Schneebeli A1,2, Visconti L3, Giardini G4, Clijsen R5,6,7, Barbero M1
1University of Applied Sciences and Arts of Southern Switzerland, Department of Business Economics, Health and Social Care, Rehabilitation Research Laboratory 2rLab, Manno, Switzerland, 2University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 3Studi Fisioterapici di Montagna, Aosta, Italy, 4Ospedale U. Parini, Centro Medicina di Montagna, SC Neurologia, Aosta, Italy, 5University of Applied Sciences and Arts of Southern Switzerland, Department of Business Economics, Health and Social Care, Rehabilitation Research Laboratory 2rLab, Landquart, Switzerland, 6University College Physiotherapy, Thim van der Laan AG, Landquart, Switzerland, 7Vrije Universiteit Brussel, Faculty of Physical Education and Physical Therapy, Brussels, Belgium
Background: Ultrasound-based techniques have been used to assess the quality of skeletal muscles as well as tendon tissues. These techniques (i.e.,ultrasound echo intensity) allow qualitative evaluation and have also recently been used to quantify the internal structure of muscles and tendon by computer-aided grayscale analysis. (GA) During ski mountaineering descending phase loading pattern is expected to subject the patellar tendon to continuous strain, moreover requires continuous tension of the quadriceps muscle-tendon unit to maintain and adjust appropriate knee angle during straight and curved trajectories.
Furthermore Achilles tendon is constantly put under load by the knee-ankle movement during the ascending phase of this discipline.
Purpose: The aim of this study was to evaluate changes on Achilles and patellar tendon internal structure after a ski mountaineering race competition.
Methods: 20 athletes have been recruited during the 19° Millet Tour du Rutor extreme (Arvier, Aosta, Italy), a 3-day ski mountaineering competition. Ultrasound measurement of Achilles and patellar tendon have been performed with a MyLab Alpha ultrasound device (Esaote, Genoa, Italy) before the first race and immediately after each of the 3 races following a standardized protocol.
Data of 10 athletes have been extracted and analyzed. The following parameters were calculated from the ultrasound images: geometric measurement (thickness and cross-sectional area, CSA); descriptive statistics derived from the grayscale histogram (GA mean± SD).
Friedman test with post hoc pairwise comparison were used to determine the difference between pre and post-race for each of the analysed parameter.
Results: Friedman test revealed significant differences (p 0.05) between the pre and post-race for the Achilles tendon thickness and CSA for each of the 3 races. Achilles tendon thickness and CSA decreased from 5.01 mm (±0.6) to 4.48 mm (±0.5) and 44.3 mm2 (±5.1) to 40.0 mm2 (±5.3) respectively.
Achilles tendon GA was significantly higher for the first and third race day but not for the second (p=0.14)
Patellar tendon thickness and CSA don't show any significant difference between pre and post-race (p>0.05) Patellar tendon GA was significantly higher for each of the 3 races (p 0.05).
Conclusion(s): Preliminary results show that Achilles and patellar tendon exhibit internal structural changes after an extreme ski mountaineering competition. Achilles tendon GA increase after the race while thickness and CSA decreased. Patellar tendon GA also increase while thickness and CSA remain stable. Changes related to tendon load can be seen from classical (i.e thickness and CSA) and innovative (GA) ultrasound based parameters.
Implications: The behavior of the Achilles and patellar tendon internal structure seem to be related to the load applied to the structure. Ultrasound grayscale analysis can be used to evaluate tendon changes in athletes who perform high level competitions.
Keywords: Ultrasound echo intensity, Achilles tendon, patellar tendon
Funding acknowledgements: We thank the Millet Tour du Rutor extreme staff and organizers for the support.
Furthermore Achilles tendon is constantly put under load by the knee-ankle movement during the ascending phase of this discipline.
Purpose: The aim of this study was to evaluate changes on Achilles and patellar tendon internal structure after a ski mountaineering race competition.
Methods: 20 athletes have been recruited during the 19° Millet Tour du Rutor extreme (Arvier, Aosta, Italy), a 3-day ski mountaineering competition. Ultrasound measurement of Achilles and patellar tendon have been performed with a MyLab Alpha ultrasound device (Esaote, Genoa, Italy) before the first race and immediately after each of the 3 races following a standardized protocol.
Data of 10 athletes have been extracted and analyzed. The following parameters were calculated from the ultrasound images: geometric measurement (thickness and cross-sectional area, CSA); descriptive statistics derived from the grayscale histogram (GA mean± SD).
Friedman test with post hoc pairwise comparison were used to determine the difference between pre and post-race for each of the analysed parameter.
Results: Friedman test revealed significant differences (p 0.05) between the pre and post-race for the Achilles tendon thickness and CSA for each of the 3 races. Achilles tendon thickness and CSA decreased from 5.01 mm (±0.6) to 4.48 mm (±0.5) and 44.3 mm2 (±5.1) to 40.0 mm2 (±5.3) respectively.
Achilles tendon GA was significantly higher for the first and third race day but not for the second (p=0.14)
Patellar tendon thickness and CSA don't show any significant difference between pre and post-race (p>0.05) Patellar tendon GA was significantly higher for each of the 3 races (p 0.05).
Conclusion(s): Preliminary results show that Achilles and patellar tendon exhibit internal structural changes after an extreme ski mountaineering competition. Achilles tendon GA increase after the race while thickness and CSA decreased. Patellar tendon GA also increase while thickness and CSA remain stable. Changes related to tendon load can be seen from classical (i.e thickness and CSA) and innovative (GA) ultrasound based parameters.
Implications: The behavior of the Achilles and patellar tendon internal structure seem to be related to the load applied to the structure. Ultrasound grayscale analysis can be used to evaluate tendon changes in athletes who perform high level competitions.
Keywords: Ultrasound echo intensity, Achilles tendon, patellar tendon
Funding acknowledgements: We thank the Millet Tour du Rutor extreme staff and organizers for the support.
Topic: Musculoskeletal: lower limb; Sport & sports injuries; Musculoskeletal
Ethics approval required: Yes
Institution: Azienda Ospedaliera Valle d'Aosta
Ethics committee: Comiatato etico Azienda Ospedaliera Valle d'Aosta
Ethics number: 23/3/2018.0026243.I
All authors, affiliations and abstracts have been published as submitted.
