Tendon Length Changes Research Articles

Influence of loading rate and limb position on patellar tendon mechanical properties in vivo

BackgroundThe aims of this study were to clarify the changes of patellar tendon length during isometric knee joint extension and the double leg squat position using ultrasonography. MethodsThe left legs of 17 healthy adults were investigated. Isometric knee extension motion was performed at three positions of knee flexion 30° (knee 30°), knee flexion 60° (knee 60°), knee flexion 90° (knee 90°), and at each limb position, 0% (0% peak torque (PT)), 40% (40% PT), 50% (50% PT), and 60% (60% PT) of the maximum knee joint extension torque were executed at random. Both double leg squat motions were randomly performed in three positions: hip flexion 30°, knee flexion 30°, ankle dorsiflexion 10° (squat 30°); hip joint flexion 60°, knee joint flexion 60°, ankle dorsiflexion 20° (squat 60°); and hip joint flexion 90°, knee joint flexion 90°, ankle dorsiflexion 30° (squat 90°). Ultrasonography was used to measure patellar tendon length. FindingsThere were no significant changes in patellar tendon length and strain between knee flexion angles of 30°, 60°, and 90° in isometric knee joint extension and the double leg squat limb position. InterpretationThe loading rate and limb position do not appear to affect the length and strain of the patellar tendon.

Patellar tendon shortening following patellofemoral joint replacement.

Patellar tendon shortening may occur following patellofemoral joint replacement (PFJR). We hypothesized that patellar tendon shortening results in unfavourable patient-reported outcomes (PROs). The aim of this study was to determine the effect of patellar tendon shortening following PFJR on PROs. In this substudy of a prospective cohort study, a total of 108 patients with isolated patellofemoral osteoarthritis underwent 124 patellofemoral joint replacements. We measured both patellar tendon length and length of the patella on pre-operative radiographs, and on radiographs acquired at eight weeks and at one year post-operative. More than 10% decrease in patellar tendon length relative to the pre-operative patellar tendon length was defined as patellar tendon shortening. Clinical outcomes were assessed using the knee-specific KOOS questionnaire (Knee Injury and Osteoarthritis Outcome Score). Repeated measures ANOVA was used to analyze for differences in change from baseline KOOS subscales between patients with and patients without patellar tendon shortening. A complete series of standardized pre-operative, eight weeks and one year post-operative radiographs was available for 87 knees in 82 patients. At eightweeks, 16 of 87 knees (18%) showed patellar tendon length shortening, and 27 of 87 knees (31%) at one year. We found no statistically significant relation between patellar tendon length shortening and change from baseline KOOS subscales at one year follow-up (pain p = 0.29, symptoms p = 0.56, ADL p = 0.23, sport or recreation p = 0.22, knee-related quality of life (QOL) p = 0.15). Patellar tendon length shortening following PFJR occurs in 31% of knees at one year, and does not result in inferior PROs.

Changes in Achilles tendon stiffness and energy cost following a prolonged run in trained distance runners.

During prolonged running, the magnitude of Achilles tendon (AT) length change may increase, resulting in increased tendon strain energy return with each step. AT elongation might also affect the magnitude of triceps surae (TS) muscle shortening and shortening velocity, requiring greater activation and increased muscle energy cost. Therefore, we aimed to quantify the tendon strain energy return and muscle energy cost necessary to allow energy storage to occur prior to and following prolonged running. 14 trained male (n = 10) and female (n = 4) distance runners (24±4 years, 1.72±0.09 m, 61±10 kg, 64.6±5.8 ml•kg-1•min-1) ran 90 minutes (RUN) at approximately 85% of lactate threshold speed (sLT). Prior to and following RUN, AT stiffness and running energy cost (Erun) at 85% sLT were determined. AT energy return was calculated from AT stiffness, measured with dynamometry and ultrasound and estimated TS force during stance. TS energy cost was estimated on the basis of AT force and assumed crossbridge mechanics and energetics. Following RUN, AT stiffness was reduced from 328±172 N•mm-1 to 299±148 N•mm-1 (p = 0.022). Erun increased from 4.56±0.32 J•kg-1•m-1 to 4.62±0.32 J•kg-1•m-1 (p = 0.049). Estimated AT energy return was not different following RUN (p = 0.99). Estimated TS muscle energy cost increased significantly by 11.8±12.3 J•stride-1, (p = 0.0034), accounting for much of the post-RUN increase in Erun (8.6±14.5 J•stride-1,r2 = 0.31). These results demonstrate that a prolonged, submaximal run can reduce AT stiffness and increase Erun in trained runners, and that the elevated TS energy cost contributes substantially to the elevated Erun.

Ultrasound estimates of Achilles tendon exhibit unexpected shortening during ankle plantarflexion

The purpose of this study was to investigate Achilles tendon (AT) length changes during a series of tasks that involved combinations of higher/lower force, and larger/smaller length changes of the medial gastrocnemius muscle-tendon unit (MTU). We sought to determine if common ultrasound-based estimates of AT length change were consistent with expectations for a passive elastic tendon acting in series with a muscle. We tested 8 healthy individuals during restricted joint calf contractions (high force, low displacement), ankle dorsi-/plantar-flexion (DF/PF) with the foot in the air (low force, high displacement), and heel raises (high force, high displacement). We experimentally estimated AT length change using two ultrasound methods, one based on muscle-tendon junction (MTJ) tracking and one based on muscle fascicle (MF) tracking. Estimates of AT length change were consistent with model expectations during restricted calf contractions, when the MTU underwent minimal length change. However, estimates of AT length changes were inconsistent with model expectations during the ankle DF/PF and heel raise tasks. Specifically, the AT was estimated to shorten substantially, often 10–20 mm, when the ankle plantarflexed beyond neutral position, despite loading conditions in which a passive, stiff spring would be expected to either lengthen (under increasing force) or maintain its length (under low force). These unexpected findings suggest the need for improvements in how we conceptually model and/or experimentally estimate MTU dynamics in vivo during motion analysis studies, particularly when the ankle plantarflexes beyond neutral.

Mid-term development of hamstring tendon length and velocity after distal femoral extension osteotomy in children with bilateral cerebral palsy: a retrospective cohort study.

Flexed knee gait can be treated with distal femoral extension osteotomy (DFEO) and additional patellar tendon advancement (PTA) in children with cerebral palsy (CP). This study assesses changes in hamstring muscle tendon length (MTL) and velocity after DFEO (+PTA). Nineteen children (mean age 13y [standard deviation 3y] at surgery) with CP and flexed knee gait who were treated with DFEO (15 limbs) or DFEO+PTA (10 limbs) were retrospectively included in this study. Gait analyses were performed preoperatively (E0), 1 year postoperatively (E1), and for 10 limbs additionally 2 to 5 years postoperatively (E2). Hamstring MTL and velocities were assessed at all examination dates using OpenSim. Hamstring MTL and velocity did not change significantly over time. From E0 to E1, knee flexion in stance improved for both DFEO and DFEO+PTA (p<0.05), knee flexion in swing only improved after DFEO+PTA (p<0.05). The improved knee flexion in stance and swing was maintained at E2. DFEO led to a significant improvement in knee kinematics at E1 which was maintained at E2. DFEO seems to prevent recurrent hamstring tightness but does not lead to lengthened or fastened hamstrings. Distal femoral extension osteotomy (DFEO) does not change hamstring muscle tendon length. DFEO does not change hamstring lengthening velocity. DFEO leads to a significant improvement in knee kinematics. Changes in knee kinematics after DFEO can be maintained at mid-term. DFEO seems to prevent recurrent hamstring tightness.

The role of the patellar tendon angle and patellar flexion angle in the interpretation of sagittal plane kinematics of the knee after knee arthroplasty: A modelling analysis

BackgroundMany different measures have been used to describe knee kinematics. This study investigated the changes of two measures, the patellar tendon angle and the patellar flexion angle, in response to variations in the geometry of the knee due to surgical technique or implant design. MethodsA mathematical model was developed to calculate the equilibrium position of the extensor mechanism for a particular tibiofemoral position. Calculating the position of the extensor mechanism allowed for the determination of the patellar tendon angle and patellar flexion angle relationships to the knee flexion angle. The model was used to investigate the effect of anterior–posterior position of the femur, change in joint line, patellar thickness (overstuffing, understuffing), and patellar tendon length; these parameters were varied to determine the effect on the patellar tendon angle/knee flexion angle and patellar flexion angle/knee flexion angle relationships. ResultsThe patellar tendon angle was a good indicator of anterior–posterior femoral position and change in patellar thickness, and the patellar flexion angle a good indicator of change in joint line, and patellar tendon length. ConclusionsThe patellar tendon angle/knee flexion angle relationship was found to be an effective means of identifying abnormal kinematics post-knee arthroplasty. However, the use of both the patellar tendon angle and patellar flexion angle together provided a more informative overview of the sagittal plane kinematics of the knee.

Altered Achilles tendon function during walking in people with diabetic neuropathy: implications for metabolic energy saving.

The Achilles tendon (AT) has the capacity to store and release elastic energy during walking, contributing to metabolic energy savings. In diabetes patients, it is hypothesized that a stiffer Achilles tendon may reduce the capacity for energy saving through this mechanism, thereby contributing to an increased metabolic cost of walking (CoW). The aim of this study was to investigate the effects of diabetes and diabetic peripheral neuropathy (DPN) on the Achilles tendon and plantarflexor muscle-tendon unit behavior during walking. Twenty-three nondiabetic controls (Ctrl); 20 diabetic patients without peripheral neuropathy (DM), and 13 patients with moderate/severe DPN underwent gait analysis using a motion analysis system, force plates, and ultrasound measurements of the gastrocnemius muscle, using a muscle model to determine Achilles tendon and muscle-tendon length changes. During walking, the DM and particularly the DPN group displayed significantly less Achilles tendon elongation (Ctrl: 1.81; DM: 1.66; and DPN: 1.54 cm), higher tendon stiffness (Ctrl: 210; DM: 231; and DPN: 240 N/mm), and higher tendon hysteresis (Ctrl: 18; DM: 21; and DPN: 24%) compared with controls. The muscle fascicles of the gastrocnemius underwent very small length changes in all groups during walking (~0.43 cm), with the smallest length changes in the DPN group. Achilles tendon forces were significantly lower in the diabetes groups compared with controls (Ctrl: 2666; DM: 2609; and DPN: 2150 N). The results strongly point toward the reduced energy saving capacity of the Achilles tendon during walking in diabetes patients as an important factor contributing to the increased metabolic CoW in these patients. NEW & NOTEWORTHY From measurements taken during walking we observed that the Achilles tendon in people with diabetes and particularly people with diabetic peripheral neuropathy was stiffer, was less elongated, and was subject to lower forces compared with controls without diabetes. These altered properties of the Achilles tendon in people with diabetes reduce the tendon's energy saving capacity and contribute toward the higher metabolic energy cost of walking in these patients.

Changes in patellar tendon length during passive knee flexion in the menstrual cycle

Changes in patellar tendon length during passive knee flexion in the menstrual cycle

Passive elongation of muscle fascicles in human muscles with short and long tendons.

This study tested the hypothesis that the ratio of changes in muscle fascicle and tendon length that occurs with joint movement scales linearly with the ratio of the slack lengths of the muscle fascicles and tendons. We compared the contribution of muscle fascicles to passive muscle‐tendon lengthening in muscles with relatively short and long fascicles. Fifteen healthy adults participated in the study. The medial gastrocnemius, tibialis anterior, and brachialis muscle‐tendon units were passively lengthened by slowly rotating the ankle or elbow. Change in muscle fascicle length was measured with ultrasonography. Change in muscle‐tendon length was calculated from estimated muscle moment arms. Change in tendon length was calculated by subtracting change in fascicle length from change in muscle‐tendon length. The median (IQR) contribution of muscle fascicles to passive lengthening of the muscle‐tendon unit, measured as the ratio of the change in fascicle length to the change in muscle‐tendon unit length, was 0.39 (0.26–0.48) for the medial gastrocnemius, 0.51 (0.29–0.60) for tibialis anterior, and 0.65 (0.49–0.90) for brachialis. Brachialis muscle fascicles contributed to muscle‐tendon unit lengthening significantly more than medial gastrocnemius muscle fascicles, but less than would be expected if the fascicle contribution scaled linearly with the ratio of muscle fascicle and tendon slack lengths.

Fat pad excision in total knee arthroplasty does not affect functional outcome or anterior knee pain at 1 year follow-up

BackgroundIn total knee arthroplasty (TKA), excision of infra patellar fat pad (IPFP) is usually done to enhance exposure. But effects of this are not clearly understood. A few studies indicate that it may lead to increased incidence of anterior knee pain (AKP). This study was undertaken to determine the effect of excision of IPFP on incidence of AKP (as indicated by Hospital for Special Surgery (HSS) patella score), Knee society score (KSS) and functional score, change in Patellar Tendon length (as measured by Insall-Salvati ratio (ISR)) and, Range of motion (ROM). Methods135 patients (151 knees) operated by two senior arthroplasty surgeons in the period of January 2014 to December 2015 were followed-up for minimum of 1year. Group 1 consisted of 106 knees in which complete excision of fat pad was done and group 2 consisted of 45 knees in which fat pad was retained. ResultsThere was no significant difference in HSS patella score of two groups during the follow-up of 1 year. KSS and functional score was significantly better for IPFP retention group at 6 week follow-up, but in later follow-ups till 1 year, the difference was not significant. The mean change in patellar tendon length for patients with the fat pad removed (ISR=−0.022) and those with it retained (−0.011) was significantly different (p=0.026). Average range of flexion in both the groups at 1 year follow-up was beyond 110 degrees. There was a significant difference in range of flexion at 1 year of follow-up (117.07 degrees in group 1 versus 118.44 degrees in group 2, p=0.04). There were no fracture or avascular necrosis of patella in either group. ConclusionAKP and functional outcome is not significantly affected by excision of IPFP. Fat pad can be sacrificed if exposure is compromised.

Influence of prosthetic joint line position on outcome after total knee replacement

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The current study had been designed so as to assess whether joint line elevation and change in patellar tendon length influences knee flexion after primary cruciate retaining TKR.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective study involved patients with advanced degenerative joint disease involving one or both knees who presented to the outpatient department of a tertiary care hospital. Exclusion criteria were any prior knee surgery. Surgery was performed under tourniquet with standard medial para-patellar arthrotomy to expose all our knees. In the study radiological assessment was done by true lateral X-ray view of knee in 30 degree of flexion. We choose Caton-Deschamps indices (CI) for diagnosis of post TKR patella infera and joint line elevation. CI&amp;lt;0.6 was defined as patella infera (normal range of CI 0.60-1.45). After all data collection comparison was done between joint line elevation versus without joint line elevation patients (with/without patellar tendon shortening) range of movement.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total of 100 patients (72 females and 28 males) with 176 knees (bilateral=76, unilateral=24) who fulfilled the above said criteria involved in study. The mean age of the patients at the time of surgery was 64.4 years with range of 54 years to 80 years. The average follow up of 24 months, with minimum follow up of 18 months. Average range of motion (ROM) in NO Joint line elevation/patella tendon shortening patient measured 107.2&lt;sup&gt;°&lt;/sup&gt;, and joint line elevation with patellar tendon shortening (prior patella infera) and joint line elevation without patella tendon shortening(prior patella infera) patient average ROM was measured 86.7 and 87.8 degree respectively.&lt;/p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In our study patellar tendon shortening and joint line elevation reduces ROM knee. Mechanical factors also explain the association between joint line elevation and patellar tendon length with range of motion. Reduction in length of extensor apparatus reduces the range of flexion.

MRI observations of patellar tendon length change after ACL reconstruction with hamstring autografts.

The post-operative patellar tendon length was studied to evaluate the possible tendon length change after anterior cruciate ligament (ACL) reconstruction with hamstring autografts. The Insall-Salvati index, modified Insall-Salvati index, curved modified Insall-Salvati index and Caton-Deschamps index were observed by MRI during a follow-up period of 12 weeks on 20 ACL reconstructed knees. The results showed no patellar baja or alta pre-existed on those ACL injured patients. After a follow-up period of 12 weeks, no patellar tendon length change was observed. It is suggested that the change of patella was not the primary reason that may contribute to the premature patellofemoral joint osteoarthritis after ACL reconstruction.

Changes in three-dimensional muscle structure of rabbit gastrocnemius, flexor digitorum longus, and tibialis anterior during growth

Muscular contraction dynamics depends on active and passive muscle properties (e.g., the force-velocity relation) as well as on the three-dimensional (3D) muscle structure (e.g., the muscle fascicle architecture and aponeurosis dimensions). Much is known about active muscle force generation and the muscle architecture at a particular age (mostly for adult specimens), but less is known about changes in muscle structure during growth. The present study analyzed growth-related changes in the muscle structure of rabbit gastrocnemius lateralis (GL), gastrocnemius medialis (GM), flexor digitorum longus (FDL), and tibialis anterior (TA). Changes in tendon length, muscle belly dimensions (length, width, thickness), as well as aponeurosis length, width, and area were determined using 55 rabbits between 18 and 108 days old. Additionally, the 3D muscle fascicle architecture of five rabbits of different ages (21, 37, 50, 70, 100 days) was determined using a manual digitizer.We found an almost linear increase over time in most of the geometrical parameters observed. GL and GM showed very similar growth characteristics. In contrast to the pronounced increase in muscle belly length of GL and GM, FDL and TA exhibited more uniform muscle belly growth in length, width, and thickness. In general, the aponeuroses of the muscles exhibited lower growth rates in width than in length, and aponeurosis areas were larger than physiological cross-sectional areas. There were almost no changes in fascicle lengths with increasing age for GL, GM, and FDL. In contrast, there was a clear increase in TA fascicle length from about 20 to over 40mm. Pennation angles of TA (11.0 ± 2.1°) and FDL (16.7 ± 3.2°) remained almost unchanged but increased for GL from 13.4 ± 3.3° to 24.3 ± 6.5° from the youngest to the oldest animal. For all muscles observed, the tendon-muscle fascicle length ratio (rTFL) changed during growth. GL and GM exhibited similar increases in rTFL from about 4–8. FDL showed the highest ratio, which increased from about 8–13, whereas TA had the lowest ratio, which decreased slightly from 2 to 1.5.The outcomes demonstrate new findings regarding changes in 3D muscle architecture and aponeurosis shape during growth, and they provide information for muscle force generation, functional relevance, and adaptation with respect to animal age. Therefore, the results help to improve understanding of muscle growth processes and can be used as input data for muscle growth modeling.

Relationship between joint torque and muscle fascicle shortening at various joint angles and intensities in the plantar flexors

Because it is difficult to measure tendon length changes directly in humans, tendon length changes during dynamic movement have been evaluated indirectly from changes in muscle fascicle length and joint angle. The purpose of this study was to examine the validity of the indirect method. Twitch contractions of the ankle plantar flexors were evoked isometrically in eight subjects. Twitch contractions evoked by singlet, doublet, and triplet stimulations were conducted at dorsiflexion 20° (DF20), plantar flexion 0° (PF0), and plantar flexion 20° (PF20). Muscle fascicle length and pennation angle were recorded by ultrasonography. The magnitude of muscle fascicle shortening was significantly smaller in DF20 than in PF0 and PF20, although the magnitude of joint torque was significantly larger in DF20 than in PF0 and PF20. Theoretically, the magnitude of tendon elongation is expected to be larger in larger joint torque conditions. However, we found that the magnitude of tendon elongation evaluated from muscle fascicle shortening was larger in a lower joint torque condition (PF20). These results suggest that the magnitude of muscle fascicle shortening does not necessarily represent tendon elongation. The larger muscle fascicle shortening in PF20 may be partly caused by eliminating slack of the muscle-tendon complex.

Influence of Preoperative Musculotendinous Junction Position on Rotator Cuff Healing After Double-Row Repair

The primary purpose of this study was to determine the effect of the preoperative position of the musculotendinous junction (MTJ) on rotator cuff healing after double-row arthroscopic rotator cuff repair. A secondary purpose was to evaluate how tendon length and MTJ position change when the rotator cuff heals. Preoperative and postoperative magnetic resonance imaging (MRI) scans of 42 patients undergoing arthroscopic double-row rotator cuff repair were reviewed. Patients undergoing repairs with other constructs or receiving augmented repairs (platelet-rich fibrin matrix) who had postoperative MRI scans were excluded. Preoperative MRI scans were evaluated for anteroposterior tear size, tendon retraction, tendon length, muscle quality, and MTJ position with respect to the glenoid in the coronal plane. The position of the MTJ was referenced off the glenoid face as either lateral or medial. Postoperative MRI scans were evaluated for healing, tendon length, and MTJ position. Of 42 tears, 36 (86%) healed, with 27 of 31 small to medium tears (87%) and 9 of 11 large to massive tears (82%) healing. Healing occurred in 94% of tears that had a preoperative MTJ lateral to the face of the glenoid but only 56% of tears that had a preoperative MTJ medial to the glenoid face (P= .0135). The measured tendon length increased an average of 14.4mm in patients whose tears healed compared with shortening by 6.4mm in patients with tears that did not heal (P < .001). The MTJ lateralized an average of 6.1mm in patients whose tears healed compared with medializing 1.9mm in patients whose tears did not heal (P= .026). The overall follow-up period of the study was from April 2005 to September 2014 (113months). The preoperative MTJ position is predictive of postoperative healing after double-row rotator cuff repair. The position of theMTJ with respect to the glenoid face is a reliable, identifiable marker on MRI scans that can be predictive of healing. Level IV, retrospective review of case series; therapeutic study.

Stretch training induces unequal adaptation in muscle fascicles and thickness in medial and lateral gastrocnemii.

This study compared adaptations in fascicle lengths, pennation angles, and muscle thickness of the lateral and medial gastrocnemii in response to 6weeks of stretch training. The nondominant plantar flexors of 11 males were stretched five times per week for 6weeks and compared with the contralateral leg and a nonstretched control group of 10 males. During stretch training, instantaneous electromyography was utilized to ensure passive muscle stretch. At baseline, week three, week six and 1week after the conclusion of stretch training, ultrasound was used to measure fascicle lengths, pennation angles, muscle thickness of the lateral gastrocnemius and medial gastrocnemius, and Achilles tendon thickness and length. Plantar flexion torque was measured, and voluntary activation was assessed. Muscle thickness increased 5.6% after 6weeks of stretch training (P=.009). The fascicles in the lateral gastrocnemius lengthened to a greater extent than the medial. Overall, fascicles lengthened 25% (P<.001) in the muscle tendon junction and 5.1% (P<.001) in the muscle belly. Pennation angles were unchanged in the medial gastrocnemius but decreased in the lateral gastrocnemius 7.1% (P=.02). There was no change in maximal voluntary contraction, voluntary activation, tendon length, or thickness. This study demonstrates that stretch training is a viable modality to alter muscle architecture of the human gastrocnemius through lengthening of muscle fascicles, decreasing pennation angles, and increasing muscle thickness, albeit adaptations are unequal between the lateral and medial heads.

Frontal Tendon Lengthening Plasty for Treatment of Structural Patella Baja

Patella baja is a severe complication seen after trauma, prolonged immobilization and surgery. Several surgical methods have been described to proximalize the patella without a change in the patella tendon length. Yet, patella tendon shortening and thickening can be regarded as the hallmark pathology. As such, we describe a technique for the lengthening of the patellar tendon to pathoconformly address underlying patella baja. The technique is reproducible and gives the possibility of an early postoperative mobilization to prevent re-baja—a typical complication after patella baja surgery.

Robot-Assisted Rehabilitation of Ankle Plantar Flexors Spasticity: A 3-Month Study with Proprioceptive Neuromuscular Facilitation.

In this paper, we aim to investigate the effect of proprioceptive neuromuscular facilitation (PNF)-based rehabilitation for ankle plantar flexors spasticity by using a Robotic Ankle–foot Rehabilitation System (RARS). A modified robot-assisted system was proposed, and seven poststroke patients with hemiplegic spastic ankles participated in a 3-month robotic PNF training. Their impaired sides were used as the experimental group, while their unimpaired sides as the control group. A robotic intervention for the experimental group started from a 2-min passive stretching to warming-up or relaxing the soleus and gastrocnemius muscles and also ended with the same one. Then a PNF training session including 30 trials was activated between them. The rehabilitation trainings were carried out three times a week as an addition to their regular rehabilitation exercise. Passive range of motion, resistance torque, and stiffness were measured in both ankles before and after the interventions. The changes in Achilles tendon length, walking speed, and lower limb function were also evaluated by the same physician or physiotherapist for each participant. Biomechanical measurements before interventions showed significant difference between the experimental group and the control group due to ankle spasticity. For the control group, there was no significant difference in the 3 months with no robotic intervention. But for the experimental group, passive dorsiflexion range of motion increased (p < 0.01), resistance torque under different dorsiflexion angle levels (0°, 10°, and 20°) decreased (p < 0.05, p < 0.001, and p < 0.001, respectively), and quasi-static stiffness under different dorsiflexion angle levels (0°, 10°, and 20°) also decreased (p < 0.01, p < 0.001, and p < 0.001, respectively). Achilles’s tendon length shortened (p < 0.01), while its thickness showed no significant change (p > 0.05). The robotic rehabilitation also improved the muscle strength (p < 0.01) and muscle control performance (p < 0.001). In addition, improvements were observed in clinical and functional measurements, such as Timed Up-and-Go (p < 0.05), normal walking speed (p > 0.05), and fast walking speed (p < 0.05). These results indicated that the PNF-based robotic intervention could significantly alleviate lower limb spasticity and improve the motor function in chronic stroke participant. The robotic system could potentially be used as an effective tool in poststroke rehabilitation training.

Influence of sagittal plane malpositioning of the patella on anterior knee pain after tibia intramedullary nailing.

Anterior knee pain (AKP) is one of the most common complications after tibia intramedullary surgery. We evaluated changes in patellar tendon length after tibia intramedullary nailing surgery using a transtendinous approach and assessed the importance of nail position in relation to the anterior tibial cortex and joint line. Two surgeons blinded to patients' pain status measured both the knee Insall-Salvati and Caton-Deschamps indexes on 30° flexion lateral knee X-rays of 33 patients. Superior nail prominence (the distance from the proximal tip of the nail to the tibial plateau) and anterior nail prominence (the distance from the anterior tip of the nail to the anterior tibial cortex) were measured on the CT. Clinical assessment showed that 10 patients (30%) had AKP at the last follow-up. HSS and Lysholm scores and the incidence of AKP were similar between patients whose IM nails were removed and those who still had them. HSS score, Insall-Salvati, and Caton-Deschamps indexes were significantly lower in the operated extremity than in the healthy limb at last follow-up. No association was demonstrated between AKP and nail position in relation to the anterior tibial cortex or tibial plateau. According to our study, although the patellar tendon shortened significantly on the affected side compared with the contralateral side, these measurements did not correlate with the presence or absence of pain. AKP and functional knee scores after tibia IM nailing using a transtendinous approach were not associated with nail position in relation to the anterior tibial cortex or tibial plateau. Level 3 (Case control study).

Medial gastrocnemius muscle-tendon interaction and architecture change during exhaustive hopping exercise

Background: Previous literature has shown in vivo changes in muscle-tendon interaction during exhaustive stretch-shortening cycle (SSC) exercise. It is unclear whether these changes in muscle-tendon length during exhaustive SSC exercise are associated with changes in mechanical efficiency (ME). The purpose of the study was to investigate whether changes in platarflexor contractile component (CC) length, tendon length, and changes in plantarflexor muscle activity could explain reduction in ME during exhaustive SSC exercise. Methods: Eight males participated in an exhaustive hopping task to fatigue. Mechanical work and energy expenditure were calculated at different time-points during the hopping task. Furthermore, hopping kinetics and kinematics, medial gastrocnemius (MG) muscle activity, and in vivo ultrasound of the MG were also collected at different time-points throughout the hopping task. Results: ME did not change during the hopping protocol despite shorter tendon and longer CC lengths as subjects approached exhaustion. Percent decreases in pennation angle and muscle thickness were most strongly correlated to time to exhaustion (r=0.94, p⩽0.05; r=0.87, p⩽0.05; respectively). Percent changes in CC length change and pennation angle were strongly correlated to percent decrease in maximal voluntary isometric plantarflexion (MVIP) force (r=−0.71, p⩽0.04; r=0.70, p⩽0.05; respectively). Braking/push-off EMG ratio increased from initial pre-fatigue values to all other time points showing neuromuscular adaptations to altered muscle lengths. Conclusion: Findings from the current study suggest that changes in CC and tendon lengths occur during repetitive hopping to exhaustion, with the amount change strongly related to time to exhaustion. ME of hopping remained unchanged in the presence of altered CC and tendon lengths.