Tendon loading profiles that promote healing in Achilles tendinopathy

项目总结 中质性跟腱病是一种疼痛、衰弱和慢性肌腱病变。复康 锻炼是患者的首选治疗方案，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。即使当患者的症状缓解时，只有 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，以偏心地加载病理性肌腱，促进愈合。然而， 日常生活中的跟腱负荷往往超过这些结构性康复负荷， 病理性肌腱的生物力学特性因患者而异。根据以下条件确定患者分组 肌腱负荷和生物力学方面的相似性是改善患者预后的关键下一步 肌腱愈合。我们的长期目标是开发个性化的康复方案，使肌腱最大化 急性和慢性跟腱损伤后的康复。这项研究的总体目标是确定 跟腱中质病患者肌腱负荷和生物力学的相似性及其原因 这些相似之处影响肌腱的愈合、疼痛和功能结果。这项研究利用创新 技术：1)在康复和日常生活中持续监测跟腱负荷；2) 使用超声应力成像技术量化肌腱状态。目标1将确定几组跟腱患者 基于负荷模式和应力成像曲线的肌腱病。目标2将决定肌腱愈合和 随着时间的推移，结果会发生变化。目标3将探讨性别对肌腱愈合和结果的影响。本研究 将是第一个确定跟腱负荷分布与肌腱愈合和 结果基于患者特定的因素，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，这项研究将确定特定的雌激素和黄体酮水平- 它可以用荷尔蒙避孕药改变--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就诊以外的领域。

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.