Tendon loading profiles that promote healing in Achilles tendinopathy

项目摘要 中间物质跟腱病是一种疼痛，衰弱和慢性肌腱病理。康复 运动是患者的第一治疗选择，但临床研究报告称，20 - 60%的患者 5年后继续经历疼痛和症状。即使患者症状缓解， 这些患者中有四分之一完全恢复了肌腱功能。目前的临床指南建议 患者进行脚跟抬高练习以偏心地加载病变肌腱并促进愈合。然而，在这方面， 日常生活中的跟腱负荷经常超过这些结构性康复负荷， 病理性肌腱的生物力学特性在患者之间变化。根据以下因素确定患者亚组 肌腱负荷和生物力学的相似性是改善患者结局的关键下一步， 肌腱愈合我们的长期目标是开发个性化的康复方案， 急性和慢性跟腱损伤后的恢复。本研究的总体目标是确定 跟腱中段病变患者肌腱负荷和生物力学的相似性以及 这些相似性影响肌腱愈合、疼痛和功能结果。这项研究利用了创新的 1）在康复和日常生活中持续监测跟腱负荷的技术，以及2） 使用超声应力成像来量化肌腱状态。目标1将确定跟腱患者组 肌腱病变的基础上负荷模式和应力成像轮廓。目标2将确定肌腱是否愈合， 结果会随着时间而改变。目的3将探讨性别对肌腱愈合和结局的影响。本研究 将是第一个确定与肌腱愈合相关的跟腱载荷分布的人， 结果基于患者特定因素，包括肌腱生物力学特性和性别。通过测量 性激素的循环水平，这项研究将确定是否特定水平的雌激素和孕激素- 这可以用荷尔蒙避孕药来改变-影响肌腱健康。最后，随着最近的转变， 对于远程医疗，这项研究将远程监测跟腱负荷，这有可能 将临床护理扩展到患者到诊所就诊之外。

PROJECT SUMMARY Mid-substance Achilles tendinopathy is a painful, debilitating, and chronic tendon pathology. Rehabilitation exercises are the first treatment option for patients, but clinical studies have reported 20-60% of patients continue to experience pain and symptoms 5-years later. Even when patients experience symptom relief, only one-quarter of these patients fully recover muscle-tendon function. Current clinical guidelines recommend patients perform heel-rise exercises to eccentrically load the pathologic tendon and promote healing. However, Achilles tendon loading during daily-living often exceeds these structured rehabilitation loads, and the biomechanical properties of pathologic tendon varies amongst patients. Identifying patient subgroups based on similarities in tendon loading and biomechanics is a critical next step towards improving patient outcomes and tendon healing. Our long-term goal is to develop personalized rehabilitation protocols that maximize tendon recovery following acute and chronic Achilles tendon injuries. The overall objective of this study is to determine similarities in tendon loading and biomechanics in patients with mid-substance Achilles tendinopathy and how these similarities affect tendon healing, pain, and functional outcomes. This study leverages innovative techniques to 1) continuously monitor Achilles tendon loading during rehabilitation and daily-living and 2) quantify tendon status using ultrasound stress-imaging. Aim 1 will identify groups of patients with Achilles tendinopathy based on loading patterns and stress-imaging profiles. Aim 2 will determine if tendon healing and outcomes change over time. Aim 3 will explore the impact of sex on tendon healing and outcomes. This study will be the first to identify Achilles tendon loading profiles that are associated with tendon healing and outcomes based on patient-specific factors including tendon biomechanical properties and sex. By measuring circulating levels of sex hormones, this study will determine if specific levels of estrogen and progesterone – which can be modified using hormonal contraceptive pills – impact tendon health. Finally, with the recent shift towards telemedicine, this study will remotely monitor Achilles tendon loading, which has the potential to expand clinical care beyond patient visits to the clinic.