Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Rev
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SYSTEMATIC REVIEW
Are the Mechanical or Material Properties of the Achilles and Patellar Tendons Altered in Tendinopathy? A Systematic Review with Meta‑analysis Steven J. Obst1 · Luke J. Heales2 · Benjamin L. Schrader1 · Scott A. Davis1 · Keely A. Dodd1 · Cory J. Holzberger1 · Louis B. Beavis1 · Rod S. Barrett3,4
© Springer International Publishing AG, part of Springer Nature 2018
Abstract Background Changes in the mechanical behaviour of the Achilles and patellar tendons in tendinopathy could affect muscle performance, and have implications for injury prevention and rehabilitation strategies. Objectives To determine the effect of clinically diagnosed tendinopathy on the mechanical and material properties of the Achilles tendon (AT) and patellar tendon (PT). Design Systematic review with meta-analysis. Methods A search of electronic databases (SPORTDiscus, CINAHL, PubMed, ScienceDirect and Google Scholar) was conducted to identify research articles that reported local and global in vivo mechanical (e.g. strain, stiffness) and/or material properties (e.g. modulus) of the AT and/or PT in people with and without tendinopathy. Effect sizes and corresponding 95% confidence intervals for individual studies were calculated for tendon strain, stiffness, modulus and cross-sectional area. Results Eighteen articles met the inclusion criteria (AT only = 11, PT only = 5, AT and PT = 2). There was consistent evidence that the reported AT strain was higher in people with tendinopathy, compared to asymptomatic controls. People with Achilles tendinopathy had a lower AT global stiffness, lower global modulus and lower local modulus, compared to asymptomatic controls. In contrast, there was no clear and consistent evidence that the global or local mechanical or material properties of the PT are altered in tendinopathy. Conclusions The in vivo mechanical and material properties of the Achilles tendon-aponeurosis are altered in tendinopathy, compared to asymptomatic tendons. Despite a similar clinical presentation to Achilles tendinopathy, patellar tendinopathy does not appear to alter the tensile behaviour of the PT in vivo.
Key Points The mechanical and material properties of the Achilles tendon-aponeurosis and patellar tendon (PT) appear to be differentially affected by tendinopathy. * Steven J. Obst [email protected] 1
School of Health, Medicine and Applied Science, Central Queensland University, Bundaberg, QLD, Australia
2
School of Health, Medicine and Applied Science, Central Queensland University, Rockhampton, QLD, Australia
3
School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
4
Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
Clinical interventions to restore tendon strength and mechanical function of the tendinopathic Achilles tendon-aponeurosis appear to be warranted. The lack of evidence for a consistent effect of tendinopathy on the mechanical and/or material properties of the PT raises the possibility that the therapeutic goal
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