Medial gastrocnemius muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic cerebral palsy

Individuals with spastic cerebral palsy (CP) typically experience muscle weakness. The mechanisms responsible for muscle weakness in spastic CP are complex and may be influenced by the intrinsic mechanical properties of the muscle and tendon. The purpose of this study was to investigate the medial gastrocnemius (MG) muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic CP. Nine relatively high functioning young adults with spastic CP (GMFCS I, 17±2 years) and 10 typically developing individuals (18±2 years) participated in the study. Active MG torque-length and Achilles tendon properties were assessed under controlled conditions on a dynamometer. EMG was recorded from leg muscles and ultrasound was used to measure MG fascicle length and Achilles tendon length during maximal isometric contractions at five ankle angles throughout the available range of motion and during passive rotations imposed by the dynamometer. Compared to the typically developing group, the spastic CP group had 33% lower active ankle plantarflexion torque across the available range of ankle joint motion, partially explained by 37% smaller MG muscle and 4% greater antagonistic co-contraction. The Achilles tendon slack length was also 10% longer in the spastic CP group. This study confirms young adults with mild spastic CP have altered muscle–tendon mechanical properties. The adaptation of a longer Achilles tendon may facilitate a greater storage and recovery of elastic energy and partially compensate for decreased force and work production by the small muscles of the triceps surae during activities such as locomotion.     

Validity of resting myotonometric assessment of lower extremity muscles in chronic stroke patients with limited hypertonia: A preliminary study

The aim of this preliminary study was to examine the validity of a recently-introduced tool (MyotonPRO) for the assessment of mechanical parameters of the main lower extremity muscles in patients with chronic stroke. Thigh and shank muscles of 20 stroke patients with limited hypertonia (11 men and 9 women; mean age: 52 ± 11 yrs) and 20 healthy controls (11 men and 9 women; mean age: 53 ± 10 yrs) were bilaterally evaluated with (i) MyotonPRO for muscle stiffness, tone and elasticity, (ii) ultrasonography for muscle and subcutaneous thickness, and (iii) dynamometry for isometric muscle strength. MyotonPRO parameters of stroke patients were reassessed a week later (inter-day test-retest design). For all the investigated muscles, MyotonPRO variables did not differ between the more affected and the less affected side of patients (P > 0.05 for main side effect), and neither differed between patients and controls (P > 0.05 for main group effect), except for gastrocnemius medialis stiffness that was higher in patients (300 ± 51 N/m) than in controls (281 ± 29 N/m; P < 0.05). Thigh muscle stiffness was negatively correlated to subcutaneous thickness (r = −0.84 for the vastus lateralis; P < 0.001), while only tibialis anterior stiffness and tone correlated positively with muscle thickness (both r = 0.46; P < 0.01). Test-retest reliability of MyotonPRO parameters was adequate, except for muscle elasticity. The validity of MyotonPRO for the evaluation of thigh muscles in chronic stroke patients is partially challenged by the poor discriminant ability and by the considerable impact of subcutaneous tissue thickness (sex-dependent) on mechanical parameters. The potential validity of MyotonPRO for the assessment of shank muscles requires further investigation.     

Quantification of the forearm muscles mechanical properties using Myotonometer: Intra- and Inter-Examiner reliability and its relation with hand grip strength

The primary objective of this study was to investigate the reliability of the myotonometer in the mechanical properties of the forearm muscles [m. extensor carpi radialis brevis (ECRB), and m. flexor carpi ulnaris (FCU)] in healthy individuals. The secondary objective was to investigate the relationship between the handgrip strength and mechanical properties of these forearm muscles. The mechanical properties (muscle tone, stiffness, and elasticity) of the ECRB and FCU were measured using the MyotonPRO device. Examiner 1 performed two sets of measurements with a time interval of 30 min to determine intra-examiner reliability. Examiner 2 performed measurements during the interval between the two sets of examiner 1. The intra- and inter-examiner reliabilities were excellent (ICC˃0.82) for muscle tone, stiffness, and elasticity of the FCU. Both intra- and inter-examiner reliability in the evaluation of ECRB muscle tone, elasticity, and stiffness was moderate to excellent (ICCs = 0.56–0.98). The muscle tone and stiffness properties of the FCU were positively correlated with the handgrip strength (p <.05). The study findings indicate that the MyotonPRO device is a reliable tool to quantify ECRB, and FCU muscles mechanical properties in healthy individuals.     

Effect of muscle contraction levels on the force-length relationship of the human Achilles tendon during lengthening of the triceps surae muscle-tendon unit

Findings from animal experiments are sometimes contradictory to the idea that the tendon structure is a simple elastic spring in series with muscle fibers, and suggest influence of muscle contraction on the tendon mechanical properties. The purpose of the present study was to investigate the influence of muscle contraction levels on the force-length relationship of the human Achilles tendon during lengthening of the triceps surae muscle-tendon unit. For seven subjects, ankle dorsiflexion was performed without (passive condition) and with contraction of plantar flexor muscles (eccentric conditions, at 3 contraction levels) on an isokinetic dynamometer. Deformation of the Achilles tendon during each trial was measured using ultrasonography. The Achilles tendon force corresponding to the tendon elongation of 10mm in the passive condition was significantly smaller than those in the eccentric conditions (p<0.05 or p<0.01). Within the eccentric conditions, the Achilles tendon force corresponding to the tendon elongation of 10mm was significantly greater in the maximal contraction level than those in submaximal eccentric conditions (p<0.05 or p<0.01). In addition, the tendon stiffness was greater in higher contraction levels (p<0.05 or p<0.01). Present results suggest that the human tendon structure is not a simple elastic spring in series with muscle fibers.     

Changes of calf muscle-tendon biomechanical properties induced by passive-stretching and active-movement training in children with cerebral palsy

Biomechanical properties of calf muscles and Achilles tendon may be altered considerably in children with cerebral palsy (CP), contributing to childhood disability. It is unclear how muscle fascicles and tendon respond to rehabilitation and contribute to improvement of ankle-joint properties. Biomechanical properties of the calf muscle fascicles of both gastrocnemius medialis (GM) and soleus (SOL), including the fascicle length and pennation angle in seven children with CP, were evaluated using ultrasonography combined with biomechanical measurements before and after a 6-wk treatment of passive-stretching and active-movement training. The passive force contributions from the GM and SOL muscles were separated using flexed and extended knee positions, and fascicular stiffness was calculated based on the fascicular force-length relation. Biomechanical properties of the Achilles tendon, including resting length, cross-sectional area, and stiffness, were also evaluated. The 6-wk training induced elongation of muscle fascicles (SOL: 8%, P = 0.018; GM: 3%, P = 0.018), reduced pennation angle (SOL: 10%, P = 0.028; GM: 5%, P = 0.028), reduced fascicular stiffness (SOL: 17%, P = 0.128; GM: 21%, P = 0.018), decreased tendon length (6%, P = 0.018), increased Achilles tendon stiffness (32%, P = 0.018), and increased Young's modulus (20%, P = 0.018). In vivo characterizations of calf muscles and Achilles tendon mechanical properties help us better understand treatment-induced changes of calf muscle-tendon and facilitate development of more effective treatments.     

A 3D model of the Achilles tendon to determine the mechanisms underlying nonuniform tendon displacements

The Achilles is the thickest tendon in the body and is the primary elastic energy-storing component during running. The form and function of the human Achilles is complex: twisted structure, intratendinous interactions, and differential motor control from the triceps surae muscles make Achilles behavior difficult to intuit. Recent in vivo imaging of the Achilles has revealed nonuniform displacement patterns that are not fully understood and may result from complex architecture and musculotendon interactions. In order to understand which features of the Achilles tendon give rise to the nonuniform deformations observed in vivo, we used computational modeling to predict the mechanical contributions from different features of the tendon. The aims of this study are to: (i) build a novel computational model of the Achilles tendon based on ultrashort echo time MRI, (ii) compare simulated displacements with published in vivo ultrasound measures of displacement, and (iii) use the model to elucidate the effects of tendon twisting, intratendon sliding, retrocalcaneal insertion, and differential muscle forces on tendon deformation. Intratendon sliding and differential muscle forces were found to be the largest factors contributing to displacement nonuniformity between tendon regions. Elimination of intratendon sliding or muscle forces reduced displacement nonuniformity by 96% and 85%, respectively, while elimination of tendon twist and the retrocalcaneal insertion reduced displacement nonuniformity by only 35% and 3%. These results suggest that changes in the complex internal structure of the tendon alter the interaction between muscle forces and tendon behavior and therefore may have important implications on muscle function during movement.     

Elastic properties of human Achilles tendon are correlated to muscle strength.

The purpose of this study was to investigate whether the mechanical properties of the Achilles tendon were correlated to muscle strength in the triceps surae in humans. Twenty-four men and twelve women exerted maximal voluntary isometric plantar flexion (MVIP) torque. The elongation (DeltaX) and strain of the Achilles tendon (epsilon), the proximal part of which is the composite of the gastrocnemius tendon and the soleus aponeurosis, at MVIP were determined from the displacement of the distal myotendinous junction of the medial gastrocnemius using ultrasonography. The Achilles tendon force at MVIP (F) was calculated from the MVIP torque and the Achilles tendon moment arm. There were no significant differences in either the F-DeltaX or F-epsilon relationships between men and women. DeltaX and epsilon were 9.8 +/- 2.6 mm and 5.3 +/- 1.6%, respectively, and were positively correlated to F (r = 0.39, P < 0.05; r = 0.39, P < 0.05), which meant that subjects with greater muscle strength could store more elastic energy in the tendon. The regression y-intercepts for the F-DeltaX (P < 0.01) and F-epsilon (P < 0.05) relationship were significantly positive. These results might indicate that the Achilles tendon was stiffer in subjects with greater muscle strength, which may play a role in reducing the probability of tendon strain injuries. It was suggested that the Achilles tendon of subjects with greater muscle strength did not impair the potential for storing elastic energy in tendons and may be able to deliver the greater force supplied from a stronger muscle more efficiently. Furthermore, the difference in the Achilles tendon mechanical properties between men and women seemed to be correlated to the difference in muscle strength rather than gender.     

Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison

Quadriceps tendon with a patellar bone block may be a viable alternative to Achilles tendon for anterior cruciate ligament reconstruction (ACL-R) if it is, at a minimum, a biomechanically equivalent graft. The objective of this study was to directly compare the biomechanical properties of quadriceps tendon and Achilles tendon allografts. Quadriceps and Achilles tendon pairs from nine research-consented donors were tested. All specimens were processed to reduce bioburden and terminally sterilized by gamma irradiation. Specimens were subjected to a three phase uniaxial tension test performed in a custom environmental chamber to maintain the specimens at a physiologic temperature (37 ± 2 °C) and misted with a 0.9 % NaCl solution. There were no statistical differences in seven of eight structural and mechanical between the two tendon types. Quadriceps tendons exhibited a significantly higher displacement at maximum load and significantly lower stiffness than Achilles tendons. The results of this study indicated a biomechanical equivalence of aseptically processed, terminally sterilized quadriceps tendon grafts with bone block to Achilles tendon grafts with bone block. The significantly higher displacement at maximum load, and lower stiffness observed for quadriceps tendons may be related to the failure mode. Achilles tendons had a higher bone avulsion rate than quadriceps tendons (86 % compared to 12 %, respectively). This was likely due to observed differences in bone block density between the two tendon types. This research supports the use of quadriceps tendon allografts in lieu of Achilles tendon allografts for ACL-R.     

Fiber architecture of the extensors of the hindlimb in semiterrestrial and arboreal guenons

Fiber architecture of the extensor musculature of the knee and ankle is examined in two African guenon species—the semiterrestrial Cercopithecus aethiops, and the arboreal C. ascanius. Using histologic and microscopic techniques to measure lengths of sarcomeres, the original lengths of muscle fasciculi and angles of pinnation in quadriceps femoris and triceps surae are reconstructed from direct measurements on cadavers. Calculations of reduced physiological cross-sectional area, mass/predicted effective tetanic tension, maximum excursion, and tendon length/fasciculus + tendon lengths are correlated to preferred locomotor modalities in the wild. For both species, greater morphological differences occur among the bellies of quadriceps femoris—rectus femoris, vastus intermedius, v. lateralis, and v. medialis—than among the bellies of triceps surae—gastrocnemius lateralis, g. medialis, plantaris, and soleus. With regard to quadriceps femoris, few differences occur between species. Interspecific differences in the triceps surae indicate (1) redirection of muscle force to accommodate arboreality in which the substrate is less than body width; (2) muscles more suited for velocity in the semiterrestrial vervets; and (3) muscles used more isotonically in vervets and more isometrically in red-tailed monkeys. The inherent flexibility of muscle may be preadaptive to a primary species shift in locomotor modality until the bony morphology is able to adapt through natural selection. © 1996 Wiley-Liss, Inc.     

Measuring Achilles tendon mechanical properties: a reliable, noninvasive method

The purpose of this technical report is to describe a cost-effective and highly reliable methodology to measure mechanical and material properties of the Achilles tendon. Subjects are positioned on an isokinetic dynamometer time synchronized to a diagnostic ultrasound device. A tendon fascicle distal to the soleus is visualized during a ramped isometric maximal plantarflexion contraction. Excursion of the fascicle and tendon torque output yield a force-elongation curve in which mechanical characteristics and material properties are derived. Excellent intrasession and intersession reliabilities were observed for both the dynamometer (intraclass correlation coefficient [ICC] 0.99, 0.95) and excursion (ICC 0.99, 0.93) measures. Practical applications for this methodology include examination of training regimes for optimal tendon adaptation and rehabilitation in the presence of tendinopathy.     

Muscle material properties in passive and active stroke-impaired muscle

Stroke survivors routinely experience long-term motor and sensory impairments. In parallel with neurological changes, material properties of muscles in the impaired limbs, such as muscle stiffness, may also change progressively. However, these stiffness measures are routinely derived from individual joint stiffness, representing whole muscle groups. Here, we use shear wave (SW) ultrasound elastography to measure SW velocity, as a surrogate measure of stiffness, to quantify material properties in individual muscles. Accordingly, the purpose of this study was to compare muscle material properties of the bicep brachii in stroke survivors and in age-matched control subjects by measuring SW velocity at rest and different voluntary activation levels. Our main findings show that at rest, the SW velocity was on average 41% greater in the paretic muscle compared the contralateral non-paretic muscle. The mean passive SW velocity across all subjects were 2.34 ± 0.41 m/s for the non-paretic side, 3.30 ± 1.20 m/s for the paretic side, and 2.24 ± 0.18 for controls. SW velocity was significantly different in muscles of the paretic and non-paretic side (p < 0.001), but not between muscles of the non-paretic and controls (p = 0.47). As voluntary activation increased, SW velocity increased non-linearly, with an average power fit of r² = 0.83 ± 0.09 for the non-paretic side, r² = 0.61 ± 0.24 for the paretic side, and r² = 0.24 ± 0.15 for the healthy age-matched controls. In active muscle (10, 25, 50, 75, 100% maximum voluntary contraction), there was no significant difference in SW velocity between the non-paretic, paretic, and control muscles.These findings suggest that stroke-impaired muscles have potentially altered muscle material properties, specifically stiffness, and that passive and active stiffness may contribute differently to total muscle stiffness.     

Mechanisms of improved knee flexion after rectus femoris transfer surgery

Rectus femoris transfer is frequently performed to treat stiff-knee gait in subjects with cerebral palsy. In this surgery, the distal tendon is released from the patella and re-attached to one of several sites, such as the sartorius or the iliotibial band. Surgical outcomes vary, and the mechanisms by which the surgery improves knee motion are unclear. The purpose of this study was to clarify the mechanism by which the transferred muscle improves knee flexion by examining three types of transfers. Muscle-actuated dynamic simulations were created of ten children diagnosed with cerebral palsy and stiff-knee gait. These simulations were altered to represent surgical transfers of the rectus femoris to the sartorius and the iliotibial band. Rectus femoris transfers in which the muscle remained attached to the underlying vasti through scar tissue were also simulated by reducing but not eliminating the muscle's knee extension moment. Simulated transfer to the sartorius, which converted the rectus femoris’ knee extension moment to a flexion moment, produced 32±8° improvement in peak knee flexion on average. Simulated transfer to the iliotibial band, which completely eliminated the muscle's knee extension moment, predicted only slightly less improvement in peak knee flexion (28±8°). Scarred transfer simulations, which reduced the muscle's knee extension moment, predicted significantly less (p<0.001) improvement in peak knee flexion (14±5°). Simulations revealed that improved knee flexion following rectus femoris transfer is achieved primarily by reduction of the muscle's knee extension moment. Reduction of scarring of the rectus femoris to underlying muscles has the potential to enhance knee flexion.     

Plasticity of human Achilles tendon mechanical and morphological properties in response to cyclic strain

The purpose of the current study in combination with our previous published data (Arampatzis et al., 2007) was to examine the effects of a controlled modulation of strain magnitude and strain frequency applied to the Achilles tendon on the plasticity of tendon mechanical and morphological properties. Eleven male adults (23.9±2.2 yr) participated in the study. The participants exercised one leg at low magnitude tendon strain (2.97±0.47%), and the other leg at high tendon strain magnitude (4.72±1.08%) of similar frequency (0.5 Hz, 1 s loading, 1 s relaxation) and exercise volume (integral of the plantar flexion moment over time) for 14 weeks, 4 days per week, 5 sets per session. The exercise volume was similar to the intervention of our earlier study (0.17 Hz frequency; 3 s loading, 3 s relaxation) allowing a direct comparison of the results. Before and after the intervention ankle joint moment has been measured by a dynamometer, tendon–aponeurosis elongation by ultrasound and cross-sectional area of the Achilles tendon by magnet resonance images (MRI). We found a decrease in strain at a given tendon force, an increase in tendon–aponeurosis stiffness and tendon elastic modulus of the Achilles tendon only in the leg exercised at high strain magnitude. The cross-sectional area (CSA) of the Achilles tendon did not show any statistically significant (P>0.05) differences to the pre-exercise values in both legs. The results indicate a superior improvement in tendon properties (stiffness, elastic modulus and CSA) at the low frequency (0.17 Hz) compared to the high strain frequency (0.5 Hz) protocol. These findings provide evidence that the strain magnitude applied to the Achilles tendon should exceed the value, which occurs during habitual activities to trigger adaptational effects and that higher tendon strain duration per contraction leads to superior tendon adaptational responses.     

Unloaded rat Achilles tendons continue to grow, but lose viscoelasticity.

Tendons can function as springs and thereby preserve energy during cyclic loading. They might also have damping properties, which, hypothetically, could reduce risk of microinjuries due to fatigue at sites of local stress concentration within the tendon. At mechanical testing, damping will appear as hysteresis. How is damping influenced by training or disuse? Does training decrease hysteresis, thereby making the tendon a better spring, or increase hysteresis and thus improve damping? Seventy-eight female 10-wk-old Sprague-Dawley rats were randomized to three groups. Two groups had botulinum toxin injected into the calf muscles to unload the left Achilles tendon through muscle paralysis. One of these groups was given doxycycline, as a systemic matrix metalloproteinase inhibitor. The third group served as loaded controls. The Achilles tendons were harvested after 1 or 6 wk for biomechanical testing. An increase with time was seen in tendon dry weight, wet weight, water content, transverse area, length, stiffness, force at failure, and energy uptake in all three groups (P < 0.001 for each parameter). Disuse had no effect on these parameters. Creep was decreased with time in all groups. The only significant effect of disuse was on hysteresis (P = 0.004) and creep (P = 0.007), which both decreased with disuse compared with control, and on modulus, which was increased (P = 0.008). Normalized glycosaminoglycan content was unaffected by time and disuse. No effect of doxycycline was observed. The results suggest that in growing animals, the tendons continue to grow regardless of mechanical loading history, whereas maintenance of damping properties requires mechanical stimulation.     

Biarticular hip extensor and knee flexor muscle moment arms of the feline hindlimb

Moment arms are important for understanding muscular behavior and for calculating internal muscle forces in musculoskeletal simulations. Biarticular muscles cross two joints and have moment arms that depend on the angle of both joints the muscles cross. The tendon excursion method was used to measure the joint angle-dependence of hamstring (biceps femoris, semimembranosus and semitendinosus) moment arm magnitudes of the feline hindlimb at the knee and hip joints. Knee angle influenced hamstring moment arm magnitudes at the hip joint; compared to a flexed knee joint, the moment arm for semimembranosus posterior at the hip was at most 7.4 mm (25%) larger when the knee was extended. On average, hamstring moment arms at the hip increased by 4.9 mm when the knee was more extended. In contrast, moment arm magnitudes at the knee varied by less than 2.8 mm (mean=1.6 mm) for all hamstring muscles at the two hip joint angles tested. Thus, hamstring moment arms at the hip were dependent on knee position, while hamstring moment arms at the knee were not as strongly associated with relative hip position. Additionally, the feline hamstring muscle group had a larger mechanical advantage at the hip than at the knee joint.     

Is Achilles tendon compliance optimised for maximum muscle efficiency during locomotion?

Tendon elasticity is important for economical locomotion; however it is unknown whether tendon stiffness is appropriate to achieve an optimal efficiency in various muscles. Here we test the hypothesis that the Achilles tendon is of an appropriate stiffness to maximise medial gastrocnemius muscle efficiency during locomotion with different power requirements. To test this hypothesis we used a three element Hill muscle model to determine how muscle fascicles would be required to change length if the series elastic element stiffness is varied, whilst the limb kinematics and muscle properties are held constant. We applied a model of muscle energetics to these data to predict muscle efficiency for a range of stiffness values in both walking and running conditions. We also compared the model results to in vivo data collected using ultrasonography. The muscle model predicted that optimal series elastic element stiffness for maximising efficiency is equal or slightly higher than that of the average Achilles tendon in running and walking, respectively. Although the peak efficiency values for running (26%) and walking (27%) are similar, the range of stiffness values achieving high efficiency in running is much smaller than that during walking. These results suggest that a compliant tendon, such as the Achilles tendon, is required for efficient running. Such a finding is important, because it describes how the stiffness of a tendon may be adapted to achieve optimal efficiency for particular athletic pursuits. The influence of varying tendon stiffness on kinematic performance may, however, play an important role in determining the efficiency of the muscle.     

Bone adaptation to altered loading after spinal cord injury: a study of bone and muscle strength

Bone loss from the paralysed limbs after spinal cord injury (SCI) is well documented. Under physiological conditions, bones are adapted to forces which mainly emerge from muscle pull. After spinal cord injury (SCI), muscles can no longer contract voluntarily and are merely activated during spasms. Based on the Ashworth scale, previous research has suggested that these spasms may mitigate bone losses. We therefore wished to assess muscle forces after SCI with a more direct measure and compare it to measures of bone strength. We hypothesized that the bones in SCI patients would be in relation to the loss of muscle forces. Six male patients with SCI 6.4 (SD 4.3) years earlier and 6 age-matched, able-bodied control subjects were investigated. Bone scans from the right knee were obtained by pQCT. The knee extensor muscles were electrically stimulated via the femoral nerve, isometric knee extension torque was measured and patellar tendon force was estimated. Tendon force upon electrical stimulation in the SCI group was 75% lower than in the control subjects (p<0.01). Volumetric bone mineral density of the patella and of the proximal tibia epiphysis were 50% lower in the SCI group than in the control subjects (p<0.01). Cortical area was lower by 43% in the SCI patients at the proximal tibia metaphysis, and by 33% at the distal femur metaphysis. No group differences were found in volumetric cortical density. Close curvilinear relationships were found between stress and volumetric density for the tibia epiphysis (r(2)=0.90) and for the patella (r(2)=0.91). A weaker correlation with the tendon force was found for the cortical area of the proximal tibia metaphysis (r(2)=0.63), and none for the distal femur metaphysis. These data suggest that, under steady state conditions after SCI, epiphyseal bones are well adapted to the muscular forces. For the metaphysis of the long bones, such an adaptation appears to be less evident. The reason for this remains unclear.     

Validity of architectural properties of the hamstring muscles: Correlation of ultrasound findings with cadaveric dissection

The purpose of this study was to compare the architectural parameters of the long head of biceps femoris (BFlh) and semitendinosus (ST) muscles by comparing measurements from ultrasound (US) with those obtained from direct dissection. The BFlh and ST architectures were examined bilaterally in 6 legs from 3 male cadavers. The fascicle length, pennation angle, muscle thickness and muscle and tendon length were obtained from direct measurement and US scans along each muscle. Intraclass correlation coefficients between the two methods ranged from 0.905 to 0.913 for the BFlh variables and from 0.774 to 0.974 for the ST parameters. Compared with the direct measurements, the US method showed a mean typical error of 0.09–0.14 cm for muscle thickness, 1.01–1.31° for the pennation angle, 0.92–1.71 cm for fascicle length and muscle–tendon length measurements. The US method is a valid alternative tool for assessing basic architectural parameters of ST and BFlh components of the hamstring muscles.     

Achilles tendon stress is more sensitive to subject-specific geometry than subject-specific material properties: A finite element analysis

This study used subject-specific measures of three-dimensional (3D) free Achilles tendon geometry in conjunction with a finite element method to investigate the effect of variation in subject-specific geometry and subject-specific material properties on tendon stress during submaximal isometric loading. Achilles tendons of eight participants (Aged 25–35 years) were scanned with freehand 3D ultrasound at rest and during a 70% maximum voluntary isometric contraction. Ultrasound images were segmented, volume rendered and transformed into subject-specific 3D finite element meshes. The mean (±SD) lengths, volumes and cross-sectional areas of the tendons at rest were 62 ± 13 mm, 3617 ± 984 mm³ and 58 ± 11 mm² respectively. The measured tendon strain at 70% MVIC was 5.9 ± 1.3%. Subject-specific material properties were obtained using an optimisation approach that minimised the difference between measured and modelled longitudinal free tendon strain. Generic geometry was represented by the average mesh and generic material properties were taken from the literature. Local stresses were subsequently computed for combinations of subject-specific and generic geometry and material properties. For a given geometry, changing from generic to subject-specific material properties had little effect on the stress distribution in the tendon. In contrast, changing from generic to subject-specific geometry had a 26-fold greater effect on tendon stress distribution. Overall, these findings indicate that the stress distribution experienced by the living free Achilles tendon of a young and healthy population during voluntary loading are more sensitive to variation in tendon geometry than variation in tendon material properties.     

Tensor fasciae latae perforator flap for reconstruction of composite Achilles tendon defects with skin and vascularized fascia

The surgical management of large defects of the Achilles tendon and overlying skin is very demanding and necessitates, as a rule, a free vascularized graft. The ideal characteristics of a thin layer of skin and a strong tendon component, combined with a reliable blood supply and minimal morbidity at the donor site, have only been partially met by all previous grafts used in this situation. The authors performed reconstructions in five patients with large defects of the Achilles tendon and overlying skin by using a perforator flap derived from the tensor fasciae latae flap. A vascularized skin-subcutis-fascia lata flap could be raised by dissecting out two to three perforating arteries through the tensor fasciae latae muscle to the ascending branch of the lateral circumflex femoral artery; the muscle was left in situ in the process. All the flaps took well without complications. At final examination after an average of 20 months, the reconstructed Achilles tendon showed good functional results, although there was a 50 to 70 percent reduction in power during plantar flexion when compared with the normal side. A very good aesthetic result could be obtained after a debulking operation was performed on the skin flap.