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Shear wave tensiometry is a noninvasive method for directly measuring wave speed as a proxy for force in tendons during dynamic activities. Traditionally, tensiometry has used broadband excitation pulses and measured the wave travel time between two sensors. In this work, we demonstrate a new method for tracking phase velocity using shaped excitations and measurements from a single sensor. We observed modulation of phase velocity in the Achilles tendon that was generally consistent with wave speed measures obtained via broadband excitation. We also noted a frequency dependence of phase velocity, which is expected for dispersive soft tissues. The implementation of this method could enhance the use of noninvasive wave speed measures to characterize tendon forces. Further, the approach allows for the design of smaller shear wave tensiometers usable for a broader range of tendons and applications. [ABSTRACT FROM AUTHOR]

Pregnancy and lactation hormones have been shown to mediate anatomical changes to the musculoskeletal system that generates animal movement. In this study, we characterize changes in the medial gastrocnemius muscle, its tendon and aponeuroses that are likely to have an effect on whole animal movement and energy expenditure, using the rat model system, Rattus norvegicus. We quantified muscle architecture (mass, cross‐sectional area, and pennation angle), muscle fiber type and diameter, and Young's modulus of stiffness for the medial gastrocnemius aponeuroses as well as its contribution to Achilles tendon in three groups of three‐month‐old female rats: virgin, primiparous pregnant, and primiparous lactating animals. We found that muscle mass drops by 23% during lactation but does not change during pregnancy. We also found that during pregnancy muscle fibers switch from Type I to IIa and during lactation from Type IIb to Type I. The stiffness of connective tissues that has a demonstrated role in locomotion, the aponeurosis and tendon, also changed. Pregnant animals had a significantly less stiff aponeurosis. However, tendon stiffness was most affected during lactation, with a significant drop in stiffness and interindividual variation. We propose that the energetic demands of locomotion may have driven the evolution of these anatomical changes in muscle‐tendon units during pregnancy and lactation to ensure more energy can be allocated to fetal development and lactation. [ABSTRACT FROM AUTHOR]

Shear wave tensiometry is a noninvasive method for directly measuring wave speed as a proxy for force in tendons during dynamic activities. Traditionally, tensiometry has used broadband excitation pulses and measured the wave travel time between two sensors. In this work, we demonstrate a new method for tracking phase velocity using shaped excitations and measurements from a single sensor. We observed modulation of phase velocity in the Achilles tendon that was generally consistent with wave speed measures obtained via broadband excitation. We also noted a frequency dependence of phase velocity, which is expected for dispersive soft tissues. The implementation of this method could enhance the use of noninvasive wave speed measures to characterize tendon forces. Further, the approach allows for the design of smaller shear wave tensiometers usable for a broader range of tendons and applications.

Shear wave tensiometry is a noninvasive approach for assessing in vivo tendon forces based on the speed of a propagating shear wave. Wave speed is measured by impulsively exciting a shear wave in a tendon and then assessing the wave travel time between skin-mounted accelerometers. Signal distortion with wave travel can cause errors in the estimated wave travel time. In this study, we investigated the use of a Kalman filter to fuse spatial and temporal accelerometer measurements of wave propagation. Spatial measurements consist of estimated wave travel times between accelerometers. Temporal measurements are the change in wave arrival at a fixed accelerometer between successive impulsive taps. The Kalman filter substantially improved the accuracy of estimated wave speeds when applied to simulated tensiometer data. The variability of estimated wave speed was reduced by ~55% in the presence of random sensor noise. It was found that increasing the number of accelerometers from two to three further reduced wave speed errors by 45%. The use of redundant accelerometers (>2) also improved the robustness of wave speed measures in the presence of uncertainty in accelerometer location. We conclude that the use of a Kalman filter and redundant accelerometers can enhance the fidelity of using shear wave tensiometers to track tendon wave speed and loading during movement. [ABSTRACT FROM AUTHOR]

Force produced by the muscle during contraction is applied to the tendon and distributed through the cross-sectional area (CSA) of the tendon. This ratio of force to the tendon CSA is quantified as the tendon mechanical property of stress. Stress is traditionally calculated using the resting tendon CSA; however, this does not take into account the reductions in the CSA resulting from tendon elongation during the contraction. It is unknown if calculating the tendon stress using instantaneous CSA during a contraction significantly increases the values of in vivo distal biceps brachii (BB) tendon stress in humans compared to stress calculated with the resting CSA. Nine young (22 ± 1 years) and nine old (76 ± 4 years) males, and eight young females (21 ± 1 years) performed submaximal isometric elbow flexion tracking tasks at force levels ranging from 2.5 to 80% maximal voluntary contraction (MVC). The distal BB tendon CSA was recorded on ultrasound at rest and during the submaximal tracking tasks (instantaneous). Tendon stress was calculated as the ratio of tendon force during contraction to CSA using the resting and instantaneous measures of CSA, and statistically evaluated with multi-level modeling (MLM) and Johnson–Neyman regions of significance tests to determine the specific force levels above which the differences between calculation methods and groups became statistically significant. The tendon CSA was greatest at rest and decreased as the force level increased (p < 0.001), and was largest in young males (23.0 ± 2.90 mm2) followed by old males (20.87 ± 2.0 mm2) and young females (17.08 ± 1.54 mm2) (p < 0.001) at rest and across the submaximal force levels. Tendon stress was greater in the instantaneous compared with the resting CSA condition, and young males had the greatest difference in the values of tendon stress between the two conditions (20 ± 4%), followed by old males (19 ± 5%), and young females (17 ± 5%). The specific force at which the difference between the instantaneous and resting CSA stress values became statistically significant was 2.6, 6.6, and 10% MVC for old males, young females, and young males, respectively. The influence of using the instantaneous compared to resting CSA for tendon stress is sex-specific in young adults, and age-specific in the context of males. The instantaneous CSA should be used to provide a more accurate measure of in vivo tendon stress in humans.

The mechanical properties of tissues are critical design parameters for biomaterials and regenerative therapies seeking to restore functionality after disease or injury. Characterizing the mechanical properties of native tissues and extracellular matrix throughout embryonic development helps us understand the microenvironments that promote growth and remodeling, activities critical for biomaterials to support. The mechanical characterization of small, soft materials like the embryonic tissues of the mouse, an established mammalian model for development, is challenging due to difficulties in handling minute geometries and resolving forces of low magnitude. While uniaxial tensile testing is the physiologically relevant modality to characterize tissues that are loaded in tension in vivo , there are no commercially available instruments that can simultaneously measure sufficiently low tensile force magnitudes, directly measure sample deformation, keep samples hydrated throughout testing, and effectively grip minute geometries to test small tissues. To address this gap, we developed a micromanipulator and spring system that can mechanically characterize small, soft materials under tension. We demonstrate the capability of this system to measure the force contribution of soft materials, silicone, fibronectin sheets, and fibrin gels with a 5 nN – 50 µN force resolution and perform a variety of mechanical tests. Additionally, we investigated murine embryonic tendon mechanics, demonstrating the instrument can measure differences in mechanics of small, soft tissues as a function of developmental stage. This system can be further utilized to mechanically characterize soft biomaterials and small tissues and provide physiologically relevant parameters for designing scaffolds that seek to emulate native tissue mechanics. The mechanical properties of cellular microenvironments are critical parameters that contribute to the modulation of tissue growth and remodeling. The field of tissue engineering endeavors to recapitulate these microenvironments in order to construct tissues de novo. Therefore, it is crucial to uncover the mechanical properties of the cellular microenvironment during tissue formation. Here, we present a system capable of acquiring microscale forces and optically measuring sample deformation to calculate the stress-strain response of soft, embryonic tissues under tension, and easily adaptable to accommodate biomaterials of various sizes and stiffnesses. Altogether, this modular system enables researchers to probe the unknown mechanical properties of soft tissues throughout development to inform the engineering of physiologically relevant microenvironments. [Display omitted] [ABSTRACT FROM AUTHOR]

Force produced by the muscle during contraction is applied to the tendon and distributed through the cross-sectional area (CSA) of the tendon. This ratio of force to the tendon CSA is quantified as the tendon mechanical property of stress. Stress is traditionally calculated using the resting tendon CSA; however, this does not take into account the reductions in the CSA resulting from tendon elongation during the contraction. It is unknown if calculating the tendon stress using instantaneous CSA during a contraction significantly increases the values of in vivo distal biceps brachii (BB) tendon stress in humans compared to stress calculated with the resting CSA. Nine young (22 ± 1 years) and nine old (76 ± 4 years) males, and eight young females (21 ± 1 years) performed submaximal isometric elbow flexion tracking tasks at force levels ranging from 2.5 to 80% maximal voluntary contraction (MVC). The distal BB tendon CSA was recorded on ultrasound at rest and during the submaximal tracking tasks (instantaneous). Tendon stress was calculated as the ratio of tendon force during contraction to CSA using the resting and instantaneous measures of CSA, and statistically evaluated with multi-level modeling (MLM) and Johnson–Neyman regions of significance tests to determine the specific force levels above which the differences between calculation methods and groups became statistically significant. The tendon CSA was greatest at rest and decreased as the force level increased (p < 0.001), and was largest in young males (23.0 ± 2.90 mm2) followed by old males (20.87 ± 2.0 mm2) and young females (17.08 ± 1.54 mm2) (p < 0.001) at rest and across the submaximal force levels. Tendon stress was greater in the instantaneous compared with the resting CSA condition, and young males had the greatest difference in the values of tendon stress between the two conditions (20 ± 4%), followed by old males (19 ± 5%), and young females (17 ± 5%). The specific force at which the difference between the instantaneous and resting CSA stress values became statistically significant was 2.6, 6.6, and 10% MVC for old males, young females, and young males, respectively. The influence of using the instantaneous compared to resting CSA for tendon stress is sex-specific in young adults, and age-specific in the context of males. The instantaneous CSA should be used to provide a more accurate measure of in vivo tendon stress in humans. [ABSTRACT FROM AUTHOR]

Internal snapping of the psoas tendon is a frequently reported condition, especially in young adolescents involved in sports. It is defined as an increased tendon excursion over bony or soft tissue prominence causing local irritation and inflammation of the tendon leading to groin pain and often is accompanied by an audible snap. Due to the lack of detailed dynamic visualization means, the exact mechanism of the condition remains poorly understood and different theories have been postulated related to the etiology and its location about the hip. In the present study we simulated psoas tendon behavior in a virtual population of 40,000 anatomies and compared tendon movement during combined abduction, flexion and external rotation and back to neutral extension and adduction. At risk phenotyopes for tendon snapping were defined as the morphologies presenting with excess tendon movement. There were little differences in tendon movement between the male and female models. In both populations, abnormal tendon excursion correlated with changes in mainly the femoral anatomy (male r = 0.72, p < 0.001, female r = 0.66, p < 0.001): increased anteversion and valgus as well as a decreasing femoral offset and ischiofemoral distance. The observed combination of shape components correlating with excess tendon movement in essence presented with a medial positioning of the minor trochanter. This finding suggest that psoas snapping and ischiofemoral impingement are possibly two presentations of a similar underlying rotational dysplasia of the femur.

Purpose: We investigated the role of elastic strain energy on the "apparent" efficiency of locomotion (AE), a parameter that is known to increase as a function of running speed (up to 0.5–0.7) well above the values of "pure" muscle efficiency (about 0.25–0.30). Methods: In vivo ultrasound measurements of the gastrocnemius medialis (GM) muscle–tendon unit (MTU) were combined with kinematic, kinetic and metabolic measurements to investigate the possible influence of the Achilles tendon mechanical behaviour on the mechanics (total mechanical work, WTOT) and energetics (net energy cost, Cnet) of running at different speeds (10, 13 and 16 km h−1); AE was calculated as WTOT/Cnet. Results: GM fascicles shortened during the entire stance phase, the more so the higher the speed, but the majority of the MTU displacement was accommodated by the Achilles tendon. Tendon strain and recoil increased as a function of running speed (P < 0.01 and P < 0.001, respectively). The contribution of elastic energy to the positive work generated by the MTU also increased with speed (from 0.09 to 0.16 J kg−1 m−1). Significant negative correlations (P < 0.01) were observed between tendon work and metabolic energy at each running speed (the higher the tendon work the lower the metabolic demand) and significant positive correlations were observed between tendon work and AE (P < 0.001) at each running speed (the higher the tendon work the higher the efficiency). Conclusion: These results support the notion that the dynamic function of tendons is integral in reducing energy expenditure and increasing the "apparent" efficiency of running. [ABSTRACT FROM AUTHOR]

Abstract Injured tendons heal through the formation of a fibrovascular scar that has inferior mechanical properties compared to native tendon tissue. Reducing inflammation that occurs as a result of the injury could limit scar formation and improve functional recovery of tendons. Prostaglandin D2 (PGD2) plays an important role in promoting inflammation in some injury responses and chronic disease processes, and the inhibition of PGD2 has improved healing and reduced disease burden in animal models and early clinical trials. Based on these findings, we sought to determine the role of PGD2 signaling in the healing of injured tendon tissue. We tested the hypothesis that a potent and specific inhibitor of hematopoietic PGD synthase (HPGDS), GSK2894631A, would improve the recovery of tendons of adult male rats following an acute tenotomy and repair. To test this hypothesis, we performed a full‐thickness plantaris tendon tenotomy followed by immediate repair and treated rats twice daily with either 0, 2, or 6 mg/kg of GSK2894631A. Tendons were collected either 7 or 21 days after surgical repair, and mechanical properties of tendons were assessed along with RNA sequencing and histology. While there were some differences in gene expression across groups, the targeted inhibition of HPGDS did not impact the functional repair of tendons after injury, as HPGDS expression was surprisingly low in injured tendons. These results indicate that PGD2 signaling does not appear to be important in modulating the repair of injured tendon tissue.

Injured tendons heal through the formation of a fibrovascular scar that has inferior mechanical properties compared to native tendon tissue. Reducing inflammation that occurs as a result of the injury could limit scar formation and improve functional recovery of tendons. Prostaglandin D2 (PGD2) plays an important role in promoting inflammation in some injury responses and chronic disease processes, and the inhibition of PGD2 has improved healing and reduced disease burden in animal models and early clinical trials. Based on these findings, we sought to determine the role of PGD2 signaling in the healing of injured tendon tissue. We tested the hypothesis that a potent and specific inhibitor of hematopoietic PGD synthase (HPGDS), GSK2894631A, would improve the recovery of tendons of adult male rats following an acute tenotomy and repair. To test this hypothesis, we performed a full‐thickness plantaris tendon tenotomy followed by immediate repair and treated rats twice daily with either 0, 2, or 6 mg/kg of GSK2894631A. Tendons were collected either 7 or 21 days after surgical repair, and mechanical properties of tendons were assessed along with RNA sequencing and histology. While there were some differences in gene expression across groups, the targeted inhibition of HPGDS did not impact the functional repair of tendons after injury, as HPGDS expression was surprisingly low in injured tendons. These results indicate that PGD2 signaling does not appear to be important in modulating the repair of injured tendon tissue. [ABSTRACT FROM AUTHOR]

It has recently been shown that shear wave speed in tendons is directly dependent on axial stress. Hence, wave speed could be used to infer tendon load provided that the wave speed-stress relationship can be calibrated and remains robust across loading conditions. The purpose of this study was to investigate the effects of loading rate and fluid immersion on the wave speed-stress relationship in ex vivo tendons, and to assess potential calibration techniques. Tendon wave speed and axial stress were measured in 20 porcine digital flexor tendons during cyclic (0.5, 1.0 and 2.0 Hz) or static axial loading. Squared wave speed was highly correlated to stress (r2 avg = 0.98) and was insensitive to loading rate (p = 0.57). The constant of proportionality is the effective density, which reflects the density of the tendon tissue and additional effective mass added by the adjacent fluid. Effective densities of tendons vibrating in a saline bath averaged 1680 kg/m3 and added mass effects caused wave speeds to be 22% lower on average in a saline bath than in air. The root-mean-square error between predicted and measured stress was 0.67 MPa (6.7% of maximum stress) when using tendon-specific calibration parameters. These errors increased to 1.31 MPa (13.1% of maximum stress) when calibrating based on group-compiled data from ten tendons. These results support the feasibility of calculating absolute tendon stresses from wave speed squared based on linear calibration relationships. [ABSTRACT FROM AUTHOR]

Achilles tendon stiffness (kAT) and Young's modulus (yAT) are important determinants of tendon function. However, their evaluation requires sophisticated equipment and time-consuming procedures. The goal of this study was twofold: to compare kAT and yAT between populations using the classical approach proposed in the literature (a combination of ultrasound and force data) and the MRI technique to understand the MRI's capability in determining differences in kAT and yAT. Furthermore, we investigated potential correlations between short and long T2* relaxation time, kAT and yAT to determine whether T2* relaxation time may be associated with material or structural properties. Twelve endurance and power athlete, and twelve healthy controls were recruited. AT T2* short and long components were measured using standard gradient echo MRI at rest, while kAT and yAT were evaluated using the classical method (combination of ultrasound and dynamometric measurements). Power athletes had the highest kAT (3064 ± 260, 2714 ± 260 and 2238 ± 189 N/mm for power athletes, endurance athletes and healthy control, respectively) and yAT (2.39 ± 0.28, 1.64 ± 0.22 and 1.97 ± 0.32 GPa for power athletes, endurance athletes and healthy control, respectively) and the lowest T2* short component (0.58 ± 0.07, 0.77 ± 0.06 and 0.74 ± 0.08 ms for power athletes, endurance athletes and healthy control, respectively). Endurance athletes had the highest T2* long component value. No correlations were reported between T2* long component, kAT or yAT in the investigated populations, whereas the T2* short component was negatively correlated with yAT. These results suggest that T2* short component could be used to investigate the differences in AT material properties in different populations. [ABSTRACT FROM AUTHOR]

A buffer solution is often used to maintain tissue hydration during mechanical testing. The most commonly used buffer solution is a physiological concentration of phosphate buffered saline (PBS); however, PBS increases the tissue’s water content and decreases its tensile stiffness. In addition, solutes from the buffer can diffuse into the tissue and interact with its structure and mechanics. These bathing solution effects can confound the outcome and interpretation of mechanical tests. Potential bathing solution artifacts, including solute diffusion, and their effect on mechanical properties, are not well understood. The objective of this study was to measure the effects of long-term exposure of rat tail tendon fascicles to several concentrations (0.9–25%) of NaCl, sucrose, polyethylene glycol (PEG), and SPEG (NaCl + PEG) solutions on water content, solute diffusion, and mechanical properties. We found that with an increase in solute concentration the apparent water content decreased for all solution types. Solutes diffused into the tissue for NaCl and sucrose, however, no solute diffusion was observed for PEG or SPEG. The mechanical properties changed for both NaCl solutions, in particular after long-term (8 h) incubation the modulus and equilibrium stress decreased compared to short-term (15 min) for 25% NaCl, and the cross sectional area increased for 0.9% NaCl. However, the mechanical properties were unchanged for both PEG and SPEG except for minor alterations in stress relaxation parameters. This study shows that NaCl and sucrose buffer solutions are not suitable for long-term mechanical tests. We therefore propose using PEG or SPEG as alternative buffer solutions that after long-term incubation can maintain tissue hydration without solute diffusion and produce a consistent mechanical response. [ABSTRACT FROM AUTHOR]

ABSTRACT The purposes of this case-control study ( N = 20) were to examine the effects of insertional Achilles tendinopathy (IAT) and tendon region on tendon strain in patients with IAT compared to a control group without tendinopathy. An ultrasound transducer was positioned over the Achilles tendon insertion during dorsiflexion tasks, which included standing and partial squat. A non-rigid image registration-based algorithm was used to estimate transverse compressive and axial tensile strains of the tendon from radiofrequency ultrasound images, which was segmented into two regions (superficial tendon and deep). For transverse compressive strain, two-way mixed effects ANOVAs demonstrated that there were interaction effects between group and tendon region for both dorsiflexion tasks (Heel lowering, p = 0.004; Partial squat, p = 0.008). For axial tensile strain, the IAT group demonstrated a main effect of lower tensile strain than the control group (Standing, p = 0.001; Partial squat, p = 0.033). There was also a main effect of greater tensile strain in the superficial region of the tendon compared to the deep during standing ( p = 0.002), but not during partial squat ( p = 0.603). Reduced transverse compressive and axial tensile strains in the IAT group indicate altered mechanical properties specific to the region of IAT pathology. Additionally, patterns of compressive strain are consistent with the theory of calcaneal impingement contributing to IAT pathology. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:910-915, 2017. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the relationship between tendon micro-morphology quantified from a sonogram and tendon mechanical characteristics measured in vivo. Nineteen adults (nine with unilateral Achilles tendinosis) participated. A commercial ultrasound scanner was used to capture longitudinal B-mode ultrasound images from the mid-portion of bilateral Achilles tendons and a custom image analysis program was used to analyze the spatial frequency content of manually defined regions of interest; in particular, the average peak spatial frequency of the regions of interest was acquired. In addition, a dynamometer and a motion analysis system indirectly measured the tendon mechanical (stiffness) and material (elastic modulus) properties. The peak spatial frequency correlated with tendon stiffness (r = 0.74, p = 0.02) and elastic modulus (r = 0.65, p = 0.05) in degenerated tendons, but not healthy tendons. This is the first study relating the mechanical characteristics of degenerated human Achilles tendon using a non-invasive micro-morphology analysis approach. [ABSTRACT FROM AUTHOR]

Abstract Background Intratendinous injections may have important effects on the properties of collagen microarchitecture, morphology, and subsequent mechanical properties of the injected tendon. The purpose of this study was to examine the effects of intratendinous PRP injections; the injectant retention within tendons, the distribution of intratendinous injectant, and whether intratendinous injection or needle fenestration alters tendon morphology or mechanics. Methods Design: Controlled Laboratory Study. Interventions: In the first part of the study, 18 lamb extensor tendons were selected to receive methylene blue‐containing PRP injection (PRP/MB), methylene blue only injection (MB), or needle fenestration. The volume of retained injectant was measured and injectant distribution and tendon morphology were examined microscopically. In the second portion of the study, 18 porcine flexor tendons were divided into control, needle fenestration, or saline injection groups. Young’s Modulus was then determined for each tendon under 0‐4% strain. Main outcome measures: 1) Injectant volume retained; 2) Injectant distribution; 3) Post‐injection/fenestration alterations in morphology, biomechanics. Results Intratendinous injectant is retained within the tendon. The difference between PRP and PRP/MB groups was not significant (p = 0.78). Intratendinous spread of the injectant solution within the tendon occurs primarily in the proximodistal direction, with very little cross‐sectional penetration. Intratendinous injections resulted in microscopic morphology disruption (e.g., separation and disorganization of both the collagen bundles and cellular distribution). There were significant differences in Young’s Modulus between control (Ectrl = 2415.48) and injected tendons (Einj = 1753.45) at 4% strain (p = 0.01). There were no differences in Young’s Modulus between fenestrated and control tendons. Conclusions Intratendinous PRP injections are retained within the tendon, and primarily distributes longitudinally with minimal cross‐sectional spread. Intratendinous injections may alter tendon morphology and mechanics.

ABSTRACT Restoring the native structure of the tendon enthesis, where collagen fibers of the midsubstance are integrated within a fibrocartilaginous structure, is problematic following injury. As current surgical methods fail to restore this region adequately, engineers, biologists, and clinicians are working to understand how this structure forms as a prerequisite to improving repair outcomes. We recently reported on the role of Indian hedgehog (Ihh), a novel enthesis marker, in regulating early postnatal enthesis formation. Here, we investigate how inactivating the Hh pathway in tendon cells affects adult (12-week) murine patellar tendon (PT) enthesis mechanics, fibrocartilage morphology, and collagen fiber organization. We show that ablating Hh signaling resulted in greater than 100% increased failure insertion strain (0.10 v. 0.05 mm/mm, p<0.01) as well as sub-failure biomechanical deficiencies. Although collagen fiber orientation appears overtly normal in the midsubstance, ablating Hh signaling reduces mineralized fibrocartilage by 32%, leading to less collagen embedded within mineralized tissue. Ablating Hh signaling also caused collagen fibers to coalesce at the insertion, which may explain in part the increased strains. These results indicate that Ihh signaling plays a critical role in the mineralization process of fibrocartilaginous entheses and may be a novel therapeutic to promote tendon-to-bone healing. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1142-1151, 2015. [ABSTRACT FROM AUTHOR]

ABSTRACT Changes in tendon viscoelastic properties are observed after injuries and during healing as a product of altered composition and structure. Continuous Shear Wave Elastography is a new technique measuring viscoelastic properties of soft tissues using external shear waves. Tendon has not been studied with this technique, therefore, the aims of this study were to establish the range of shear and viscosity moduli in healthy Achilles tendons, determine bilateral differences of these parameters and explore correlations of viscoelasticity to plantar flexion strength and tendon area. Continuous Shear Wave Elastography was performed over the free portion of both Achilles tendons from 29 subjects. Isometric plantar flexion strength and cross sectional area were measured. The average shear and viscous moduli was 83.2 kPa and 141.0 Pa-s, respectively. No correlations existed between the shear or viscous modulus and area or strength. This indicates that viscoelastic properties can be considered novel, independent biomarkers. The shear and viscosity moduli were bilaterally equivalent ( p = 0.013, 0.017) which allows determining pathologies through side-to-side deviations. The average bilateral coefficient of variation was 7.2% and 9.4% for shear and viscosity modulus, respectively. The viscoelastic properties of the Achilles tendon may provide an unbiased, non-subjective rating system of tendon recovery and optimizing treatment strategies. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:926-931, 2015. [ABSTRACT FROM AUTHOR]

Tendons function to transfer load from muscle to bone through their complex composition and hierarchical structure, consisting mainly of type I collagen. Recent evidence suggests that type II diabetes may cause alterations in collagen structure, such as irregular fibril morphology and density, which could play a role in the mechanical function of tendons. Using the db/db mouse model of type II diabetes, the diabetic skin was found to have impaired biomechanical properties when compared to the non-diabetic group. The purpose of this study was to assess the effect of diabetes on biomechanics, collagen fiber re-alignment, and biochemistry in three functionally different tendons (Achilles, supraspinatus, patellar) using the db/db mouse model. Results showed that cross-sectional area and stiffness, but not modulus, were significantly reduced in all three tendons. However, the tendon response to load (transition strain, collagen fiber re-alignment) occurred earlier in the mechanical test, contrary to expectations. In addition, the patellar tendon had an altered response to diabetes when compared to the other two tendons, with no changes in fiber re-alignment and decreased collagen content at the midsubstance of the tendon. Overall, type II diabetes alters tendon mechanical properties and the dynamic response to load. [ABSTRACT FROM AUTHOR]

Supersonic shear imaging (SSI) is an ultrasound imaging modality that can provide insight into tissue mechanics by measuring shear wave propagation speed, a property that depends on tissue elasticity. SSI has previously been used to characterize the increase in Achilles tendon shear wave speed that occurs with loading, an effect attributable to the strain-stiffening behavior of the tissue. However, little is known about how shear wave speed varies spatially, which is important, given the anatomical variation that occurs between the calcaneus insertion and the gastrocnemius musculotendon junction. The purpose of this study was to investigate spatial variations in shear wave speed along medial and lateral paths of the Achilles tendon for three different ankle postures: resting ankle angle (R, i.e. neutral), plantarflexed (P; R - 15°), and dorsiflexed (D; R+15°). We observed significant spatial and posture variations in tendon shear wave speed in ten healthy young adults. Shear wave speeds in the Achilles free tendon averaged 12 + 1.2 m/s in a resting position, but decreased to 7.2 + 1.8 m/s with passive plantarflexion. Distal tendon shear wave speeds often reached the maximum tracking limit (16.3 m/s) of the system when the ankle was in the passively dorsiflexed posture ( +15° from R). At a fixed posture, shear wave speeds decreased significantly from the free tendon to the gastrocnemius musculotendon junction, with slightly higher speeds measured on the medial side than on the lateral side. Shear wave speeds were only weakly correlated with the thickness and depth of the tendon, suggesting that the distal-to-proximal variations may reflect greater compliance in the aponeurosis relative to the free tendon. The results highlight the importance of considering both limb posture and transducer positioning when using SSI for biomechanical and clinical assessments of the Achilles tendon. [ABSTRACT FROM AUTHOR]

The non-enzymatic reaction of proteins with glucose (glycation) is a topic of rapidly growing importance in human health and medicine. There is increasing evidence that this reaction plays a central role in ageing and disease of connective tissues. Of particular interest are changes in type- I collagens, long-lived proteins that form the mechanical backbone of connective tissues in nearly every human organ. Despite considerable correlative evidence relating extracellular matrix (ECM) glycation to disease, little is known of how ECM modification by glucose impacts matrix mechanics and damage, cell-matrix interactions, and matrix turnover during aging. More daunting is to understand how these factors interact to cumulatively affect local repair of matrix damage, progression of tissue disease, or systemic health and longevity. This focused review will summarize what is currently known regarding collagen glycation as a potential driver of connective tissue disease. We concentrate attention on tendon as an affected connective tissue with large clinical relevance, and as a tissue that can serve as a useful model tissue for investigation into glycation as a potentially critical player in tissue fibrosis related to ageing and diabetes. [ABSTRACT FROM AUTHOR]

The goal of the current study was to investigate the fidelity of a 2D ultrasound elastography method for the measurement of tendon motion and strain. Ultrasound phantoms and ex vivo porcine flexor tendons were cyclically stretched to 4% strain while cine ultrasound radiofrequency (RF) data and video data were simultaneously collected. 2D ultrasound elastography was used to estimate tissue motion and strain from RF data, and surface tissue motion and strain were separately estimated using digital image correlation (DIC). There were strong correlations (R² > 0.97) between DIC and RF measurements of phantom displacement and strain, and good agreement in estimates of peak phantom strain (DIC: 3.5 ± 0.2%; RF: 3.7 ± 0.1%). For tendon, elastographic estimates of displacement profiles also correlated well with DIC measurements (R² > 0.92), and exhibited similar estimated peak tendon strain (DIC: 2.6 ± 1.4%; RF: 2.2 ± 1.3%). Elastographic tracking with B-Mode images tended to under-predict peak strain for both the phantom and tendon. This study demonstrates the capacity to use quantitative elastographic techniques to measure tendon displacement and strain within an ultrasound image window. The approach may be extendible to in vivo use on humans, which would allow for the non-invasive analysis of tendon deformation in both normal and pathological states. [ABSTRACT FROM AUTHOR]

ABSTRACT Tendons have complex mechanical properties that depend on their structure and composition. Some studies have assessed the role of small leucine-rich proteoglycans (SLRPs) in the mechanical response of tendon, but the relationships between sophisticated mechanics, assembly of collagen and SLRPs have not been well characterized. In this study, biglycan gene expression was varied in a dose dependent manner using biglycan null, biglycan heterozygote and wild type mice. Measures of mechanical (tension and compression), compositional and structural changes of the mouse patellar tendon were evaluated. Viscoelastic, tensile dynamic modulus was found to be increased in the biglycan heterozygous and biglycan null tendons compared to wild type. Gene expression analyses revealed biglycan gene expression was closely associated in a dose-dependent allelic manner. No differences were seen between genotypes in elastic or compressive properties or quantitative measures of collagen structure. These results suggest that biglycan, a member of the SLRP family, plays a role in tendon viscoelasticity that cannot be completely explained by its role in collagen fibrillogenesis. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1430-1437, 2013 [ABSTRACT FROM AUTHOR]

Injury and degeneration of tendon, the soft tissue that mechanically links muscle and bone, can cause substantial pain and loss of function. This review discusses the composition and function of healthy tendon and describes the structural, biological, and mechanical changes initiated during the process of tendon healing. Biochemical pathways activated during repair, experimental injury models, and parallels between tendon healing and tendon development are emphasized, and cutting-edge strategies for the enhancement of tendon healing are discussed. [ABSTRACT FROM AUTHOR]

The interactions of small leucine-rich proteoglycans (SLRPs) with collagen fibrils, their association with water, and their role in fibrillogenesis suggests that SLRPs may play an important role in tendon mechanics. Some studies have assessed the role of SLRPs in the mechanical response of the tendon, but the relationships between sophisticated mechanics, assembly of collagen, and SLRPs have not been well characterized. Decorin content was varied in a dose dependent manner using decorin null, decorin heterozygote, and wild type mice. Quantitative measures of mechanical (tension and compression), compositional, and structural changes of the mouse patellar tendon were evaluated. Viscoelastic, tensile dynamic modulus was increased in the decorin heterozygous tendons compared to wild type. These tendons also had a significant decrease in total collagen and no structural changes compared to wild type. Decorin null tendons did not have any mechanical changes; however, a significant decrease in the average fibril diameter was found. No differences were seen between genotypes in elastic or compressive properties, and all tendons demonstrated viscoelastic mechanical dependence on strain rate and frequency. These results suggest that decorin, a member of the SLRP family, plays a role in tendon viscoelasticity that cannot be completely explained by its role in collagen fibrillogenesis. In addition, reductions in decorin do not cause large changes in indentation compressive properties, suggesting that other factors contribute to these properties. Understanding these relationships may ultimately help guide development of tissue engineered constructs or treatment modalities. [ABSTRACT FROM AUTHOR]

This paper aims to highlight the need for a refined tendon model to reproduce the main mechanical features of the integrated muscle-tendon unit (MTU). Elastic nonlinearities of the tendon, both at the nano and microscale, are modeled by a multiscale approach, accounting for the hierarchical arrangement (from molecules up to the fibers) of the collagen structures within the tissue. This model accounts also for the variation of tendon stiffness due to physical activity. Since the proposed tendon model is based on tissue-structured histology, the training-driven adaptation laws are directly formulated starting from histological evidences. Such a tendon description is integrated into a viscoelastic Hill-type model of the whole MTU. A fixed-end contraction test is numerically simulated, and results based on both linear and nonlinear tendon elastic model are compared. Sound and effective time-histories of muscle contractile force and fiber length are obtained only accounting for tendon elastic nonlinearities, which allow to quantitatively recover some experimental data. Finally, proposed numerical results give clear indications toward a rational explanation of the influence of tendon remodeling induced by physical activity on muscular contractile force. [ABSTRACT FROM AUTHOR]

The heterogeneous composition and mechanical properties of the supraspinatus tendon offer an opportunity for studying the structure-function relationships of fibrous musculo-skeletal connective tissues. Previous uniaxial testing has demonstrated a correlation between the collagen fiber angle distribution and tendon mechanics in response to tensile loading both parallel and transverse to the tendon longitudinal axis. However, the planar mechanics of the supraspinatus tendon may be more appropriately characterized through biaxial tensile testing, which avoids the limitation of nonphysiologic traction-free boundary conditions present during uniaxial testing. Combined with a structural constitutive model, biaxial testing can help identify the specific structural mechanisms underlying the tendon's two-dimensional mechanical behavior. Therefore, the objective of this study was to evaluate the contribution of collagen fiber organization to the planar tensile mechanics of the human supraspinatus tendon by fitting biaxial tensile data with a structural constitutive model that incorporates a sample-specific angular distribution of nonlinear fibers. Regional samples were tested under several biaxial boundary conditions while simultaneously measuring the collagen fiber orientations via polarized light imaging. The histograms of fiber angles were fit with a von Mises probability distribution and input into a hyperelastic constitutive model incorporating the contributions of the uncrimped fibers. Samples with a wide fiber angle distribution produced greater transverse stresses than more hjghly aligned samples. The structural model fit the longitudinal stresses well (me-dian R²≥ 0.96) and was validated by successfully predicting the stress response to a mechanical protocol not used for parameter estimation. The transverse stresses were fit less well with greater errors observed for less aligned samples. Sensitivity analyses and relatively affine fiber kinematics suggest that these errors are not due to inaccuracies in measuring the collagen fiber organization. More likely, additional strain energy terms representing tiber-fiber interactions are necessary to provide a closer approximation of the transverse stresses. Nevertheless, this approach demonstrated that the longitudinal tensile mechanics of the supraspinatus tendon are primarily dependent on the moduli, crimp, and angular distribution of its collagen fibers. These results add to the existing knowledge of structure-function relationships in fibrous musculoskeletal tissue, which is valuable for understanding the etiology of degenerative disease, developing effective tissue engineering design strategies, and predicting outcomes of tissue repair. [ABSTRACT FROM AUTHOR]

The incidence of tendon degeneration and rupture increases with advancing age. The mechanisms underlying this increased risk remain unknown but may arise because of age-related changes in tendon mechanical properties and structure. Our purpose was to determine the effect of aging on tendon mechanical properties and collagen fibril morphology. Regional mechanical properties and collagen fibril characteristics were determined along the length of tibialis anterior (TA) tendons from adult (8- to 12-mo-old) and old (28- to 30-mo-old) mice. Tangent modulus of all regions along the tendons increased in old age, but the increase was substantially greater in the proximal region adjacent to the muscle than in the rest of the tendon. Overall end-to-end modulus increased with old age at maximum tendon strain (799 ± 157 vs. 1,419 ± 91 MPa) and at physiologically relevant strain (377 ± 137 vs. 798 ± 104 MPa). Despite the dramatic changes in tendon mechanical properties from adulthood to old age, collagen fibril morphology and packing fraction remained relatively constant in all tendon regions examined. Since tendon properties are influenced by their external loading environment, we also examined the effect of aging on TA muscle contractile properties. Maximum isometric force did not differ between the age groups. We conclude that TA tendons stiffen in a region-dependent manner throughout the life span, but the changes in mechanical properties are not accompanied by corresponding changes in collagen fibril morphology or force-generating capacity of the TA muscle. [ABSTRACT FROM AUTHOR]

A three-dimensional constitutive model for muscle and tendon tissues is developed. Muscle and tendon are considered as composite materials that consist of fibers and the connective tissues and biofluids surrounding the fibers. The model is nonlinear, rate dependent, and anisotropic due to the presence of the fibers. Both the active and passive behaviors of the muscle are considered. The muscle fiber stress depends on the strain (length), strain-rate (velocity), and the activation level of the muscle, whereas the tendon fiber exhibits only passive behavior and the stress depends only on the strain. Multiple fiber directions are modeled via superposition. A methodology for the numerical implementation of the constitutive model in a general-purpose finite element program is developed. The current scheme is used for either static or dynamic analyses. The model is validated by studying the extension of a squid tentade during a strike to catch prey. The behavior of parallel-fibered and pennate muscles, as well as the human semitendinosus muscie, is studied. [ABSTRACT FROM AUTHOR]

Abstract: Chronic tendinopathy of the human Achilles tendon (AT) is common but its injury mechanism is not fully understood. It has been hypothesised that heat energy losses from the AT during running could explain the degeneration of AT material seen with injury. A mathematical model of AT temperature distribution was used to predict what temperatures the core of the AT could reach during running. This model required input values for mechanical properties of the AT (stiffness, hysteresis, cross-sectional area (CSA), strain during running) which were determined using a combination of ultrasound imaging, kinematic and kinetic data. AT length data were obtained during hopping and treadmill running (12kmph) using ultrasound images of the medial gastrocnemius (50Hz) and kinematic data (200Hz). AT force data were calculated from inverse dynamics during hopping and combined with AT length data to compute AT stiffness and hysteresis. AT strain was computed from AT length data during treadmill running. AT CSA was measured on transverse ultrasound scans of the AT. Mean±sd tendon properties were: stiffness=176±41Nmm−1, hysteresis=17±12%, strain during running=3.5±1.8% and CSA=42±8mm2. These values were input into the model of AT core temperature and this was predicted to reach at least 41°C during running. Such temperatures were deemed to be conservative estimates but still sufficient for tendon hyperthermia to be a potential cause of tendon injury. [Copyright &y& Elsevier]

Abstract: Biceps tendon pathology is a common clinical problem often seen in conjunction with rotator cuff tears. A previous study found detrimental changes to biceps tendons in the presence of rotator cuff tears in a rat model. Therefore, the objective of this study was to utilize this model along with models of altered loading to investigate the effect of altered loading on the initiation of these detrimental changes. We created supraspinatus and infraspinatus rotator cuff tears in the rat and followed these tears with either increased or decreased loading. Mechanical properties were determined along the length of the biceps tendon 4 and 8 weeks following injury. At the insertion site, stiffness increased with decreased loading, while detrimental changes were seen with increased loading 4 weeks following detachments. Increased loading resulted in decreased mechanical properties along the entire tendon length at both time points. Decreased loading resulted in both increased and decreased tendon properties at different regions of the tendon at 4 weeks, but by 8 weeks, there were no differences between decreased loading and detachment alone. We could not conclude where changes begin in the tendon with altered loading, but did demonstrate that regional differences exist. These results support that there is an effect of altered loading, as decreased loading resulted in variable changes at 4 weeks that were no different from detachment alone by 8 weeks, and increased loading resulted in detrimental properties along the entire length at both 4 and 8 weeks. [Copyright &y& Elsevier]

The mechanical properties of the frog semitendinosus (ST) tendon and aponeurosis were measured during passive tensile loading to a force equal to ST maximum tetanic tension and during active isometric muscle contraction. During active contraction, both the tendon and aponeurosis regions initially strained at rates exceeding 400%/s while near the end of the muscle contraction, strain rates were nearly zero. At this point, the strain in the tendon region was equal to that observed during slow passive loading to the same tension level. However, for the aponeurosis, even near the zero strain rate, strain at the end of the active contraction was significantly below that observed during slow passive loading (p < 0.001). Specifically, when aponeurosis strain rate was almost zero, aponeurosis strain was 13.8 ± 3% (means ± SEM, n = 10), which was significantly below that measured during passive loading (23.7 ± 5%) suggesting that active contraction actually altered aponeurosis material properties. These data demonstrate that, while the tendon and aponeurosis regions have different passive biomechanical properties and both demonstrate viscosity typical of other connective tissues, the aponeurosis region of the frog ST actually changed its intrinsic properties during muscle contraction. Thus, extrapolation of biomechanical data obtained at nonphysiological strain rates or under conditions where the muscle-tendon junction has been interrupted should be made with caution.Copyright © 2000 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Patellar tendinopathy is a common overuse injury in sports such as volleyball, basketball, and long-distance running. Microdamage accumulation, in response to repetitive loading of the tendon, plays an important role in the pathophysiology of patellar tendinopathy. This damage presents mechanically as a reduction in Young's modulus and an increase in residual strain. In this study, 19 human patellar tendon samples underwent cyclic testing in load control until failure, segmented by four ramped tests where digital image correlation (DIC) was used to assess anterior surface strain distributions. Ramped tests were performed prior to cyclic testing and at timepoints corresponding to 10%, 20%, and 30% of cyclic stiffness reduction. Young's modulus significantly decreased and cyclic energy dissipation significantly increased over the course of cyclic testing. The DIC analysis illustrated a heterogeneous strain distribution, with strain concentrations increasing in magnitude and size over the course of cyclic testing. Peak stress and initial peak strain magnitudes significantly correlated with the number of cycles to failure (r2 = 0.65 and r2 = 0.57, respectively, p < 0.001); however, the rates of peak cyclic strain and modulus loss displayed the highest correlations with the number of cycles to failure (r2 = 96% and r2 = 86%, respectively, p < 0.001). The high correlation between the rates of peak cyclic strain and modulus loss suggest that non-invasive methods to continuously monitor tendon strain may provide meaningful predictions of overuse injury in the patellar tendon. [ABSTRACT FROM AUTHOR]

Despite many in vitro mechanical experiments of tendon being conducted at room temperature, few assessments have been made to determine how the structural response of tendon to mechanical overload may vary with ambient temperature. We explored whether damage to the collagen nanostructure of tendon resulting from tensile rupture varies with temperature. Use of bovine tail tendons in combination with NaBH 4 crosslink stabilization treatment allowed us to probe the mechanisms underlying the observed changes. Untreated tendons and NaBH 4 -stabilized tendons were pulled to rupture at temperatures of 24, 37, and 55 °C. Of nine mechanical parameters measured from the resulting stress-strain curves, only yield stress differed between the tendons tested at 37 and 24 °C. When tested at 55 °C, untreated tendons showed large reductions in ultimate strength and toughness, while NaBH 4 -stabilized tendons showed smaller reductions. Differential scanning calorimetry was used to assess damage to the collagen fibril nanostructure of tendons resulting from rupture, with samples from the ruptured tendons compared to samples from the same tendons removed prior to loading. While there was indication that overload-induced molecular packing disruption to collagen fibrils may be heightened at 37 °C, statistical increases in damage compared to that occurring at 24 °C were only seen when testing was conducted at 55 °C. The results show that the temperature sensitivity of tendon to ramp loading depends on crosslinking within the tissue. In poorly crosslinked tissues, collagen may be more susceptible to mechanical damage when tested at physiologic temperature compared to room temperature. For tendons with a high density of thermally stable crosslinks, such as the human Achilles or patellar tendons, testing at room temperature should produce comparable results to testing at physiologic temperature. [ABSTRACT FROM AUTHOR]