A1 Journal article (refereed)
Achilles Tendon Stiffness : Influence of Measurement Methodology (2024)

Khair, R. M., Sukanen, M., & Finni, T. (2024). Achilles Tendon Stiffness : Influence of Measurement Methodology. Ultrasound in Medicine and Biology, 50(10), 1522-1529. https://doi.org/10.1016/j.ultrasmedbio.2024.06.005

JYU authors or editors

Khair, Raad
Sukanen, Maria
Juutinen, Taija

Publication details

All authors or editors: Khair, Ra'ad M.; Sukanen, Maria; Finni, Taija

Journal or series: Ultrasound in Medicine and Biology

ISSN: 0301-5629

eISSN: 1879-291X

Publication year: 2024

Publication date: 29/07/2024

Volume: 50

Issue number: 10

Pages range: 1522-1529

Publisher: Elsevier

Publication country: United Kingdom

Publication language: English

DOI: https://doi.org/10.1016/j.ultrasmedbio.2024.06.005

Publication open access: Openly available

Publication channel open access: Partially open access channel

Publication is parallel published (JYX): https://jyx.jyu.fi/handle/123456789/97095

Abstract

Objective
Mechanical stiffness derived from force-elongation curves is fundamentally different from shear wave (SW) elastography-based tissue properties. We compared these techniques, with a total of five methods of assessing Achilles tendon (AT) stiffness.

Methods
Seventeen participants (12 male and 5 female) with unilateral AT rupture performed submaximal contractions at 30% and 10% maximal isometric contraction torque of the un-injured limb. SW velocity was acquired at rest. Force-elongation curves were assessed from the free AT and the medial gastrocnemius (MG) tendon. Mechanical stiffness was determined near the end of the linear region of the force-elongation curve and from the toe region. Bivariate correlations between mechanical stiffness and SW velocity, as well as pairwise t-tests between limbs, were computed.

Results
In the injured limb, SW velocity correlated with MG tendon and free AT toe-region stiffness during 10% (r = 0.59, p = 0.020 and r = 0.60, p = 0.011, respectively) and 30% of submaximal contractions (r = 0.56, p = 0.018 and r = 0.67, p = 0.004, respectively). The un-injured limb showed no associations. In both limbs pooled together, SW velocity correlated with MG tendon toe-region stiffness in 30% of submaximal contractions (r = 0.43, p = 0.012). Free tendon mechanical stiffness was lower in the injured limb, with a mean difference of 148.5 Nmm⁻¹ (95% CI: 35.6–261.3, p = 0.013), while SW velocity was higher in the injured limb (1.67 m × s⁻¹, 95% CI; -2.4 to -0.9, p < 0.001).

Conclusion
SW elastography may reflect AT viscoelastic properties at the initial slope of the force-length curve with strains <1% but cannot offer insight into AT mechanics at higher loads. Extended toe regions in the injured limb could have caused the association between mechanical stiffness and SW-based stiffness.

Keywords: tendons; calcaneal tendon; elasticity (physical properties); stiffness; ultrasonography; research methods; comparative research; biomechanics