Supraspinatus Muscle and Tendon Characteristics 1 Year After Surgical Rotator Cuff Repair Compared With Contralateral Shoulder: Data From the CUT-N-MOVE Trial.

BACKGROUND: It is necessary to better understand the structural characteristics of the supraspinatus tendon and associated muscle after rotator cuff repair and in the event of retear. PURPOSE: To study structural differences between the repaired and contralateral shoulders 1 year after rotator cuff repair in patients who received either progressive exercise therapy (PR) or usual care (UC) in a randomized controlled trial and to investigate whether there was interaction with tendon retear and limb dominance. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients with surgically repaired traumatic full-thickness rotator cuff tears involving the supraspinatus tendon were included. After surgery, they were randomized to PR or UC (active from postoperative week 2 or 6, respectively). The subacromial structures (acromiohumeral distance, supraspinatus tendon thickness, and vascularity) and the supraspinatus muscle thickness were examined with ultrasound at the 1-year follow-up. RESULTS: A total of 79 patients were included. The characteristics of the 2 intervention groups (PR and UC) were comparable, including the Western Ontario Rotator Cuff Index score and number of retears. The authors found significantly thinner supraspinatus tendon (PR, P < .001; UC, P = .003) and reduced acromiohumeral distance (PR, P = .023; UC, P = .025) in the repaired versus the contralateral shoulders in both intervention groups. For neovascularization, there was no interlimb difference in either of the groups or between groups (PR vs UC). In patients with intact tendons, there was no interlimb difference in the muscle thickness, but in patients with tendon retear the muscle was significantly thinner on the repaired side (P = .024 and P < .001, respectively). When the dominant supraspinatus tendon was repaired (both groups), it was significantly thinner than the nondominant healthy tendon, but this difference was not seen when the nondominant supraspinatus tendon was repaired (P = .006). CONCLUSION: One year after rotator cuff surgery, the repaired supraspinatus tendon was significantly thinner and the corresponding acromiohumeral distance was reduced. In patients with retear, the supraspinatus muscle was significantly thinner on the repaired side and early initiation of tendon-loading exercises did not affect these findings. REGISTRATION: NCT02969135 (ClinicalTrials.gov identifier).

Differential contributions of ankle plantarflexors during submaximal isometric muscle action: a PET and EMG study.

The objective of this study was to investigate the relative contributions of superficial and deep ankle plantarflexors during repetitive submaximal isometric contractions using surface electromyography (SEMG) and positron emission tomography (PET). Myoelectric signals were obtained from twelve healthy volunteers (27.3±4.2yrs). A tracer ([(18)F]-FDG) was injected during the exercise and PET scanning was done immediately afterwards. The examined muscles included soleus (Sol), medial gastrocnemius (MG), lateral gastrocnemius (LG), and flexor hallucis longus (FHL). It was found that isometric maximal voluntary contraction (MVC) force, muscle glucose uptake (GU) rate, and SEMG of various plantarflexors were comparable bilaterally. In terms of %EMG MVC, FHL and MG displayed the highest activity (∼34%), while LG (∼21%) had the lowest activity. Cumulative SEMG from all parts of the triceps surae (TS) muscle accounted for ∼70% of the combined EMG signal of all four plantarflexors. As for GU, the highest quantity was observed in MG (2.4±0.8µmol*100g(-1)*min(-1)), whereas FHL (1.8±0.6µmol*100g(-1)*min(-1)) had the lowest uptake. Cumulative GU of TS constituted nearly 80% of the combined GU. The findings of this study provide valuable reference for studies where individual muscle contributions are estimated using models and simulations.

Lower strength of the human posterior patellar tendon seems unrelated to mature collagen cross-linking and fibril morphology.

The human patellar tendon is frequently affected by tendinopathy, but the etiology of the condition is not established, although differential loading of the anterior and posterior tendon may be associated with the condition. We hypothesized that changes in fibril morphology and collagen cross-linking would parallel differences in material strength between the anterior and posterior tendon. Tendon fascicles were obtained from elective ACL surgery patients and tested micromechanically. Transmission electron microscopy was used to assess fibril morphology, and collagen cross-linking was determined by HPLC and calorimetry. Anterior fascicles were markedly stronger (peak stress: 54.3 +/- 21.2 vs. 39.7 +/- 21.3 MPa; P < 0.05) and stiffer (624 +/- 232 vs. 362 +/- 170 MPa; P < 0.01) than posterior fascicles. Notably, mature pyridinium type cross-links were less abundant in anterior fascicles (hydroxylysylpyridinoline: 0.859 +/- 0.197 vs. 1.416 +/- 0.250 mol/mol, P = 0.001; lysylpyridinoline: 0.023 +/- 0.006 vs. 0.035 +/- 0.006 mol/mol, P < 0.01), whereas pentosidine and pyrrole concentrations showed no regional differences. Fibril diameters tended to be larger in anterior fascicles (7.819 +/- 2.168 vs. 4.897 +/- 1.434 nm(2); P = 0.10). Material properties did not appear closely related to cross-linking or fibril morphology. These findings suggest region-specific differences in mechanical, structural, and biochemical properties of the human patellar tendon.

Viscoelastic behavior of discrete human collagen fibrils.

Whole tendon and fibril bundles display viscoelastic behavior, but to the best of our knowledge this property has not been directly measured in single human tendon fibrils. In the present work an atomic force microscopy (AFM) approach was used for tensile testing of two human patellar tendon fibrils. Fibrils were obtained from intact human fascicles, without any pre-treatment besides frozen storage. In the dry state a single isolated fibril was anchored to a substrate using epoxy glue, and the end of the fibril was glued on to an AFM cantilever for tensile testing. In phosphate buffered saline, cyclic testing was performed in the pre-yield region at different strain rates, and the elastic response was determined by a stepwise stress relaxation test. The elastic stress-strain response corresponded to a second-order polynomial fit, while the viscous response showed a linear dependence on the strain. The slope of the viscous response showed a strain rate dependence corresponding to a power function of powers 0.242 and 0.168 for the two patellar tendon fibrils, respectively. In conclusion, the present work provides direct evidence of viscoelastic behavior at the single fibril level, which has not been previously measured.

Differences in the movement pattern of a forward lunge in two types of anterior cruciate ligament deficient patients: copers and non-copers.

OBJECTIVE: To determine whether differences in the knee joint movement pattern of a forward lunge could be quantified in healthy subjects and in anterior cruciate ligament deficient subjects who were able to return to the same activity level as before their injury (copers) and in those who were not (non-copers). DESIGN: The movement patterns of the injured leg of the coper and non-coper anterior cruciate ligament deficient subjects and the right leg of the control subjects were compared statistically. BACKGROUND: The forward lunge seems to be a less stressful test than the commonly used one-legged hop test, which makes it a possible tool for evaluating and comparing the functional performance of non-copers and copers. METHODS: The movement pattern of a forward lunge was analysed by using a two-dimensional inverse dynamics method. The electromyographic activity of the quadriceps and hamstring muscles were recorded. RESULTS: The non-copers moved more slowly and loaded the knee joint less than the copers and controls. The copers moved more slowly during the knee flexion phase but as fast as the controls during the knee extension. The EMG results suggest that the copers stabilized their knee joint by increasing the co-contraction of the hamstrings during the extension phase. CONCLUSIONS: Differences between the three groups' movement patterns could be quantified. The forward lunge test seems appropriate to discriminate between the knee function in coper and non-coper anterior cruciate ligament deficient subjects. RELEVANCE: Information about the performance of movements, which significantly load the knee joint in coper and non-coper anterior cruciate ligament deficient patients may contribute to a better understanding of dynamic knee joint stabilization, which is relevant in relation to the development of rehabilitation strategies.