stiffness, Young's modulus, and tendon non-uniform displacement) properties were measured at baseline and at 6 and 12 weeks of the intervention. RESULTS Significant functional improvements were observed, with VISA-A scores and hopping results showing marked improvements (p < 0.001). Morphologically, no significant changes in volume, midportion CSA, or AP diameter were found, although a trend toward decreased CSA between 30-70% of tendon length was noted. Mechanically, significant increases in Achilles tendon stiffness (p = 0.001) and Young's modulus (p < 0.001) were observed over the course of the rehabilitation program. No differences in tendon non-uniform displacement were found following a 12-week rehabilitation program. CONCLUSIONS These findings suggest that tendon adaptation in response to mechanical loading primarily involves changes in mechanical properties rather than morphology, highlighting the complexity and variability in tendon adaptation. Clinically, these mechanical properties could be considered in the load progression throughout rehabilitation as potentially higher strains will be induced when clinical improvements precede mechanical adaptations.

中文翻译:


跟腱机械而非形态学特性随着慢性中期跟腱病患者的康复而变化。



目的跟腱病 (AT) 与肌腱形态和机械特性改变有关,但尚不清楚这些特性是否在机械负荷时逆转以促进肌腱愈合。本研究旨在确定病理肌腱的形态和机械特性在整个 12 周的离心康复方案中的适应程度。方法 招募了 40 名患有中期 AT 的参与者,并参加了为期 12 周的离心康复计划。通过维多利亚运动评估研究所-跟腱 (VISA-A) 和跳跃记录功能和症状。肌腱的形态学 (即 体积、中段横截面积 (CSA) 和前后 (AP) 直径)和力学 (即 刚度、杨氏模量和肌腱不均匀位移)特性在基线和干预的 6 周和 12 周时测量。结果 观察到显著的功能改善,VISA-A 评分和跳跃结果显示显着改善 (p < 0.001)。在形态学上,未发现体积、中段 CSA 或 AP 直径的显着变化,尽管注意到 CSA 在肌腱长度的 30-70% 之间有减少的趋势。在机械方面,在康复计划过程中观察到跟腱刚度 (p = 0.001) 和杨氏模量 (p < 0.001) 显着增加。在为期 12 周的康复计划后,未发现肌腱不均匀移位的差异。结论这些发现表明,响应机械负荷的肌腱适应主要涉及机械性能的变化而不是形态的变化,突出了肌腱适应的复杂性和可变性。 在临床上,这些机械性能可以在整个康复过程中的负荷进展中考虑,因为当临床改善先于机械适应时,可能会诱发更高的应变。
更新日期:2024-11-18
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