Mechanical changes in the Achilles tendon due to insertional Achilles tendinopathy.
Mechanical changes in the Achilles tendon due to insertional Achilles tendinopathy.
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DOI：
10.1016/j.jmbbm.2015.08.022
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发表时间：
2016-01
影响因子：
3.9
通讯作者：
Buckley MR
中科院分区：
文献类型：
--
作者：
Bah I;Kwak ST;Chimenti RL;Richards MS;P Ketz J;Samuel Flemister A;Buckley MR
插入性跟腱病（IAT）是一种疼痛和衰弱的疾病，对非手术干预反应不佳。据认为，这种疾病可能起源于跟腱压缩由于跟骨撞击。因此，与IAT相关的压缩力学变化可能阐明其病因并提供指导有效治疗的线索。然而，组织的机械特性尚未被表征。因此，本研究的目的是测量切除的IAT组织的力学性能，并与健康尸体对照组织进行比较。基于IAT引起的跟腱成分变化，我们假设IAT组织的压缩模量将显著高于健康对照组织，并与症状严重程度相关。我们进一步假设IAT肌腱在跟腱止点处的压缩力学性能分布会发生改变。跟腱止点的组织取自健康供体和接受IAT清创手术的患者。然后在两种不同加载速率下，在循环无侧限压缩条件下对每个供体的几个（约15个）组织样本进行机械测试，并分析所获得的数据，以确定每个供体的机械性能分布（割线和切线压缩模量和过渡应变）。虽然从IAT肌腱切除的组织的中值机械性能与健康组织没有显著差异，但每个供体内的机械性能分布发生了显着改变。特别是，健康肌腱包含更多的低模量（顺应性）和高过渡应变比IAT肌腱，证明了一个显着较低的第25百分位割线模量和较高的第75百分位过渡应变的标本。此外，这些参数与VISA-A量表测量的症状严重程度显著相关。最后，研究发现，预处理和缓慢加载都降低了健康和IAT标本的割线模量，这表明活动前缓慢，受控的踝关节背屈可能有助于IAT患者管理疾病相关的疼痛。
Insertional Achilles tendinopathy (IAT) is a painful and debilitating condition that responds poorly to non-surgical interventions. It is thought that this disease may originate from compression of the Achilles tendon due to calcaneal impingement. Thus, compressive mechanical changes associated with IAT may elucidate its etiology and offer clues to guide effective treatment. However, the mechanical properties of tissue have not been characterized. Therefore, the objective of this study was to measure the mechanical properties of excised IAT tissue and compare with healthy cadaveric control tissue. Based on the known compositional changes in the Achilles tendon caused by IAT, we hypothesized that the compressive modulus of IAT tissue would be significantly higher than in healthy control tissue and would correlate with symptom severity. We further hypothesized that IAT tendons would exhibit an altered distribution of compressive mechanical properties across the Achilles tendon insertion. Tissue from the Achilles tendon insertion was acquired from healthy donors and from patients undergoing debridement surgery for IAT. Several (~15) tissue specimens from each donor were then mechanically tested under cyclic unconfined compression at two different loading rates and the acquired data was analyzed to determine the distribution of mechanical properties (secant and tangent compressive moduli and transition strain) for each donor. While the median mechanical properties of tissue excised from IAT tendons were not significantly different than healthy tissue, the distribution of mechanical properties within each donor was dramatically altered. In particular, healthy tendons contained more low modulus (compliant) and high transition strain specimens than IAT tendons, as evidenced by a significantly lower 25th percentile secant modulus and higher 75th percentile transition strain. Furthermore, these parameters were significantly correlated with symptom severity as measured with the VISA-A scale. Finally, it was found that preconditioning and slow loading both reduced the secant modulus of healthy and IAT specimens, suggesting that slow, controlled ankle dorsiflexion prior to activity may help IAT patients manage disease-associated pain.
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作者：
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通讯作者：
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