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The purpose of this study was to determine the intra-rater, inter-examiner and inter-observer reliability of biceps femoris long head (BFlh) tendon strain using ultrasound imaging. Nineteen patients (age: 20.4 +/- 0.35 y) were tested twice with a 1-wk interval. Each session included passive stretching from three different hip positions. Tests were performed independently by two examiners while BFlh tendon displacement (mm) and strain (%) were manually extracted from ultrasound video footages by two observers. Intra-rater comparisons revealed an intra-class correlation coefficient (ICC2,1) range of 0.87 to 0.98 and a variability less than 4.74%. Interexaminer comparisons revealed an ICC2,1 range of 0.83 to 0.99 and less than 4.69% variability. Inter-observer ICCs ranged from 0.93 to 0.97 with variability less than 4.89%. Using a well-defined scanning protocol, two experienced examiners attained high levels of intra-rater agreement, with similarly excellent results for inter-rater and inter-observer reliability for BFlh tendon displacement and strain. (E-mail: ekellis@phed-sr.auth.gr) (C) 2017 World Federation for Ultrasound in Medicine & Biology.
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.
Core stability exercises are regular part of exercise programs for asymptomatic individuals across ages. The purpose of this study was to examine deep abdominal and multifidus muscle thickness in children and adults and to determine reliability of the rehabilitative ultrasound (RUSI) imaging. Transversus abdominis and lumbar multifidus thickness at rest and during core stability exercise were examined in pre-pubertal children (N = 23), adolescents (N = 20), young adults (N = 21) and middle-aged adults (N = 22). Thirty-nine participants were re-tested one week after to establish reliability. Muscle thickness at rest was lower in children and adolescents compared with young and middle-aged adults (p < 0.008). Young adults displayed the highest relative transversus abdominis thickness upon contraction (p < 0.008). Lumbar multfidus contraction thickness was greater in young-adults than middle-aged adults and prepubertal children (p < 0.008), but it was similar between young-adults and adolescents (p > 0.008). Reliability was high for both muscles (ICC3,3 = 0.76 - 0.99). The age-related differences in muscle thickness indicate that core stability exercises may be beneficial for children and middle-aged adults.
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.
Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 ± 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean ± SD) and statistical testing for group differences was performed (α = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 ± 0.7 mm/5.6 ± 0.7 mm) nor in controls (4.8 ± 0.4 mm/4.9 ± 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (M1: 3.5 ± 0.5 mm, M2: 3.8 ± 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p ≤ 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.
Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 +/- 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean SD) and statistical testing for group differences was performed (cy = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 +/- 0.7 mm/5.6 +/- 0.7 mm) nor in controls (4.8 +/- 0.4 mm/4.9 +/- 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (Ml: 3.5 +/- 0.5 mm, M2: 3.8 +/- 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p <= 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.
Objectives-Sonography of muscle architecture provides physicians and researchers with information about muscle function and muscle-related disorders. Inter-rater reliability is a crucial parameter in daily clinical routines. The aim of this study was to assess the inter-rater reliability of sonographic muscle architecture assessments and quantification of errors that arise from inconsistent probe positioning and image interpretation.
Results-Inter-rater reliability was good overall (ICC, 0.77-0.90; IRV, 9.0%-13.4%; bias LoA, 0.2 +/- 0.2-1.7 +/- 3.0). Superior and inferior pennation angles showed high systematic bias and LoA in all setups, ranging from 2.0 degrees +/- 2.2 degrees to 3.4 degrees +/- 4.1 degrees. The highest IRV was found for muscle thickness (13.4%). "When the probe position was standardized, the SEM for muscle thickness decreased from 0.1 to 0.05 cm.
Conclusions-Sonographic examination of muscle architecture of the medial gastrocnemius has good to high reliability. In contrast to pennation angle measurements, length measurements can be improved by standardization of the probe position.