TY - JOUR A1 - Rector, Michael V. A1 - Intziegianni, Konstantina A1 - Müller, Steffen A1 - Mayer, Frank A1 - Cassel, Michael T1 - Reproducibility of an ankle joint rotation correction method for assessment of Achilles tendon elongation JF - Isokinetics and exercise science : official journal of the European Isokinetic Society N2 - BACKGROUND: The Achilles tendon (AT) requires optimal material and mechanical properties to function properly. Calculation of these properties depends on accurate measurement of input parameters (i.e. tendon elongation). However, the measurement of AT elongation with ultrasound during maximum voluntary isometric contraction (MVIC) is overestimated by ankle joint rotation (AJR). Methods to correct the influence of this rotation on AT elongation exist, yet their reproducibility in clinical settings is unknown. OBJECTIVE: To evaluate the test-retest reproducibility of AT elongation during MVIC after AJR correction. METHODS: Ten participants attended test and retest measurements where they performed plantar-flexion MVIC on a dynamometer. Simultaneously, ultrasound recorded AT elongation as the displacement of the medial gastrocnemius-myotendinous junction, while an electrogoniometer measured AJR. The ankle was then passively rotated to the AJR achieved during MVIC and AT elongation again determined. Elongation was corrected by subtracting this passive AT elongation from the total AT elongation during MVIC. Reproducibility was evaluated using ICC (2.1), test-retest variability (TRV, %), Bland-Altman analyses (Bias +/- LoA [1.96*SD]) and standard error of the measurement (SEM). RESULTS: Corrected AT elongation reproducibility exhibited an ICC = 0.79, SEM = 0.2 cm and TRV = 20 +/- 19%. Bias +/- LoA were determined to be 0.0 +/- 0.8 cm. CONCLUSIONS: Using this ultrasound and electrogoniometer-based method, corrected AT elongation can be assessed reproducibly. KW - Ultrasonography KW - Achilles tendon KW - reproducibility KW - isokinetic KW - ankle joint rotation Y1 - 2017 U6 - https://doi.org/10.3233/IES-160644 SN - 0959-3020 SN - 1878-5913 VL - 25 IS - 1 SP - 47 EP - 52 PB - IOS Press CY - Amsterdam ER - TY - THES A1 - Intziegianni, Konstantina T1 - Influence of age and pathology on Achilles tendon properties under functional tasks T1 - Einfluss von Alter und Pathologie auf Eigenschaften der Achillessehne während funktionaler Aufgaben N2 - Prevalence of Achilles tendinopathy increases with age, leading to a weaker tendon with predisposition to rupture. Previous studies, investigating Achilles tendon (AT) properties, are restricted to standardized isometric conditions. Knowledge regarding the influence of age and pa-thology on AT response under functional tasks remains limited. Therefore, the aim of the thesis was to investigate the influence of age and pathology on AT properties during a single-leg vertical jump. Healthy children, asymptomatic adults and patients with Achilles tendinopathy participated. Ultrasonography was used to assess AT-length, AT-cross-sectional area and AT-elongation. The reliability of the methodology used was evaluated both Intra- and inter-rater at rest and at maximal isometric plantar-flexion contraction and was further implemented to investigate tendon properties during functional task. During the functional task a single-leg vertical jump on a force plate was performed while simultaneously AT elongation and vertical ground reaction forces were recorded. AT compliance [mm/N] (elongation/force) and AT strain [%] (elongation/length) were calculated. Differences between groups were evaluated with respect to age (children vs. adults) and pathology (asymptomatic adults vs. patients). Good to excellent reliability with low levels of variability was achieved in the assessment of AT properties. During the jumps AT elongation was found to be statistical significant higher in children. However, no statistical significant difference was found for force among the groups. AT compliance and strain were found to be statistical significant higher only in children. No significant differences were found between asymptomatic adults and patients with tendinopathy. The methodology used to assess AT properties is reliable, allowing its implementation into further investigations. Higher AT-compliance in children might be considered as a protective factor against load-related injuries. During functional task, when higher forces are acting on the AT, tendinopathy does not result in a weaker tendon. N2 - Die Prävalenz der Achillessehenentendinopathie steigt mit zunehmendem Alter, was zu einer geschwächten Sehnenstruktur mit Prädisposition zur Ruptur führt. Frühere Studien, welche Achillesssehnen(AS)-Eigenschaften untersuchten, beschränkten sich auf standardisierte isometrische Bedingungen. Der Einfluss von Alter und Pathologie auf das AS-Verhalten während funktioneller Bewegungen ist unklar. Das die Ziel der vorliegenden Arbeit war es daher, den Einfluss des Alters und Pathologie auf AS-Eigenschaften während einen einbeinigen vertikalen Sprung zu untersuchen. Es wurden gesunde Kinder, asymptomatische Erwachsene und Patienten mit Achillessehnene-ndinopathie eingeschlossen. Sonographisch wurden AS-Länge, -Querschnittsfläche (cross-sectional area) und -Dehnung gemessen. Intra- und inter-rater Reliabilität der genutzten Methoden wurden sowohl in Ruhe als auch unter maximaler isometrischer Plantarflexion bestimmt und nachfolgend zur Untersuchung der funktionellen AS-Eigenschaften implementiert. Hierzu wurde ein einbeiniger vertikaler Sprung auf einer Kraftmessplatte absolviert und zeitgleich AS-Compliance sowie vertikale Bodenreaktionskräfte regsitriert. AS-Compliance [mm/N] (Dehnung/Kraft) und AS-Verformung [%] (Dehnung/Länge) wurden kalkuliert. Die Gruppenunterschiede wurden in Bezug auf Alter (Kinder vs. Erwachsene) und Pathologie (Erwachsene vs. Patienten) evaluiert. Bei der Bewertung der verwendeten Methode wurde eine gute bis sehr gute Reliabilität mit geringer Variabilität zur Beurteilung der AS-Eigenschaften erreicht. Während der einbeinigen Sprünge zeigte sich eine statistisch signifikant höhere AS-Dehnung bei Kindern verglichen zu Erwachsenen. Ein statistisch signifikanter Kraft-Unterschied bestand zwischen den Gruppen nicht. AS-Compliance und –Verformung waren ausschließlich statistisch signifikant höher bei den Kindern. Keine signifikanten Unterschiede zwischen Erwachsenen und Patienten wurden gefunden. Die Methodik zur Bestimmung der AS-Eigenschaften ist zuverlässig, was deren Implementierung in weitere funktionelle Untersuchungen ermöglicht. Die höhere funktionelle AS-Compliance bei Kindern kann als Schutz vor Überlastungsschäden diskutiert werden. Während funktioneller Aufgaben, bei denen höhere Kräfte auf die AS wirken, ging das Vorhandensein einer Tendinopathie nicht mit einer schwächeren Sehne einher. KW - Achilles tendon KW - tendinopathy KW - age KW - reliability KW - tendon mechanical properties KW - Achillessehne KW - Tendinopathie KW - Alter KW - Sehnen mechanische Eigenschaften Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-398732 ER - TY - JOUR A1 - Intziegianni, Konstantina A1 - Cassel, Michael A1 - König, Niklas A1 - Müller, Steffen A1 - Fröhlich, Katja A1 - Mayer, Frank T1 - Ultrasonography for the assessment of the structural properties of the Achilles tendon in asymptomatic individuals: An intra-rater reproducibility study JF - Isokinetics and exercise science : official journal of the European Isokinetic Society N2 - BACKGROUND: Reproducible measurements of tendon structural properties are a prerequisite for accurate diagnosis of tendon disorders and for determination of their mechanical properties. Despite the widely used application of Ultrasonography (US) in musculoskeletal assessment, its operator dependency and lack of standardization influences the consistency of the measurement. OBJECTIVE: To evaluate the intra-rater reproducibility of a standardized US method assessing the structural properties of the Achilles tendon (AT). METHODS: Sixteen asymptomatic participants were positioned prone on an isokinetic dynamometer with the knee extended and ankle at 90. flexion. US was used to assess AT-length, cross-sectional area (CSA), and AT-elongation during isometric plantarflexion contraction. The intra-rater reproducibility was assessed by ICC (2.1), Test-Retest Variability (TRV, %), Bland-Altman analyses (Bias +/- LoA [1.96*SD]), and Standard-Error of Measurement (SEM). RESULTS: Measurements of AT-length demonstrated an ICC of 0.93, TRV of 4.5 +/- 3.9%, Bias +/- LoA of -2.8 +/- 25.0 mm and SEM of 6.6 mm. AT-CSA showed an ICC of 0.79, TRV of 8.7 +/- 9.6%, Bias +/- LoA of 1.7 +/- 19.4 mm(2) and SEM of 5.3 mm(2). AT-elongation revealed an ICC of 0.92, TRV of 12.9 +/- 8.9%, Bias +/- LoA of 0.3 +/- 5.7 mm and SEM of 1.5 mm. CONCLUSIONS: The presented methodology allows a reproducible assessment of Achilles tendon structural properties when performed by a single rater. KW - Ultrasonography KW - Achilles tendon KW - reproducibility KW - isokinetic Y1 - 2015 U6 - https://doi.org/10.3233/IES-150586 SN - 0959-3020 SN - 1878-5913 VL - 23 IS - 4 SP - 263 EP - 270 PB - IOS Press CY - Amsterdam ER - TY - JOUR A1 - Cassel, Michael A1 - Müller, Steffen A1 - Carlsohn, Anja A1 - Baur, Heiner A1 - Jerusel, N. A1 - Mayer, Frank T1 - Intra- and interrater variability of sonographic investigations of patella and achilles tendons JF - Sportverletzung, Sportschaden : Grundlagen, Prävention, Rehabilitation N2 - Background: Clinical examinations of tendon disorders routinely include ultrasound examinations, despite the fact that availability of data concerning validity criteria of these measurements are limited. The present study therefore aims to evaluate the reliability of measurements of Achilles- and Patella tendon diameter and in the detection of structural adaptations. Materials and Methods: In 14 healthy, recreationally active subjects both asymptomatic Achilles (AT) and patella tendons (PT) were measured twice by two examiners in a test-retest design. Besides the detection of anteroposterior (a.p.-) and mediolateral (m.l.-) diameters, areas of hypoechogenicity and neovascularisation were registered. Data were analysed descriptively with calculation of test-retest variability (TRV), intraclass-correlation coefficient (ICC) and Bland and Altman's plots with bias and 95% limits of agreement (LOA). Results: Intra- and interrater differences of AT- and PT-a.p.-diameter varied from 0.2 - 1.2 mm, those of AT- and PT-m.l-diameter from 0.7-5.1 mm. Areas of hypoechogenicity were visible in 24% of the tendons, while 15% showed neovascularisations. Intrarater AT-a.p.-diameters showed sparse deviations (TRV 4.5-7.4%; ICC 0.60-0.84; bias -0.05-0.07 mm; LOA-0.6-0.5 to -1.1 - 1.0 mm), while interrater AT- and PT-m.l.-diameters were highly variable (TRV 13.7-19.7%; ICC 0.11-0.20; bias -1.4-4.3 mm; LOA-5.5-2.7 to -10.5 - 1.9 mm). Conclusion: Our results suggest that the measurement of AT- and PT-a.p.-diameters is a reliable parameter. In contrast, reproducibility of AT- and PT-m.l.-diameters is questionable. The study corroborates the presence of hypoechogenicity and neovascularisation in asymptomatic tendons. KW - ultrasound KW - Achilles tendon KW - Patella tendon KW - intra- and inter-rater variability KW - tendon diameter Y1 - 2012 U6 - https://doi.org/10.1055/s-0031-1281839 SN - 0932-0555 VL - 26 IS - 1 SP - 21 EP - 26 PB - Thieme CY - Stuttgart ER -