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Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion

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Abstract
Torsion of the Achilles tendon (AT) enhances tensile strength, but a high degree of torsion might also be a risk factor for Achilles tendinopathy, due to greater internal compression exerted during tensile loading. However, evidence supporting the grounds for this assumption is lacking. Hence, we aimed to investigate the impact of AT torsion type on intratendinous pressure. Eighteen human fresh frozen cadaveric legs were mounted in a testing rig and a miniature pressure catheter was placed through ultrasound-guided insertion in the midportion region of the AT. Intratendinous pressure was measured during a simulated straight-knee calf stretch and eccentric heel drop. The AT was then carefully dissected and classified into Type I (least), Type II (moderate), and Type III (extreme) torsion. Of the ATs examined, nine were found to have Type I torsion (50%), nine Type II (50%), and none Type III. It was found that the intratendinous pressure of the AT increased exponentially with ankle dorsiflexion during both exercises (p < 0.001) and that this increase was greater in ATs with Type II torsion than Type I torsion (p < 0.05). This study provides the first biomechanical data to support the hypothesis that in athletes with a high degree of torsion in the AT, the midportion area will experience more internal compression during exercise, for example, calf stretching and eccentric heel drops. Whether this phenomenon is also associated with an elevated risk for Achilles tendinopathy needs further prospective investigation.
Keywords
tendon torsion, stretching, intratendinous pressure, eccentric loading, biomechanics, Achilles tendon

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MLA
Pringels, Lauren, et al. “Intratendinous Pressure of the Achilles Tendon during Exercise Is Related to the Degree of Tendon Torsion.” SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS, vol. 33, no. 11, 2023, pp. 2230–38, doi:10.1111/sms.14467.
APA
Pringels, L., Stouthandel, M., Van Hoof, T., Martens, M., Chevalier, A., Burssens, A., … Vanden Bossche, L. (2023). Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion. SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS, 33(11), 2230–2238. https://doi.org/10.1111/sms.14467
Chicago author-date
Pringels, Lauren, Michael Stouthandel, Tom Van Hoof, Manuel Martens, Amélie Chevalier, Arne Burssens, Evi Wezenbeek, and Luc Vanden Bossche. 2023. “Intratendinous Pressure of the Achilles Tendon during Exercise Is Related to the Degree of Tendon Torsion.” SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS 33 (11): 2230–38. https://doi.org/10.1111/sms.14467.
Chicago author-date (all authors)
Pringels, Lauren, Michael Stouthandel, Tom Van Hoof, Manuel Martens, Amélie Chevalier, Arne Burssens, Evi Wezenbeek, and Luc Vanden Bossche. 2023. “Intratendinous Pressure of the Achilles Tendon during Exercise Is Related to the Degree of Tendon Torsion.” SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS 33 (11): 2230–2238. doi:10.1111/sms.14467.
Vancouver
1.
Pringels L, Stouthandel M, Van Hoof T, Martens M, Chevalier A, Burssens A, et al. Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion. SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS. 2023;33(11):2230–8.
IEEE
[1]
L. Pringels et al., “Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion,” SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS, vol. 33, no. 11, pp. 2230–2238, 2023.
@article{01H8GWK0J0NH2MKKAQNQRX2T70,
  abstract     = {{Torsion of the Achilles tendon (AT) enhances tensile strength, but a high degree of torsion might also be a risk factor for Achilles tendinopathy, due to greater internal compression exerted during tensile loading. However, evidence supporting the grounds for this assumption is lacking. Hence, we aimed to investigate the impact of AT torsion type on intratendinous pressure. Eighteen human fresh frozen cadaveric legs were mounted in a testing rig and a miniature pressure catheter was placed through ultrasound-guided insertion in the midportion region of the AT. Intratendinous pressure was measured during a simulated straight-knee calf stretch and eccentric heel drop. The AT was then carefully dissected and classified into Type I (least), Type II (moderate), and Type III (extreme) torsion. Of the ATs examined, nine were found to have Type I torsion (50%), nine Type II (50%), and none Type III. It was found that the intratendinous pressure of the AT increased exponentially with ankle dorsiflexion during both exercises (p < 0.001) and that this increase was greater in ATs with Type II torsion than Type I torsion (p < 0.05). This study provides the first biomechanical data to support the hypothesis that in athletes with a high degree of torsion in the AT, the midportion area will experience more internal compression during exercise, for example, calf stretching and eccentric heel drops. Whether this phenomenon is also associated with an elevated risk for Achilles tendinopathy needs further prospective investigation.}},
  author       = {{Pringels, Lauren and Stouthandel, Michael and Van Hoof, Tom and Martens, Manuel and Chevalier, Amélie and Burssens, Arne and Wezenbeek, Evi and Vanden Bossche, Luc}},
  issn         = {{0905-7188}},
  journal      = {{SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS}},
  keywords     = {{tendon torsion,stretching,intratendinous pressure,eccentric loading,biomechanics,Achilles tendon}},
  language     = {{eng}},
  number       = {{11}},
  pages        = {{2230--2238}},
  title        = {{Intratendinous pressure of the Achilles tendon during exercise is related to the degree of tendon torsion}},
  url          = {{http://doi.org/10.1111/sms.14467}},
  volume       = {{33}},
  year         = {{2023}},
}

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