Fatigue-induced Alterations of the Patellar Tendon in Elite Sprint Track Cyclists

Abstract

This study aims to investigate morphological and mechanical properties and echogenicity of the patellar tendon (PT) after acute fatigue-induced alterations in sprint track cyclists. Fourteen elite track cyclists participated in this study. The exercise protocol consisted of three maximal start accelerations (over a distance of 62.5 m), one maximal start acceleration (at both 125 m and 250 m), and sprints from the standing start. Immediately after testing all measurements, PT stiffness and thickness were set at 5–10–15–20 mm distal from the apex of the patella and 5–10 mm proximal to the tibial tuberosity. CSA was set at proximal, middle, and distal, while echogenicity was at proximal and distal points. The results showed significant increases in PT stiffness at all reference points after start acceleration (p<0.001). PT thickness showed similar results for stiffness, except for location placed at TT-5 (p<0.001). CSA increased significantly in proximal, middle, and distal regions (p<0.001), while echogenicity of the tendon increased in proximal and distal regions (p<0.001) after start acceleration. Regional-dependent alterations of PT thickness and stiffness may be related to anatomical and physiological mechanisms due to acute isometric contraction in the initial phase of standing start. Tendon echogenicity might be also useful in monitoring tendon mechanical properties and defining acute fatigue-induced changes.

Key words

stiffness - thickness - overloading - ultrasonography - myotonometry

Publication History

Received: 14 September 2022

Accepted: 23 January 2023

Accepted Manuscript online:
23 January 2023

Article published online:
06 October 2023

• References

• 1 Martin JC, Davidson CJ, Pardyjak ER.. Understanding sprint-cycling performance: The integration of muscle power, resistance, and modeling. Int J Sports Physiol Perform 2007; 2: 5-21
• 2 Ferguson HA, Harnish C, Chase JGJSm-o. Using field based data to model sprint track cycling performance. Sports Med – Open 2021; 7: 1-12
• 3 Klich S, Krymski I, Michalik K. et al. Effect of short-term cold-water immersion on muscle pain sensitivity in elite track cyclists. Phys Ther Sport 2018; 32: 42-47
• 4 Klich S, Ficek K, Krymski I. et al. Quadriceps and patellar tendon thickness and stiffness in elite track cyclists: An ultrasonographic and myotonometric evaluation. Front Physiol 2020; 11: 1659
• 5 Wanich T, Hodgkins C, Columbier JA. et al. Cycling injuries of the lower extremity. J Am Acad Orthop Surg 2007; 15: 748-756
• 6 Penailillo L, Blazevich AJ, Nosaka K.. Muscle fascicle behavior during eccentric cycling and its relation to muscle soreness. Med Sci Sports Exerc 2015; 47: 708-717
• 7 Edama M, Kageyama I, Nakamura M. et al. Anatomical study of the inferior patellar pole and patellar tendon. Scand J Med Sci Sports 2017; 27: 1681-1687
• 8 Klich S, Kosendiak A, Krymski I. et al. Ultrasound imaging of patellar tendon thickness in elite sprint track cyclists and elite soccer players: An intra-rater and inter-rater reliability study. Plos One 2022; 17: e0270871
• 9 Weinreb JH, Sheth C, Apostolakos J. et al. Tendon structure, disease, and imaging. Muscles Ligaments Tendons J 2014; 4: 66-73
• 10 del Baño-Aledo ME, Martínez-Payá JJ, Ríos-Díaz J. et al. Ultrasound measures of tendon thickness: Intra-rater. Inter-rater and Inter-machine reliability. Muscles Ligaments Tendons J 2017; 7: 192
• 11 Skou ST, Aalkjaer JM.. Ultrasonographic measurement of patellar tendon thickness – a study of intra- and interobserver reliability. Clin Imaging 2013; 37: 934-937
• 12 Gellhorn AC, Carlson MJ.. Inter-rater, intra-rater, and inter-machine reliability of quantitative ultrasound measurements of the patellar tendon. Ultrasound Med Biol 2013; 39: 791-796
• 13 O’Connor PJ, Grainger AJ, Morgan S. et al. Ultrasound assessment of tendons in asymptomatic volunteers: A study of reproducibility. Eur Radiol 2004; 14: 1968-1973
• 14 Holm PM, Skou ST, Olesen JL. et al. Ultrasonographic assessment of patellar tendon thickness at 16 clinically relevant measurement sites – A study of intra-and interrater reliability. J Bodyw Mov Ther 2019; 23: 344-351
• 15 Toprak U, Ustuner E, Uyanik S. et al. Comparison of ultrasonographic patellar tendon evaluation methods in elite junior female volleyball players: Thickness versus cross-sectional area. Diagn Interv Imaging 2012; 18: 200-207
• 16 Castro J, Livino de Carvalho K, Silva PE. et al. Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients. PloS one 2019; 14: e0219057
• 17 Ekizos A, Papatzika F, Charcharis G. et al. Ultrasound does not provide reliable results for the measurement of the patellar tendon cross sectional area. J Electromyogr Kinesiol 2013; 23: 1278-1282
• 18 Kongsgaard M, Reitelseder S, Pedersen TG. et al. Region specific patellar tendon hypertrophy in humans following resistance training. Acta Physiol 2007; 191: 111-121
• 19 Couppe C, Kongsgaard M, Aagaard P. et al. Habitual loading results in tendon hypertrophy and increased stiffness of the human patellar tendon. J Appl Physiol 2008; 105: 805-810
• 20 Malliaras P, Kamal B, Nowell A. et al. Patellar tendon adaptation in relation to load-intensity and contraction type. J Biomech 2013; 46: 1893-1899
• 21 Sato Y, Kösters A, Rieder F. et al. Quantitative Analysis of Patellar Tendon After Total Knee Arthroplasty Using Echo Intensity: A Nonrandomized Controlled Trial of Alpine Skiing. J Arthroplasty 2020; 35: 2858-2864
• 22 Nardello F, Bernabè R, Bettega S. et al. Kinematics of Backward Standing Starts in Elite Cyclists: The Effect of Initial Crank Angle. Res Q Exerc Sport 2022; 12: 1-9
• 23 Jansen C, McPhee J.. Predictive dynamic simulation of Olympic track cycling standing start using direct collocation optimal control. Multibody Syst Dyn 2020; 49: 53-70
• 24 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344-349
• 25 Watanabe K, Sato T, Mukaimoto T. et al. Electromyographic analysis of thigh muscles during track cycling on a velodrome. J Sports Sci 2016; 34: 1413-1422
• 26 Martin JC, Wagner BM, Coyle EF.. Inertial-load method determines maximal cycling power in a single exercise bout. Med Sci Sports Exerc 1997; 29: 1505-1512
• 27 Giombini A, Dragoni S, Di Cesare A. et al. Asymptomatic A chilles, patellar, and quadriceps tendinopathy: A longitudinal clinical and ultrasonographic study in elite fencers. Scand J Med Sci Sports 2013; 23: 311-316
• 28 Beggs I, Bianchi S, Bueno A. et al. European society of musculoskeletal radiology. Musculoskeletal Ultrasound Technical Guidelines IV Hip. 2016
• 29 Schneider CA, Rasband WS, Eliceiri KW.. NIH Image to ImageJ: 25 years of image analysis. Nat Methods 2012; 9: 671-675
• 30 Richardson JT.. Eta squared and partial eta squared as measures of effect size in educational research. Rev Educ Res 2011; 6: 135-147
• 31 Hopkins WG, Marshall SW, Batterham AM. et al. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc 2009; 41: 3-13
• 32 Basso O, Amis AA, Race A. et al. Patellar tendon fiber strains: Their differential responses to quadriceps tension. Clin Orthop Relat Res 2002; 400: 246-53
• 33 Andarawis-Puri N, Flatow EL.. Tendon fatigue in response to mechanical loading. J Musculoskelet Neuronal Interact 2011; 11: 106-114
• 34 Zhang Q, Iyer A, Lambeth K. et al. Ultrasound Echogenicity-based Assessment of Muscle Fatigue During Functional Electrical Stimulation. Annual International Conference of the IEEE Engineering in Medicine and Biology Society IEEE Engineering in Medicine and Biology Society Annual International Conference 2021; 5948-5952
• 35 Malliaras P, Cook J.. Changes in anteroposterior patellar tendon diameter support a continuum of pathological changes. Br J Sports Med 2011; 45: 1048-1051
• 36 Stone MH, Sands WA, Carlock J. et al. The importance of isometric maximum strength and peak rate-of-force development in sprint cycling. J Strength Cond. Res 2004; 18: 878-884
• 37 Douglas J, Ross A, Martin JC.. Maximal muscular power: Lessons from sprint cycling. Sports Med – Open 2021; 7: 48
• 38 Young FC, Cristi-Sánchez I, Danes-Daetz C. et al. Patellar Tendon Stiffness in Elite Breakdancers Assessed by Myotonometric Measurement. J Dance Med Sci 2018; 22: 179-183
• 39 Cristi-Sánchez I, Danes-Daetz C, Neira A. et al. Patellar and Achilles Tendon Stiffness in Elite Soccer Players Assessed Using Myotonometric Measurements. Sports Health 2019; 11: 157-162
• 40 Burgess KE, Connick MJ, Graham-Smith P. et al. Plyometric vs. isometric training influences on tendon properties and muscle output. J Strength Cond Res 2007; 21: 986-989
• 41 Kubo K, Ikebukuro T, Maki A. et al. Time course of changes in the human Achilles tendon properties and metabolism during training and detraining in vivo. Eur J Appl Physiol 2012; 112: 2679-2691
• 42 Arampatzis A, Mersmann F, Bohm S.. Individualized muscle-tendon assessment and training. Front Physiol 2020; 11
• 43 O'Brien TD, Reeves ND, Baltzopoulos V. et al. Mechanical properties of the patellar tendon in adults and children. J Biomech 2010; 43: 1190-1195
• 44 Yu Z, SJRoMP Boseck. Scanning acoustic microscopy and its applications to material characterization. Rev Mod Phys 1995; 67: 863
• 45 Suydam SM, Buchanan TS.. Is echogenicity a viable metric for evaluating tendon properties in vivo?. J Biomech 2014; 47: 1806-1809