Examination of knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis.

BACKGROUND: Joint moment arm is a major element that determines joint torque. This study aimed to investigate factors associated with knee extensor and valgus moment arms of the patellar tendon in older individuals with and without knee osteoarthritis. METHODS: Thirty-six participants with knee osteoarthritis (mean age, 78.1 ± 6.0 years) and 43 healthy controls (mean age, 73.0 ± 6.3 years) were analyzed. Magnetic resonance images (MRI) from the knee joint and thigh were acquired using a 3.0 T MRI scanner. The three-dimensional moment arm was defined as the distance between the contact point of the tibiofemoral joint and the patellar tendon line. The three-dimensional moment arm was decomposed into sagittal and coronal components, which were calculated as knee extensor and valgus moment arms, respectively. Quadriceps muscle volume, epicondylar width, bisect offset, Insall-Salvati ratio, and Kellgren-Lawrence grade were assessed. Multiple regression analyses were performed in the healthy control and knee osteoarthritis groups, with knee extensor and valgus moment arms as dependent variables. FINDINGS: Knee extensor moment arm was significantly associated with epicondylar width and the Insall-Salvati ratio in the healthy control group and with Kellgren-Lawrence grade, epicondylar width, and quadriceps muscle volume in the knee osteoarthritis group. Valgus knee moment arm was significantly associated with bisect offset in both the groups. INTERPRETATION: Knee size, osteoarthritis severity, and quadriceps muscle volume affect the knee extensor moment arm in knee osteoarthritis, whereas lateral patellar displacement affects the valgus knee moment arms in older individuals with and without knee osteoarthritis.

Quantitative evaluation of the biomechanical and viscoelastic properties of the dog patellar tendon in response to neuromuscular blockade at different stifle angles.

The patellar tendon (PT) is crucial for maintaining stability and facilitating movement in the stifle joint. Elastography has been recognized as a prominent method for evaluating PT properties in humans and dogs. The utilization of oscillation methods in canine studies remains limited despite their extensive documentation in human studies. Our study represents the first effort to quantitatively assess and compare the effects of muscle relaxant on the biomechanical and viscoelastic characteristics of the PT at varying stifle angles in living dogs. Five healthy female beagles were used in this study. Biomechanical (tone, stiffness, and decrement) and viscoelastic (relaxation time and creep) properties of the PT were measured using MyotonPRO (Myoton Ltd, Estonia) prior to and following administration of rocuronium (0.5 mg/kg/body weight) at normal, extended, and flexed positions. Rocuronium was selected for its safety, controllability, and widespread clinical use in veterinary anesthesia. Two-way analysis of variance showed that tone, stiffness, and decrement were significantly higher (P < 0.001) in the control group than in the muscle relaxation group. At the same time, relaxation time and creep were significantly lower (P < 0.001) in the control group than in the muscle relaxation group. The findings indicate that stifle angle position and muscle rexalant administration fundamentally alter the biomechanical loading conditions of the PT, leading to changes in its viscoelastic properties. Therefore, this novel quantitative data could benefit clinical settings that necessitate accurate and objective methods for risk identification and monitoring PT biomechanics in dogs.

Patellar Tendon Adaptations to Downhill Running Training and Their Relationships With Changes in Mechanical Stress and Loading History.

ABSTRACT: Bontemps, B, Gruet, M, Louis, J, Owens, DJ, Miríc, S, Vercruyssen, F, and Erskine, RM. Patellar tendon adaptations to downhill running training and their relationships with changes in mechanical stress and loading history. J Strength Cond Res 38(1): 21-29, 2024-It is unclear whether human tendon adapts to moderate-intensity, high-volume long-term eccentric exercise, e.g., downhill running (DR) training. This study aimed to investigate the time course of patellar tendon (PT) adaptation to short-term DR training and to determine whether changes in PT properties were related to changes in mechanical stress or loading history. Twelve untrained, young, healthy adults (5 women and 7 men) took part in 4 weeks' DR training, comprising 10 sessions. Running speed was equivalent to 60-65% V̇O2max, and session duration increased gradually (15-30 minutes) throughout training. Isometric knee extensor maximal voluntary torque (MVT), vastus lateralis (VL) muscle physiological cross-sectional area (PCSA) and volume, and PT CSA, stiffness, and Young's modulus were assessed at weeks 0, 2, and 4 using ultrasound and isokinetic dynamometry. Patellar tendon stiffness (+6.4 ± 7.4%), Young's modulus (+6.9 ± 8.8%), isometric MVT (+7.5 ± 12.3%), VL volume (+6.6 ± 3.2%), and PCSA (+3.8 ± 3.3%) increased after 4 weeks' DR (p < 0.05), with no change in PT CSA. Changes in VL PCSA correlated with changes in PT stiffness (r = 0.70; p = 0.02) and Young's modulus (r = 0.63; p = 0.04) from 0 to 4 weeks, whereas changes in MVT did not correlate with changes in PT stiffness and Young's modulus at any time point (p > 0.05). To conclude, 4 weeks' DR training promoted substantial changes in PT stiffness and Young's modulus that are typically observed after high-intensity, low-volume resistance training. These tendon adaptations seemed to be driven primarily by loading history (represented by VL muscle hypertrophy), whereas increased mechanical stress throughout the training period did not seem to contribute to changes in PT stiffness or Young's modulus.

Specific collagen peptides increase adaptions of patellar tendon morphology following 14-weeks of high-load resistance training: A randomized-controlled trial.

ABSTRACTThe purpose of this study was to investigate the effect of a supplementation with specific collagen peptides (SCP) combined with resistance training (RT) on changes in structural properties of the patellar tendon. Furthermore, tendon stiffness as well as maximal voluntary knee extension strength and cross-sectional area (CSA) of the rectus femoris muscle were assessed. In a randomized, placebo-controlled study, 50 healthy, moderately active male participants completed a 14-week resistance training program with three weekly sessions (70-85% of 1 repetition maximum [1RM]) for the knee extensors. While the SCP group received 5g of specific collagen peptides daily, the other group received the same amount of a placebo (PLA) supplement. The SCP supplementation led to a significant greater (p < 0.05) increase in patellar tendon CSA compared with the PLA group at 60% and 70% of the patellar tendon length starting from the proximal insertion. Both groups increased tendon stiffness (p < 0.01), muscle CSA (p < 0.05) and muscular strength (p < 0.001) throughout the intervention without significant differences between the groups. The current study shows that in healthy, moderately active men, supplementation of SCP in combination with RT leads to greater increase in patellar tendon CSA than RT alone. Since underlying mechanisms of tendon hypertrophy are currently unknown, further studies should investigate potential mechanisms causing the increased morphology adaptions following SCP supplementation.Trial registration: German Clinical Trials Register identifier: DRKS00029244..

A daily supplementation of 5 g of specific collagen peptides during 14 weeks of high-load resistance training increase patellar tendon hypertrophy compared to the same training regimen and placebo.The resistance training-induced CSA increase, which was most pronounced on proximal and medial patellar tendon sites, is uniformly potentiated along the entire tendon length by supplementation.Patellar tendon stiffness, CSA of the rectus femoris muscle and maximal voluntary knee extension strength increase due to training independently from supplementation.Increased tendon CSA as a result of a stimulating effect of the supplementation with specific collagen peptides on collagen synthesis might be able to decrease tendon stress and support tendon healing.

PIEZO1 gain-of-function gene variant is associated with elevated tendon stiffness in humans.

Prolonged periods of increased physical demands can elicit anabolic tendon adaptations that increase stiffness and mechanical resilience or conversely can lead to pathological processes that deteriorate tendon structural quality with ensuing pain and potential rupture. Although the mechanisms by which tendon mechanical loads regulate tissue adaptation are largely unknown, the ion channel PIEZO1 has been implicated in tendon mechanotransduction, with human carriers of the PIEZO1 gain-of-function variant E756del displaying improved dynamic vertical jump performance compared with noncarriers. Here, we sought to examine whether increased tendon stiffness in humans could explain this increased performance. We assessed tendon morphological and mechanical properties with ultrasound-based techniques in 77 participants of Middle- and West-African descent, and we measured their vertical jumping performance to assess potential functional consequences in the context of high tendon strain-rate loading. Carrying the E756del gene variant (n = 30) was associated with 46.3 ± 68.3% (P = 0.002) and 45.6 ± 69.2% (P < 0.001) higher patellar tendon stiffness and Young's modulus compared with noncarrying controls, respectively. Although these tissue level measures strongly corroborate the initial postulate that PIEZO1 plays an integral part in regulating tendon material properties and stiffness in humans, we found no detectable correlation between tendon stiffness and jumping performance in the tested population that comprised individuals of highly diverse physical fitness level, dexterity, and jumping ability.NEW & NOTEWORTHY The E756del gene variant causes overactivity of the mechanosensitive membrane channel PIEZO1 and is suspected to upregulate tendon collagen cross linking. In human carriers of E756del, we found increased patellar tendon stiffness but similar tendon lengths and cross-sectional areas, directly supporting the premise that PIEZO1 regulates human tendon stiffness at the level of tissue material properties.

Quantification of patellar tendon strain and opportunities for personalized tendon loading during back squats.

Tendon strain during exercise is a critical regulatory factor in tendon adaptive responses and there are indications for an optimal range of strain that promotes tendon adaptation. Back squats are used to improve patellar tendon properties in sport and clinical settings. To date, the operating patellar tendon strain during back squats is unknown and current recommendations for individual exercise loading are based on the one repetition maximum (1RM). Here, we quantified patellar tendon strain during loaded back squats at 40, 60 and 80% of the 1RM and during maximum isometric knee extension contractions (MVC) using ultrasonography. Kinematics, ground reaction forces and muscle electromyographic activity were also recorded. Additionally, maximum tendon strain during the MVC and the percentage of 1RM were used as explanatory variables to estimate the individual patellar tendon strain during the squats. Strain increased with increasing 1RM loading (4.7 to 8.2%), indicating that already medium-loading back squats may provide a sufficient stimulus for tendon adaptation. The individual variability was, however, too high to generalize these findings. Yet, there was a high agreement between the individually estimated and measured patellar tendon strain (R2 = 0.858) during back squats. We argue that this approach may provide new opportunities for personalized tendon exercise.

Persons with Patellar Tendinopathy Exhibit Greater Patellar Tendon Stress during a Single-Leg Landing Task.

PURPOSE: This study aimed to compare peak maximum principal stress in the patellar tendon between persons with and without patellar tendinopathy during a simulated single-leg landing task. A secondary purpose was to determine the biomechanical predictor(s) of peak maximum principal stress in the patellar tendon. METHODS: Using finite element (FE) modeling, patellar tendon stress profiles of 28 individuals (14 with patellar tendinopathy and 14 pain-free controls) were created at the time of the peak knee extensor moment during single-leg landing. Input parameters to the FE model included subject-specific knee joint geometry and kinematics, and quadriceps muscle forces. Independent t -tests were used to compare the peak maximum principal stress in the patellar tendon and biomechanical variables used as input variables to the FE model (knee flexion, knee rotation in the frontal and transverse planes and the peak knee extensor moment) between groups. A stepwise regression model was used to determine the biomechanical predictor(s) of peak maximum principal stress in the patellar tendon for both groups combined. RESULTS: Compared with the control group, persons with patellar tendinopathy exhibited greater peak maximum principal stress in the patellar tendon (77.4 ± 25.0 vs 60.6 ± 13.6 MPa, P = 0.04) and greater tibiofemoral joint internal rotation (4.6° ± 4.6° vs 1.1° ± 4.2°, P = 0.04). Transverse plane rotation of the tibiofemoral joint was the best predictor of peak maximum principal stress in the patellar tendon ( r = 0.51, P = 0.01). CONCLUSIONS: Persons with patellar tendinopathy exhibit greater peak patellar tendon stress compared with pain-free individuals during single-leg landing. The magnitude of peak patellar tendon stress seems to be influenced by the amount of tibiofemoral rotation in the transverse plane.

Metabolic and molecular responses of human patellar tendon to concentric- and eccentric-type exercise in youth and older age.

Exercise training can induce adaptive changes to tendon tissue both structurally and mechanically; however, the underlying compositional changes that contribute to these alterations remain uncertain in humans, particularly in the context of the ageing tendon. The aims of the present study were to determine the molecular changes with ageing in patellar tendons in humans, as well as the responses to exercise and exercise type (eccentric (ECC) and concentric (CON)) in young and old patellar tendon. Healthy younger males (age 23.5 ± 6.1 years; n = 27) and older males (age 68.5 ± 1.9 years; n = 27) undertook 8 weeks of CON or ECC training (3 times per week; at 60% of 1 repetition maximum (1RM)) or no training. Subjects consumed D2O throughout the protocol and tendon biopsies were collected after 4 and 8 weeks for measurement of fractional synthetic rates (FSR) of tendon protein synthesis and gene expression. There were increases in tendon protein synthesis following 4 weeks of CON and ECC training (P < 0.01; main effect by ANOVA), with no differences observed between young and old males, or training type. At the transcriptional level however, ECC in young adults generally induced greater responses of collagen and extracellular matrix-related genes than CON, while older individuals had reduced gene expression responses to training. Different training types did not appear to induce differential tendon responses in terms of protein synthesis, and while tendons from older adults exhibited different transcriptional responses to younger individuals, protein turnover changes with training were similar for both age groups.

Changes in tendon blood circulation and heart rate variability after intermittent compression to patellar and Achilles tendons.

BACKGROUND: The purpose of this study was to compare changes in tendon blood circulation and heart rate variability after intermittent compression to the patellar and Achilles tendons. METHODS: Before the intermittent compression to tendons (3 min) and the recovery period (40 min), the blood volume and oxygen saturation of the patellar and Achilles tendons were measured using red laser lights. In addition, heart rate and ratio of low-frequency to high-frequency components of heart rate variability were measured. FINDINGS: Blood volume and oxygen saturation of patellar and Achilles tendons significantly increased after intermittent compression stimulation (both p ≤ 0.001). There were no differences in increases of blood volume (p = 0.575) and oxygen saturation (p = 0.055) between patellar and Achilles tendons. For both tendons treatments, heart rate (p = 0.698) and ratio of low-frequency to high-frequency components of heart rate variability (p = 0.518) did not change during the experimental period. In addition, the change in blood volume for Achilles tendon was significantly correlated with that in heart rate but not ratio of low-frequency to high-frequency components of heart rate variability, whereas the change in blood volume for patellar tendon was not significantly correlated with that in the heart rate or ratio of low-frequency to high-frequency components of heart rate variability,. INTERPRETATION: These results suggest that intermittent compression-induced changes in blood circulation were similar between patellar and Achilles tendons. In addition, the increase in blood volume after intermittent compression stimulation in the Achilles tendon would be related to the increased metabolism of the tendon.

Effects of isometric loading intensity on patellar tendon microvascular response.

Acute increases in tendon blood flow and oxygenation after stress (i.e., hyperemic response) can enhance tendon recovery. While loading intensity is a fundamental part of resistance training programs, its effects on tendon's hyperemic response are unknown. This study aimed to compare acute changes in total (total hemoglobin [THb]) and oxygenated hemoglobin (HbO2 ) concentrations in the patellar tendon after isometric exercise at different intensities. Thirteen participants performed 8 (5 s) isometric knee extensions at 25%, 50%, and 75% maximal load (maximal voluntarily isometric contraction [MVIC]), separated by 20 min recovery, prescribed in randomized and counterbalanced order. Changes in patellar tendon THb, HbO2 and deoxygenated hemoglobin (HHb) in response to exercise at each intensity were measured using near-infrared spectroscopy. Post-exercise, HbO2 increased with 50% ( η p 2  = 0.305, f = 5.26, p < 0.01) and 75% ( η p 2  = 0.245, f = 4.56, p < 0.01) but not 25% ( η p 2  = 0.088, f = 1.16, p = 0.339) MVIC, while THb increased in 50% ( η p 2  = 0.305, f = 5.26, p = 0.01) but not 25% ( η p 2  = 0.067, f = 0.865, p = 0.51) or 75% ( η p 2  = 0.126, f = 1.729, p = 0.14) MVIC. Additionally, increasing load from 25% to 50% MVIC resulted in greater THb (f = 2.459, p = 0.43), HbO2 (f = 3.389, p = 0.13) and HHb (f = 0.320, p = 0.01) post-exercise responses, but no differences were observed between 50% and 75% MVIC (THb: f = 0.748, p = 0.59; HbO2 : f = 0.825, p = 0.54; HHb: f = 0.713, p = 0.62). Our results suggest there is a loading threshold at ~50% MVIC at which the tendon hyperemic response is fully achieved. Training above this intensity is not expected to provide any additional change to the tendon microvascular response. Therefore, moderate loading seems to be sufficient to fully elicit the patellar tendon hyperemic response that's believed to stimulate tendon healing.

Relationships between tendon structure and clinical impairments in patients with patellar tendinopathy.

The clinical relevance of altered tendon structure in patellar tendinopathy is contested since structural change persists after symptom resolution. The purpose of this study was to explore the relationships between tendon structure and clinical impairments in patellar tendinopathy. In this retrospective, secondary analysis of individuals with patellar tendinopathy (n = 41), tendon structure (thickness, cross-sectional area [CSA], shear modulus, and viscosity), symptom severity, lower extremity function (counter-movement jump [CMJ] height), and quadriceps muscle performance (knee extension force and central activation ratio [CAR]) were recorded for the symptomatic limb. Relationships among structure, symptom severity, lower extremity function, and quadriceps muscle performance were examined using sequential regression models. Adjusting for age, sex, body mass index, and pain levels, there were significant positive relationships for thickness (p < 0.001, ß = 0.718) and viscosity (p = 0.006, ß = 0.496) with CMJ height. There were significant negative relationships between CSA with both CMJ height (p = 0.001, ß = -0.538) and CAR (p = 0.04, ß = -0.517). This is the first study to demonstrate relationships between tendon structure and lower extremity function or quadriceps muscle performance in patients with patellar tendinopathy. Clinical significance: Since structural changes persist after symptom resolution, addressing these changes may assist in restoring lower extremity function and quadriceps muscle performance.

Variation in the patellar tendon moment arm identified with an improved measurement framework.

The mechanical advantage of the knee extensor mechanism depends heavily on the patellar tendon moment arm (PTMA). Understanding which factors contribute to its variation may help improve functional outcomes following arthroplasty. This study optimized PTMA measurement, allowing us to quantify the contribution of different variables. The PTMA was calculated about the instantaneous helical axis of tibiofemoral rotation from optical tracked kinematics. A fabricated knee model facilitated calculation optimization, comparing four data smoothing techniques (raw, Butterworth filtering, generalized cross-validated cubic spline-interpolation and combined filtering/interpolation). The PTMA was then measured for 24 fresh-frozen cadaveric knees, under physiologically based loading and extension rates. Combined filtering/interpolation enabled sub-mm PTMA calculation accuracy throughout the range of motion (root-mean-squared error 0.2 mm, max error 0.4 mm), whereas large errors were measured for raw, filtered-only and interpolated-only techniques at terminal flexion/extension. Before scaling, the mean PTMA was 46 mm; PTMA magnitude was consistently larger in males (mean differences: 5 to 10 mm, p < .05) and was strongly related to knee size: larger knees have a larger PTMA. However, while scaling eliminated sex differences in PTMA magnitude, the peak PTMA occurred closer to terminal extension in females (female 15°, male 29°, p = .01). Knee size accounted for two-thirds of the variation in PTMA magnitude, but not the flexion angle where peak PTMA occurred. This substantial variation in angle of peak PTMA has implications for the design of musculoskeletal models and morphotype-specific arthroplasty. The developed calculation framework is applicable both in vivo and vitro for accurate PTMA measurement.

Efectos del autoinjerto hueso-tendón patelar-hueso sobre la posición articular y la fuerza en pacientes con reconstrucción del ligamento cruzado anterior / Effects of bone-patellar tendon-bone autograft on joint position and strength in patients with anterior cruciate ligament reconstruction

RESUMEN: El objetivo del estudio fue comparar el déficit propioceptivo a través del Joint position sense (JPS) y Force steadiness en pacientes con reconstrucción del ligamento cruzado anterior (LCA) injerto hueso-tendón patelar-hueso (HTH) 6 a 12 meses postcirugía. Participaron 15 pacientes (13 hombres y 2 mujeres, 25,5 ± 1,3 años) con reconstrucción de LCA con autoinjerto HTH y 20 personas sin lesión del LCA (19 hombres y 1 mujer, 24,1 ± 0,8 años). Para evaluar la sensación de posición de la articulación de la rodilla se midió la Joint position sense (JPS) en tres rangos: 0°-30°, 31°-60° y 61°-90° y la sensación de fuerza del cuádriceps fue evaluada con la prueba Force steadiness (FS) al 15 % de la contracción voluntaria máxima (CVM), ambas pruebas realizadas 6 a 12 meses post cirugía. Los resultados mostraron que no hubo diferencias estadísticamente significativas en la sensación de la posición articular (JPS 0°-30°) (p=0.564) y 31°-60° (p=0.681), mientras que en el rango 61°-90° (p=0.003) existieron diferencias estadísticamente significativas. En las mediciones de sensación de fuerza del cuádriceps (FS al 15 % CVM) entre los pacientes operados de LCA técnica HTH y el grupo control no hubo diferencias estadísticas (p= 0.987) La sensación de la fuerza del cuádriceps medida con la prueba FS al 15 % CVM no presentaría déficit entre los 6 a 12 meses en pacientes post operados de LCA al ser comparados con sujetos sin lesión ni cirugía de este ligamento. Se concluye que la sensación de la posición articular medida con la prueba JPS en en tres rangos articulares de pacientes con reconstrucción de LCA injerto HTH 6 a 12 meses post cirugía sólo mostró alteraciones en el rango de 61°- 90° al ser comparado con el grupo control, lo cual indica que la sensación de la posición articular presenta un déficit en este rango específico.

SUMMARY: The aim of the study was to compare the proprioceptive deficit through the Joint position sense (JPS) and Force steadiness in patients with anterior cruciate ligament (ACL) bone-patellar tendon-bone graft (PTH) reconstruction 6 to 12 months post-surgery. Fifteen patients (13 men and 2 women, 25.5 ± 1.3 years) with ACL reconstruction with HTH autograft and 20 persons without ACL injury (19 men and 1 woman, 24.1 ± 0.8 years) participated. To assess knee joint position sensation, Joint position sense (JPS) was measured in three ranges: 0°-30°, 31°- 60° and 61°-90° and quadriceps strength sensation was assessed with the Force steadiness (FS) test at 15 % of maximal voluntary contraction (MVC), both tests performed 6 to 12 months post surgery. The results showed that there were no statistically significant differences in joint position sensation (JPS 0°-30°) (p=0.564) and 31°-60° (p=0.681), while in the range 61°-90° (p=0.003) there were statistically significant differences. In the quadriceps strength sensation measurements (FS at 15 % CVM) between the patients operated on ACL HTH technique and the control group there were no statistical differences (p= 0.987). The quadriceps strength sensation measured with the FS test at 15 % CVM would not present a deficit between 6 to 12 months in post- operated ACL patients when compared to subjects without injury or surgery of this ligament. It is concluded that the joint position sensation measured with the JPS test in three joint ranges of patients with ACL reconstruction HTH graft 6 to 12 months post surgery only showed alterations in the range of 61°- 90° when compared to the control group, indicating that the joint position sensation presents a deficit in this specific range.

Association between patellar tendon moment arm and running performance in endurance runners.

A shorter joint moment arm (MA) may help maintain the necessary muscle force when muscle contractions are repeated. This beneficial effect may contribute to reducing the energy cost during running. In this study, we examined the correlation between patellar tendon MA and running performance in endurance runners. The patellar tendon MA and quadriceps femoris muscle volume (MV) in 42 male endurance runners and 14 body size-matched male untrained participants were measured using a 1.5-T magnetic resonance system. The patellar tendon MA was significantly shorter in endurance runners than in untrained participants (p = 0.034, d = 0.65). In endurance runners, shorter patellar tendon MA correlated significantly with better personal best 5000-m race rime (r = 0.322, p = 0.034). A trend toward such a significant correlation was obtained between quadriceps femoris MV and personal best 5000-m race time (r = 0.303, p = 0.051). Although the correlation between patellar tendon MA and personal best 5000-m race time did not remain significant after adjusting for the quadriceps femoris MV (partial r = 0.247, p = 0.120), a stepwise multiple regression analysis (conducted with body height, body mass, patellar tendon MA, and quadriceps femoris MV) selected the patellar tendon MA (ß = 0.322) as only a predictive variable for the personal best 5000-m race time (adjusted R2  = 0.081, p = 0.038). These findings suggest that the shorter patellar tendon MA, partially accorded with the smaller quadriceps femoris size, may be a favorable morphological variable for better running performance in endurance runners.

Examination of the proximodistal patellar position in small dogs in relation to anatomical features of the distal femur and medial patellar luxation.

OBJECTIVE: To determine the influence of anatomical features of the distal femur on the proximodistal patellar position and compare the proximodistal patellar position between dogs with and without medial patellar luxation (MPL). STUDY DESIGN: Retrospective case series (n = 71). METHODS: Mediolateral-view radiographs of clinical cases of dogs weighing less than 15 kg were obtained. The stifle joint angle, patellar ligament length, patellar length, size of the femoral condyle, trochlear length, and trochlear angle were measured and included in multiple linear regression analyses to ascertain their effects on the proximodistal patellar position. Radiographs were divided into MPL and control groups. The effects of MPL on the proximodistal patellar position and morphological factors were also examined. RESULTS: The final model for the proximodistal patellar position revealed that the patella became distal as the ratio of the patellar ligament length to patellar length decreased, the trochlear angle relative to the femur increased, the trochlear length relative to the patellar length increased, or the trochlear length relative to the femoral condyle width decreased. The proximodistal patellar position in the MPL group was not significantly different from that in the control group despite the trend towards a distally positioned patella (p = 0.073). The MPL group showed a significantly shorter trochlea (p<0.001) and greater trochlear angle relative to the femur (p = 0.029) than the control group. CONCLUSION: The proximodistal patellar position depends on multiple factors, and its determination based on PLL/PL alone may not be appropriate. Dogs with MPL did not have a proximally positioned patella compared with dogs without MPL. Although hindlimbs with MPL had a shorter trochlea than those without patellar luxation, this difference did not appear to be sufficient to displace the patellar position proximally in small dogs, possibly compensated by increased trochlear angle relative to the femur.

The Human Muscle Size and Strength Relationship: Effects of Architecture, Muscle Force, and Measurement Location.

PURPOSE: This study aimed to determine the best muscle size index of muscle strength by establishing if incorporating muscle architecture measurements improved the human muscle size-strength relationship. The influence of calculating muscle force and the location of anatomical cross-sectional area (ACSA) measurements on this relationship were also examined. METHODS: Fifty-two recreationally active men completed unilateral isometric knee extension strength assessments and magnetic resonance imaging scans of the dominant thigh and knee to determine quadriceps femoris size variables (ACSA along the length of the femur, maximum ACSA (ACSAMAX), and volume (VOL)) and patellar tendon moment arm. Ultrasound images (two sites per constituent muscle) were analyzed to quantify muscle architecture (fascicle length, pennation angle) and, when combined with VOL (from magnetic resonance imaging), facilitated calculation of quadriceps femoris effective PCSA (EFFPCSA) as potentially the best muscle size determinant of strength. Muscle force was calculated by dividing maximum voluntary torque by the moment arm and addition of antagonist torque (derived from hamstring EMG). RESULTS: The associations of EFFPCSA (r = 0.685), ACSAMAX (r = 0.697), or VOL (r = 0.773) with strength did not differ, although qualitatively VOL explained 59.8% of the variance in strength, ~11%-13% greater than EFFPCSA or ACSAMAX. All muscle size variables had weaker associations with muscle force than maximum voluntary torque. The association of strength-ACSA at 65% of femur length (r = 0.719) was greater than for ACSA measured between 10%-55% and 75%-90% (r = -0.042-0.633) of femur length. CONCLUSIONS: In conclusion, using contemporary methods to assess muscle architecture and calculate EFFPCSA did not enhance the muscle strength-size association. For understanding/monitoring muscle size, the major determinant of strength, these findings support the assessment of muscle volume, which is independent of architecture measurements and was most highly correlated with strength.

Effect of Knee Angle and Quadriceps Muscle Force on Shear-Wave Elastography Measurements at the Patellar Tendon.

Shear-wave elastography (SWE) is a non-invasive imaging technique that provides estimates of tissue stiffness via shear-wave speed measurements. No standardized protocol currently exists for SWE of the patellar tendon, which may be influenced by knee angle and quadriceps muscle force. In this study, the reliability of SWE in cadaveric patellar tendons was examined at three knee angles (0°, 30° and 60°) and three quadriceps muscle forces (0, 50 and 100 N). Shear-wave speed was significantly higher at a knee angle of 60° than at 0° or 30° (increases of 7% and 9%, respectively), and when the quadriceps muscle force was greater than or equal to 50 N (increase of 15%). SWE of the patellar tendon displayed excellent repeatability regardless of knee angle as long as no quadriceps force was generated (intra-class correlation coefficient ≥0.91). This research illustrates the importance of controlling knee angle and quadriceps force for consistency and comparison of SWE results.

Morphological Characteristics of Passive and Active Structures of the Foot Across Populations With Different Levels of Physical Activity.

BACKGROUND: Imaging diagnosis plays a fundamental role in the evaluation and management of injuries suffered in sports activities. OBJECTIVE: To analyze the differences in the thickness of the Achilles tendon, patellar tendon, plantar fascia, and posterior tibial tendon in the following levels of physical activity: persons who run regularly, persons otherwise physically active, and persons with a sedentary lifestyle. DESIGN: Cross-sectional and observational. PARTICIPANTS: The 91 volunteers recruited from students at the university and the Triathlon Club from December 2016 to June 2019. The data were obtained (age, body mass index, and visual analog scale for quality of life together with the ultrasound measurements). RESULTS: Tendon and ligament thickness was greater in the runners group than in the sedentary and active groups with the exception of the posterior tibial tendon. The thickness of the Achilles tendon was greater in the runners than in the other groups for both limbs (P = .007 and P = .005). This was also the case for the cross-sectional area (P < .01) and the plantar fascia at the heel insertion in both limbs (P = .034 and P = .026) and for patellar tendon thickness for the longitudinal measurement (P < .01). At the transversal level, however, the differences were only significant in the right limb (P = .040). CONCLUSION: The thickness of the Achilles tendon, plantar fascia, and patellar tendon is greater in runners than in persons who are otherwise active or who are sedentary.

Quantification of patellar tendon reflex using portable mechanomyography and electromyography devices.

Deep tendon reflexes are one of the main components of the clinical nervous system examinations. These assessments are inexpensive and quick. However, evaluation can be subjective and qualitative. This study aimed to objectively evaluate hyperreflexia of the patellar tendon reflex using portable mechanomyography (MMG) and electromyography (EMG) devices. This study included 10 preoperative patients (20 legs) who had a pathology that could cause bilateral patellar tendon hyperreflexia and 12 healthy volunteers (24 legs) with no prior history of neurological disorders. We attached MMG/EMG sensors onto the quadriceps and tapped the patellar tendon with maximal and constant force. Our results showed a significantly high amplitude of the root mean square (RMS) and low frequency of the mean power frequency (MPF) in the rectus femoris, vastus medialis, and vastus lateralis muscles in both EMG and MMG with both maximal and constant force. Especially in the patients with cervical and thoracic myelopathy, the receiver operating characteristic (ROC) curve for diagnosing hyperreflexia of the patellar tendon showed a moderate to very high area under the curve for all EMG-RMS, EMG-MPF, MMG-RMS, and MMG-MPF values. The use of EMG and MMG for objectively quantifying the patellar tendon reflex is simple and desirable for future clinical applications and could help diagnose neurological disorders.

Infrapatellar Fat Pad Resection or Preservation during Total Knee Arthroplasty: A Systematic Review.

Considerations of how to improve postoperative outcomes for total knee arthroplasty (TKA) have included preservation of the infrapatellar fat pad (IPFP). Although the IPFP is commonly resected during TKA procedures, there is controversy regarding whether resection or preservation should be implemented, and how this influences outcomes. Therefore, the purpose of this systematic review was to evaluate how IPFP resection and preservation impacts postoperative flexion, pain, Insall-Salvati Ratio (ISR), Knee Society Score (KSS), patellar tendon length (PTL), and satisfaction in primary TKA. PubMed, EBSCO host, and SCOPUS were queried to retrieve all reports evaluating IPFP resection or preservation during TKA, which resulted into 488 studies. Two reviewers independently reviewed these articles for eligibility based on pre-established inclusion and exclusion criteria. Eleven studies were identified for final analysis, which reported on 11,996 cases. Patient demographics, type of surgical intervention, follow-up duration, and clinical outcome measures were collected and analyzed. Complete resection was implemented in 3,723 cases (31%), partial resection in 5,458 cases (45.5%), and preservation of the IPFP in 2,815 cases (23.5%). Clinical outcome measures included PTL (5 studies), knee flexion (4 studies), pain (6 studies), KSS (3 studies), ISR (3 studies), and patient satisfaction (1 study). No differences were found following IPFP resection for patient satisfaction (p = 0.98), ISR (p > 0.05), and KSS (p > 0.05). There was mixed evidence for PTL, pain, and knee flexion following IPFP resection versus preservation. Studies of shorter follow-up intervals suggested improved pain following resection, while reports of longer follow-up times indicated that resection resulted in increased pain. Given the mixed data available from the current literature, we were unable to conclude that one surgical technique can definitively be considered superior over the other. More extensive research, including randomized controlled trials, is required to better elucidate potential differences between the surgical handling choices. Future studies should focus on patient conditions in which one technique would be best indicated to establish guidelines for best surgical outcomes in those patients.