ICON 2023: International Scientific Tendinopathy Symposium Consensus - the core outcome set for Achilles tendinopathy (COS-AT) using a systematic review and a Delphi study of professional participants and patients.

To develop a core outcome set for Achilles tendinopathy (COS-AT) for use in clinical trials we performed a five-step process including (1) a systematic review of available outcome measurement instruments, (2) an online survey on truth and feasibility of the available measurement instruments, (3) an assessment of the methodological quality of the selected outcome measurement instruments, (4) an online survey on the outcome measurement instruments as COS and (5) a consensus in-person meeting. Both surveys were completed by healthcare professionals and patients. The Outcome Measures in Rheumatology guidelines with a 70% threshold for consensus were followed.

TENDINopathy Severity Assessment - Achilles (TENDINS-A): Development and Content Validity Assessment of a New Patient-Reported Outcome Measure for Achilles Tendinopathy.

To develop a new patient-reported outcome measure (PROM) assessing TENDINopathy Severity of the Achilles (TENDINS-Achilles) and evaluate its content validity. Mixed-methods, modified Delphi. We performed 1 round of semistructured one-on-one interview responses with professionals and patients, for initial item generation.

ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy.

Background: Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated.

Objective: To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains.

Targeted Achilles Tendon Training and Rehabilitation Using Personalized and Real-Time Multiscale Models of the Neuromusculoskeletal System.

Musculoskeletal tissues, including tendons, are sensitive to their mechanical environment, with both excessive and insufficient loading resulting in reduced tissue strength. Tendons appear to be particularly sensitive to mechanical strain magnitude, and there appears to be an optimal range of tendon strain that results in the greatest positive tendon adaptation. At present, there are no tools that allow localized tendon strain to be measured or estimated in training or a clinical environment.

Influence of altered geometry and material properties on tissue stress distribution under load in tendinopathic Achilles tendons - A subject-specific finite element analysis.

Achilles tendon material properties and geometry are altered in Achilles tendinopathy. The purpose of this study was to determine the relative contributions of altered material properties and geometry to free Achilles tendon stress distribution during a sub-maximal contraction in tendinopathic relative to healthy tendons. Tendinopathic (n = 8) and healthy tendons (n = 8) were imaged at rest and during a sub-maximal voluntary isometric contraction using three-dimensional freehand ultrasound.

Three-dimensional morphology and volume of the free Achilles tendon at rest and under load in people with unilateral mid-portion Achilles tendinopathy.

New Findings: What is the central question of this study? The aim was to determine the effect of mid-portion Achilles tendinopathy (MAT) on free Achilles tendon three-dimensional morphology and volume at rest and under load in people with unilateral MAT. What is the main finding and its importance? Tendinopathic tendon had a larger resting tendon cross-sectional area and anteroposterior diameter relative to healthy tendon. When loaded, tendinopathic tendon experienced a reduction in transverse morphology (i.

Recovery of human Achilles tendon three-dimensional deformation following conditioning.

Objectives: The tendon conditioning effect is transient, but the time course of recovery from conditioning is not known. This study examined the time-course recovery of three-dimensional (3D) Achilles tendon (AT) deformation immediately following a standardised AT conditioning protocol.

Design: Randomised crossover.

The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound.

Mid-portion Achilles tendinopathy (MAT) alters the normal three-dimensional (3D) morphology of the Achilles tendon (AT) at rest and under a single tensile load. However, how MAT changes the 3D morphology of the AT during repeated loading remains unclear. This study compared the AT longitudinal, transverse and volume strains during repeated loading of the tendinopathic AT with those of the contralateral tendon in people with unilateral MAT.

Achilles tendon stress is more sensitive to subject-specific geometry than subject-specific material properties: A finite element analysis.

This study used subject-specific measures of three-dimensional (3D) free Achilles tendon geometry in conjunction with a finite element method to investigate the effect of variation in subject-specific geometry and subject-specific material properties on tendon stress during submaximal isometric loading. Achilles tendons of eight participants (Aged 25-35years) were scanned with freehand 3D ultrasound at rest and during a 70% maximum voluntary isometric contraction. Ultrasound images were segmented, volume rendered and transformed into subject-specific 3D finite element meshes.

Should We Care About Tendon Structure? The Disconnect Between Structure and Symptoms in Tendinopathy.

We can visualize tendons better than ever before. Medical imaging today provides increasingly higher-resolution images, enabling larger fields of view that allow clinicians and researchers to more precisely characterize tendon structure. Yet, does seeing a patient's tendon provide any meaningful benefit to our clinical reasoning, and will it make a difference to treatment outcomes? It is little surprise that concomitant with this imaging availability is a renewed debate over the relationship between the appearance of tendon structure and symptomology.

Three-dimensional morphology and strain of the human Achilles free tendon immediately following eccentric heel drop exercise.

Our understanding of the immediate effects of exercise on Achilles free tendon transverse morphology is limited to single site measurements acquired at rest using 2D ultrasound. The purpose of this study was to provide a detailed 3D description of changes in Achilles free tendon morphology immediately following a single clinical bout of exercise. Freehand 3D ultrasound was used to measure Achilles free tendon length, and regional cross-sectional area (CSA), medio-lateral (ML) diameter and antero-posterior (AP) diameter in healthy young adults (N=14) at rest and during isometric muscle contraction, immediately before and after 3×15 eccentric heel drops.

Three-dimensional deformation and transverse rotation of the human free Achilles tendon in vivo during isometric plantarflexion contraction.

Freehand three-dimensional ultrasound (3DUS) was used to investigate longitudinal and biaxial transverse deformation and rotation of the free Achilles tendon in vivo during a voluntary submaximal isometric muscle contraction. Participants (n = 8) were scanned at rest and during a 70% maximal voluntary isometric contraction (MVIC) of the plantarflexors. Ultrasound images were manually digitized to render a 3D reconstruction of the free Achilles tendon for the computation of tendon length, volume, cross-sectional area (CSA), mediolateral diameter (MLD), anteroposterior diameter (APD), and transverse rotation.

Examining injury risk and pain perception in runners using minimalist footwear.

Background: This study examines the effect of progressive increases in footwear minimalism on injury incidence and pain perception in recreational runners.

Methods: One hundred and three runners with neutral or mild pronation were randomly assigned a neutral (Nike Pegasus 28), partial minimalist (Nike Free 3.0 V2) or full minimalist shoe (Vibram 5-Finger Bikila).

Comparison of a physiotherapy program versus dexamethasone injections for plantar fasciopathy in prolonged standing workers: a randomized clinical trial.

Objective: To investigate the effectiveness of a physiotherapy-based exercise program versus dexamethasone injection for chronic plantar fasciopathy in workers standing for prolonged periods of time.

Design: A parallel group nonblinded randomized controlled trial with 12-week follow-up.

Setting: An outpatient sports medicine clinic in Vancouver, British Columbia, Canada.

In vivo measurement of human achilles tendon morphology using freehand 3-D ultrasound.

This study investigated the accuracy of phantom volume and length measurements and the reliability of in vivo Achilles tendon (AT) volume, length and cross-sectional area measurements obtained using freehand 3-D ultrasound. Participants (n = 13) were scanned on consecutive days under active and passive loading conditions. In vivo AT length was evaluated using a two-point method and an approach that accounted for AT curvature (centroid method).

Effects of running on human Achilles tendon length-tension properties in the free and gastrocnemius components.

The elastic properties of the human Achilles tendon are important for locomotion; however, in vitro tests suggest that repeated cyclic contractions lead to tendon fatigue - an increase in length in response to stress applied. In vivo experiments have not, however, demonstrated mechanical fatigue in the Achilles tendon, possibly due to the limitations of using two-dimensional ultrasound imaging to assess tendon strain. This study used freehand three-dimensional ultrasound (3DUS) to determine whether the free Achilles tendon (calcaneus to soleus) or the gastrocnemius tendon (calcaneus to gastrocnemius) demonstrated tendon fatigue after running exercise.

Regional bone geometry of the tibia in triathletes and stress reactions--an observational study.

Objectives: The association between tibial morphology and tibial stress fractures or tibial stress syndrome was examined in triathletes with an unusually high incidence of these injuries.

Design: A cross-sectional study design examined associations between tibial geometry from MRI images and training and injury data between male and female triathletes and between stress fracture (SF) and non-stress fracture (NSF) groups.

Methods: Fifteen athletes (7 females, 8 males) aged 17-23 years who were currently able to train and race were recruited from the New Zealand Triathlete Elite Development Squad.

Immediate effect of exercise on achilles tendon properties: systematic review.

Introduction: Understanding the mechanical and morphological adaptation of the Achilles tendon (AT) in response to acute exercise could have important implications for athletic performance, injury prevention, and rehabilitation. The purpose of this study was to conduct a systematic review and critical evaluation of the literature to determine the immediate effect of a single bout of exercise on the mechanical and morphological properties of the AT in vivo.

Methods: Five electronic research databases were systematically searched for intervention-based studies reporting mechanical and morphological properties of the AT after a single bout of exercise.

Analysis of knee flexion angles during 2 clinical versions of the heel raise test to assess soleus and gastrocnemius function.

Study Design: Controlled laboratory study, using a repeated-measures, counterbalanced design.

Objectives: To provide estimates on the average knee angle maintained, absolute knee angle error, and total repetitions performed during 2 versions of the heel raise test.

Background: The heel raise test is performed in knee extension (EHRT) to assess gastrocnemius and knee flexion (FHRT) for soleus.

Scientific bases and clinical utilisation of the calf-raise test.

Background: Athletes commonly sustain injuries to the triceps surae muscle-tendon unit. The calf-raise test (CRT) is frequently employed in sports medicine for the detection and monitoring of such injuries. However, despite being widely-used, a recent systematic review found no universal consensus relating to the test's purpose, parameters, and standard protocols.

Raising the standards of the calf-raise test: a systematic review.

The calf-raise test is used by clinicians and researchers in sports medicine to assess properties of the calf muscle-tendon unit. The test generally involves repetitive concentric-eccentric muscle action of the plantar-flexors in unipedal stance and is quantified by the number of raises performed. Although the calf-raise test appears to have acceptable reliability and face validity, and is commonly used for medical assessment and rehabilitation of injuries, no universally acceptable test parameters have been published to date.

Pre-race health status and medical events during the 2005 World Adventure Racing Championships.

Adventure racing is a wilderness multisport endurance event with the potential for significant injury and illness; however specific contributing factors have not been extensively studied. A prospective cross-sectional study was conducted that collected data during the 2005 Adventure Racing World Championship on pre-, in- and post-race injury and illness and determined pre-race training volumes and health profiles in 184 athletes (46 teams of 4 athletes). In the 6 months prior to the event, 79.

Chronic tendinopathy: effectiveness of eccentric exercise.

Objectives: To determine the effectiveness of eccentric exercise (EE) programmes in the treatment of common tendinopathies.

Data Sources: Relevant randomised controlled trials (RCTs) were sourced using the OVID website databases: MEDLINE (1966-Jan 2006), CINAHL (1982-Jan 2006), AMED (1985-Jan 2006), EMBASE (1988-Jan 2006), and all EBM reviews--Cochrane DSR, ACP Journal Club, DARE, and CCTR (Jan 2006). The Physiotherapy Evidence Database (PEDro) was also searched using the keyword: eccentric.