A non-invasive method of tendon force measurement

The ability to measure the forces exerted in vivo on tendons and, consequently, the forces produced by muscles on tendons, offers a unique opportunity to investigate questions in disciplines as varied as physiology, biomechanics, orthopaedics and neuroscience. Until now, tendon loads could be assessed directly only by means of invasive sensors implanted within or attached to these collagenous structures. This study shows that the forces acting on tendons can be measured, in a non-invasive way, from the analysis of the propagation of an acoustic wave. Using the equine superficial digital flexor tendon as a model, it is demonstrated that the velocity of an ultrasonic wave propagating along the main axis of a tendon increases with the force applied to this tendon. Furthermore, we show that this velocity measurement can be performed even in the presence of skin overlying the tendon. To validate this measurement technique in vivo, the ultrasonic velocity plots obtained in the Achilles tendon at the walk were compared to the loads plots reported by other authors using invasive transducers.     

In vivo tendon force measurement of 2-week duration in sheep

Tendon tension in vivo may be determined indirectly by measuring intratendinous pressure, by using a buckle transducer or by measuring the tendon strain. All of these methods require appropriate calibration, which is highly dependent on various variables. To measure the tendon load in vivo during a period of 2 weeks in sheep, a measurement technique has been developed using a force sensor interposed serially between the humeral head and the tendon end. Within a supporting frame, a flexion-sensitive force transducer is subjected to three-point bending stress. The load is transmitted by sutures from the tendon end through a hole in the sensor frame, orthogonal to the force transducer. In this configuration, the sensor measures the tensile force acting on the tendon, largely independent of the loading direction. The sensor was screwed to the humeral head and connected to the tendon end which was previously released from its insertion site along with a bone chip, using sutures. Connecting wires passed subcutaneously to a skin outlet about 30 cm away from the transducer. The sensor output was linear to the measured load up to 300 N, with maximum hysteresis of 18% full scale. All sensors worked in vivo without drift over a period of up to 14 days with no change in the calibration data. Forces up to 310 N have been recorded in vivo with daily tension measurements. This study shows that serial tendon tension measurement is feasible and allows for reliable, repeatable recording of the absolute tendon tension at the expense of tendon integrity.     

Influence of tendon tears on ultrasound echo intensity in response to loading

Acoustoelastic (AE) ultrasound image analysis is a promising non-invasive approach that uses load-dependent echo intensity changes to characterize stiffness of tendinous tissue. The purpose of this study was to investigate whether AE can detect localized changes in tendon stiffness due to partial and full-thickness tendon tears. Ovine infraspinatus tendons with different levels of damage (Intact, 33%, 66% and full thickness cuts initiated on the articular and bursal sides) were cyclically loaded in a mechanical testing system while cine ultrasound images were recorded. The load-induced changes in echo intensity on the bursal and articular side of the tendon were determined. Consistent with AE theory, the undamaged tendons exhibited an increase in echo intensity with tendon loading, reflecting the strain-stiffening behavior of the tissue. In the intact condition, the articular region demonstrated a significantly greater increase in echo intensity during loading than the bursal region. Cuts initiated on the bursal side resulted in a progressive decrease in echo intensity of the adjacent tissue, likely reflecting the reduced load transmission through that region. However, image intensity information was less sensitive for identifying load transmission changes that result from partial thickness cuts initiated on the articular side. We conclude that AE approaches may be useful to quantitatively assess load-dependent changes in tendon stiffness, and that disruption of AE behavior may be indicative of substantial tendon damage.     

Influence of forearm orientation on biceps brachii tendon mechanics and elbow flexor force steadiness

Achilles tendon mechanics influence plantar flexion force steadiness (FS) and balance. In the upper limb, elbow flexor FS is greater in supinated and neutral forearm orientations compared to pronated, with contributions of tendon mechanics remaining unknown in position-dependent FS. This study investigated whether distal biceps brachii (BB) tendon mechanics across supinated, neutral and pronated forearm orientations influence position-dependent FS of the elbow flexors. Eleven males (23 ± 3 years) performed submaximal isometric elbow flexion tasks at low (5, 10% maximal voluntary contraction (MVC)) and high (25, 50, 75% MVC) force levels in supinated, neutral and pronated forearm orientations. Distal BB tendon elongation and CSA were recorded on ultrasound to calculate mechanics of tendon stress, strain and stiffness. Relationships between FS, calculated as coefficient of variation (CV) of force, and tendon mechanics were evaluated with multiple regressions. Supinated and neutral were ∼50% stronger and ∼60% steadier than pronated (p < 0.05). Tendon stress was ∼52% greater in supinated and neutral compared to pronated, tendon strain was ∼36% greater in neutral than pronated (p < 0.05), while tendon stiffness (267.4 ± 78.9 N/mm) did not differ across orientations (p > 0.05). At low forces, CV of force was predicted by MVC (r²: 0.52) in supinated, and MVC and stress in neutral and pronated (r²: 0.65–0.81). At high force levels, CV of force was predicted by MVC and stress in supinated (r²: 0.49), and MVC in neutral (r²: 0.53). Absolute strength and tendon mechanics influence the ability of the BB tendon to distribute forces, and thus are key factors in position-dependent FS.     

Influence of sensor size on the accuracy of in-vivo ligament and tendon force measurements.

In-vivo tendon forces are commonly measured using transducers, which detect tension in the tendon fibers. A poorly understood source of measurement errors is the difference in stress distribution within the tendon between experimental and transducer calibration conditions. The objective of this study was to investigate this source of error, and to determine whether these errors could be minimized by proper selection of transducer size. The study was conducted using the infrapatellar ligament (patellar tendon) of New Zealand White rabbits. Tendon force was measured with two different size implantable force transducers (IFTs), one Wide and one Narrow, and by a strain gaged load cell in series with the tendon. Tests were conducted at five different loading conditions selected to produce five different stress distributions within the tendon. One loading condition corresponded to a typical post-experiment calibration, and the data from that condition were used to develop a calibration equation for the transducer. The errors that resulted from using this calibration were determined by comparing the tendon force measured by the in-series load cell with the force predicted from the IFT output using the calibration equation. Changes in stress distribution produced measurement errors up to 64 N with the Narrow IFT but only 24 N with the Wide IFT. We found the measurement error was dependent on sensor width. Our results support the hypothesis that measurement errors can be caused by differences in tendon stress distribution between calibration and experimental conditions. We further showed that these errors can be minimized by using an IFT, which samples the tension in a large percentage of the tendon fibers. Information from this study can be used for selection of an appropriately sized implantable force transducer for measuring tendon and ligament force.     

Influence of infection rate and migration on extinction of disease in spatial epidemics

Extinction of disease can be explained by the patterns of epidemic spreading, yet the underlying causes of extinction are far from being well understood. To reveal a mechanism of disease extinction, a cellular automata model with both birth, death rate and migration is presented. We find that, in single patch, when the infection rate is small or large enough, the disease will disappear for a long time. When the invasion form is in the coexistence of stable spiral and turbulent wave state, the disease will persist. Also, we find that the migration has dual effects on the epidemic spreading. On one hand, in the extinction region of single patch, if the migration rate is large enough, there is a phase transition from the disease free to endemic state in two patches. On the other hand, migration will induce extinction in the regime, which can ensure the persistence of the disease in single patch, due to emergence of anti-phase synchrony. The results obtained well reveal the effect of infection rate and migration on the extinction of the disease, which enriches the finding in the filed of epidemiology and may provide some new ideas to control the disease in the real world.     

Influence of Achilles tendon vibration on the vertical posture during standing with asymmetrical leg loading

The shift of the common center of pressure (CCP) and the center of pressure (CP) of one leg was studied during the Achilles tendon vibration of one or both legs while the subject was standing with symmetrical load on the legs or with the load transferred to one leg. The CP shift of the standing subject during unilateral Achilles tendon vibration depended on both the side of application of vibration and on the distribution of the leg load. During standing with a asymmetrical load on the legs, the shift of the CCP was larger than when the vibration was applied to the loaded leg. The CP shift of one leg was greater if both vibration and the load were applied to it. Vibration of the unloaded leg caused a CP shift in the loaded contralateral leg. In this case, vibration of the left unloaded leg did not cause any noticeable CP shift of the left leg, while vibration of the unloaded right leg caused a CP shift of the right leg. Under the similar conditions of loading and vibration, the displacement of the CP of the right leg was larger than the displacement of the CP of the left leg. It may be suggested that postural asymmetry and unilateral vibration of the leg muscles change the internal representation of the position of the body axis in relation to the vertical, which affects the displacement of the CP of one leg in response to afferent stimulation of the leg muscles.     

Influence of ground reaction force perturbations on anterior cruciate ligament loading during sidestep cutting

Anterior cruciate ligament (ACL) injury risk is likely increased under unexpected loading conditions. Such situations may arise from mid-air contact with another athlete, or misjudgments in landing height, stride length or surface compliance resulting in an unbalanced landing and unexpected changes in the ground reaction forces (GRFs). The purpose this study was to identify how GRF perturbations influence ACL loading during sidestep cutting. Muscle-actuated simulations of sidestep cutting were generated and analyzed for 20 subjects. Perturbations of 20, 40 and 60% of the nominal value were applied to the posterior, vertical, and medial GRF. Open-loop, forward dynamics simulations were run with no feedback or correction mechanism which allowed deviations from the experimentally measured kinematics as a result of the GRF perturbations. Posterior and vertical GRF perturbations significantly increased ACL loading, although the change was more pronounced with posterior perturbations. These changes were primarily due to the sagittal plane component of ACL loading regardless of perturbation direction. Peak ACL loading occurred almost immediately after initial ground contact, and was thus predicated on initial joint configuration. The results of this study give merit to including knee flexion angle at initial ground contact in the evolving neuromuscular training modalities aimed at preventing non-contact ACL injury.     

Ex vivo mechanical loading of tendon

Injuries to the tendon (e.g., wrist tendonitis, epicondyltis) due to overuse are common in sports activities and the workplace. Most are associated with repetitive, high force hand activities. The mechanisms of cellular and structural damage due to cyclical loading are not well known. The purpose of this video is to present a new system that can simultaneously load four tendons in tissue culture. The video describes the methods of sterile tissue harvest and how the tendons are loaded onto a clamping system that is subsequently immersed into media and maintained at 37 degrees C. One clamp is fixed while the other one is moved with a linear actuator. Tendon tensile force is monitored with a load cell in series with the mobile clamp. The actuators are controlled with a LabView program. The four tendons can be repetitively loaded with different patterns of loading, repetition rate, rate of loading, and duration. Loading can continue for a few minutes to 48 hours. At the end of loading, the tendons are removed and the mid-substance extracted for biochemical analyses. This system allows for the investigation of the effects of loading patterns on gene expression and structural changes in tendon. Ultimately, mechanisms of injury due to overuse can be studies with the findings applied to treatment and prevention.     

Effects of tendon and muscle belly dissection on muscular force transmission following tendon transfer in the rat

The aim of the present study was to quantify to what extent the scar tissue formation following the transfer of flexor carpi ulnaris (FCU) to the distal tendon of extensor carpi radialis (ECR) affects the force transmission from transferred FCU in the rat. Five weeks after recovery from surgery (tendon transfer group) and in a control group, isometric length-force characteristics of FCU were assessed for progressive stages of dissection: (i) with minimally disrupted connective tissues, (ii) after full dissection of FCU distal tendon exclusively, and (iii) after additional partial dissection of FCU muscle belly. Total and passive length-force characteristics of transferred and control FCU changed significantly by progressive stages of dissection. In both groups, tendon dissection decreased passive FCU force exerted at the distal tendon, as well as the slope of the length-force curve. However, force and slope changes were more pronounced for transferred FCU compared to controls. No additional changes occurred after muscle belly dissection. In contrast, total force increased in transferred FCU following both tendon and muscle belly dissection at all lengths studied, while dissection decreased total force of control FCU. In addition, after tendon and muscle belly dissection, we found decreased muscle belly lengths at equal muscle-tendon complex lengths of transferred FCU. We conclude that scar tissue limits the force transmission from transferred FCU muscle via the tendon of insertion to the skeleton, but that some myofascial connectivity of the muscle should be classified as physiological.     

Mechanisms of force generation and force transmission during interstitial leukocyte migration

For innate and adaptive immune responses it is essential that inflammatory cells use quick and flexible locomotion strategies. Accordingly, most leukocytes can efficiently infiltrate and traverse almost every physiological or artificial environment. Here, we review how leukocytes might achieve this task mechanistically, and summarize recent findings on the principles of cytoskeletal force generation and transduction at the leading edge of leukocytes. We propose a model in which the cells switch between adhesion‐receptor‐mediated force transmission and locomotion modes that are based on cellular deformations, but independent of adhesion receptors. This plasticity in migration strategies allows leukocytes to adapt to the geometry and molecular composition of their environment.     

Estimation of low back loading on nurses during patient handling tasks: the importance of bedside reaction force measurement

By means of video recording, measurement of ground reaction forces, and biomechanical modeling of the lower part of the body, the low back loading of nurses during patient handling can be estimated. In this study the force exerted on the bedside by a nurse during different patient handling tasks was measured, and the contribution to the moment at the L4/L5 joint was investigated. It is shown that the bedside reaction moment contributes significantly to the total moment, and could lead to substantial over-estimation if not appropriately included in the calculations, when using an upward biomechanical model for estimating the spinal load of nurses during patient handling tasks.     

Habitual loading results in tendon hypertrophy and increased stiffness of the human patellar tendon.

The purpose of this study was to examine patellar tendon (PT) size and mechanical properties in subjects with a side-to-side strength difference of >/=15% due to sport-induced loading. Seven elite fencers and badminton players were included. Cross-sectional area (CSA) of the PT obtained from MRI and ultrasonography-based measurement of tibial and patellar movement together with PT force during isometric contractions were used to estimate mechanical properties of the PT bilaterally. We found that distal tendon and PT, but not mid-tendon, CSA were greater on the lead extremity compared with the nonlead extremity (distal: 139 +/- 11 vs. 116 +/- 7 mm(2); mid-tendon: 85 +/- 5 vs. 77 +/- 3 mm(2); proximal: 106 +/- 7 vs. 83 +/- 4 mm(2); P < 0.05). Distal tendon CSA was greater than proximal and mid-tendon CSA on both the lead and nonlead extremity (P < 0.05). For a given common force, stress was lower on the lead extremity (52.9 +/- 4.8 MPa) compared with the nonlead extremity (66.0 +/- 8.0 MPa; P < 0.05). PT stiffness was also higher in the lead extremity (4,766 +/- 716 N/mm) compared with the nonlead extremity (3,494 +/- 446 N/mm) (P < 0.05), whereas the modulus did not differ (lead 2.27 +/- 0.27 GPa vs. nonlead 2.16 +/- 0.28 GPa) at a common force. These data show that a habitual loading is associated with a significant increase in PT size and mechanical properties.     

Influence of the direction of the cable force and of the radius of the hammer path on speed fluctuations during hammer throwing

Hammer speed increases gradually during a throw, but this general increasing trend has one fluctuation superimposed in each turn. In some throwers, gravity and the forward translation of the system produce most of the fluctuation; in others, a marked fluctuation remains after the effects of gravity and of the forward translation of the system have been subtracted out. The remaining fluctuation could be produced through two mechanisms: (a) pulling on the hammer cable in a direction alternately ahead and behind the position of the centroid of the hammer path and (b) alternately shortening and lengthening the distance between the hammer head and the centroid of its path. Three-dimensional film analysis of eight highly-skilled throwers showed that the portion of the hammer speed fluctuation not due to gravity nor to the forward motion is produced mainly by pulling alternately ahead and behind the position of the centroid of the hammer path.     

Effects of repeated Achilles tendon vibration on triceps surae force production

Many studies reported benefits of whole-body vibration (WBV) on muscle force production. Therefore, WBV may be an important technique for muscle re-education. However vibrating platforms are heavy tools that cannot be easily used by all patients. Thus, we propose to apply vibrations directly to the Achilles tendon at rest with a portable vibrator. We investigated whether 14 days of such a vibration program would enhance triceps surae force production in healthy subjects. If successful, such a protocol could be utilized to prevent deleterious effects of hypo-activity. Twenty-nine healthy students participated in this study. The electrical evoked twitch and maximal voluntary contraction (MVC) in plantar-flexion, and electromyograms (EMG) were quantified before and at the end of the program. The vibration program consisted of 14 days of daily vibration applied at rest (duration: 1 h; frequency: 50 Hz). After the program, there was an increase in MVC associated with greater EMG of the TS. No sign of hypertrophy were found on the twitch parameters and the EMG–torque relationships. Repeated vibrations of the Achilles tendon lead to an increase in plantar-flexor activation and thus to greater force developed in voluntary conditions whilst the contractile properties assessed by the twitch are not modified. This program could be beneficial to persons with hypo-activity who are not candidates for WBV.