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Calibration of the shear wave speed-stress relationship in in situ Achilles tendons using cadaveric simulations of gait and isometric contraction.

ABSTRACT: It has been shown that shear wave speed is directly dependent on axial stress in ex vivo tendons. Hence, a wave speed sensor could be used to track tendon loading during movement. However, adjacent soft tissues and varying joint postures may affect the wave speed-load relationship for intact tendons. The purpose of this study was to determine whether the proportional relationship between squared wave speed and stress holds for in situ cadaveric Achilles tendons, to evaluate whether this relationship is affected by joint angle, and to assess potential calibration techniques. Achilles tendon wave speed and loading were simultaneously measured during cadaveric simulations of gait and isometric contractions performed in a robotic gait simulator. Squared wave speed and axial stress were highly correlated during isometric contraction at all ankle postures (R²_avg = 0.98) and during simulations of gait (R²_avg = 0.92). Ankle plantarflexion angle did not have a consistent effect on the constant of proportionality (p = 0.217), but there was a significant specimen-angle interaction effect (p < 0.001). Wave speed-based predictions of tendon stress were most accurate (average RMS error = 11% of maximum stress) when calibrating to isometric contractions performed in a dorsiflexed posture that resembled the posture at peak Achilles loading during gait. The results presented here show that the linear relationship between tendon stress and squared shear wave speed holds for a case resembling in vivo conditions, and that calibration during an isometric task can yield accurate predictions of tendon loading during a functional task.

SUBMITTER: Martin JA

PROVIDER: S-EPMC7405430 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesUltrasound often corroborates clinical diagnosis of Achilles tendinopathy (AT). Traditional measures assess macromorphological features or use qualitative grading scales, primarily focused within the free tendon. Shear wave imaging can non-invasively quantify tendon elasticity, yet it is unknown if proximal structures are affected by tendon pathology. The purpose of the study was to determine the characteristics of both traditional sonographic measures and regional shear wave speed (SWS) between limbs in patients with AT.MethodsTwenty patients with chronic AT were recruited. Traditional sonographic measures of tendon structure were measured. Regional SWS was collected in a resting ankle position along the entire length of the tendon bilaterally. SWS measures were extracted and interpolated across evenly distributed points corresponding to the free tendon (FT), soleus aponeurosis (SA), and gastrocnemius aponeurosis (GA). Comparisons were made between limbs in both traditional sonographic measures and regional SWS.ResultsSymptomatic tendons were thicker (10.2 (1.9) vs. 6.8 (1.8) mm; p < 0.001) and had more hyperemia (p = 0.001) and hypoechogenicity (p = 0.002) than the contralateral tendon. Regional SWS in the FT was lower in the symptomatic limb compared to the contralateral limb (11.53 [10.99, 12.07] vs. 10.97 [10.43, 11.51]; p = 0.03). No differences between limbs were found for the SA (p = 0.13) or GA (p = 0.99).ConclusionsLower SWS was only observed in the FT in AT patients, indicating that alterations in tendon elasticity associated with AT were localized to the FT and did not involve the proximal passive tendon structures.Key points• Baseline characteristics of a pilot sample of 20 subjects suffering from chronic Achilles tendinopathy showed differences in conventional sonographic measures of tendon thickness, qualitatively assessed hypoechogenicity, hyperemia, and quantitative measures of shear wave speed. • Regional shear wave speeds were lower in the free tendon but not in the proximal regions of the soleus or gastrocnemius aponeuroses in Achilles tendinopathy patients. • Using shear wave imaging to estimate tendon stiffness may prove beneficial for clinical validation studies to address important topics such as return to activity and the effectiveness of rehabilitation protocols.

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Calibration of the shear wave speed-stress relationship in in situ Achilles tendons using cadaveric simulations of gait and isometric contraction.

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