SERKAN TAŞ, SEVAL YILMAZ, MEHMET RUHİ ONUR, ABDULLAH RUHİ SOYLU, ONUR ALTUNTAŞ, FEZA KORKUSUZ

Patellar tendon mechanical properties change with gender, body mass index and quadriceps femoris muscle strength

Objective: The purpose of this study is to assess the effect and correlation of gender, body mass index(BMI) and quadriceps femoris (QF) muscle strength on patellar tendon (PT) thickness and stiffness inhealthy sedentary individuals.Methods: This study was carried out with 67 (36 female, 31 male) healthy sedentary individuals betweenthe ages of 18e44 (28.0 ± 7.5 years). The individuals included in the study were divided into two groupsaccording to their gender and BMI (18.5< BMI < 25 and 25 < BMI). The body composition was determined with Tanita Body Composition Analyser. PT thickness and stiffness was measured with ACUSONS3000 Ultrasonography Device using 9L4 ultrasonography probe. QF concentric muscle strength of theindividuals was measured with Biodex®System 4 Dynamometer at 60/sec angular speed.Results: It was found that PT stiffness was higher in males compared to females (p< 0.001). It was foundthat PT stiffness was lower in obese individuals compared to individuals with normal weight (p¼ 0.017).A negative and weak correlation was found between BMI and PT stiffness (r¼ 0.26, p ¼ 0.032), whereasa negative and moderate correlation was found between fat percentage and PT stiffness (r¼ 0.50,p< 0.001). A moderate correlation was found between BMI and PT thickness (r ¼ 0.54, p < 0.001). It wasfound that peak torque at 60/sec angular speed had a moderate correlation with PT stiffness (r¼ 0.44,p< 0.001) and PT thickness (r ¼ 0.45, p < 0.001).Conclusions: PT stiffness is correlated and affected by gender, BMI and QF muscle strength whereas PTthickness is correlated and affected only to BMI and QF muscle strength.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This is anopen access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Wang JH, IosiŞdis MI, Fu FH. Biomechanical basis for tendinopathy. Clin Orthop Relat Res. 2006;443:320e332.

Stone MH, Sanborn K, O'Bryant HS, et al. Maximum strength-power performance relationships in collegiate throwers. J Strength Cond Res. 2003;17(4):739e745.

Bijur PE, Horodyski M, Egerton W, Kurzon M, Lifrak S, Friedman S. Comparison of injury during cadet basic training by gender. Arch Pediatr Adolesc Med. ;151(5):456e461.

Kelly BM, Rao N, Louis SS, Kostes BT, Smith RM. Bilateral, simultaneous, spontaneous rupture of quadriceps tendons without trauma in an obese pa tient: a case report. Arch Phys Med Rehabil. 2001;82(3):415e418.

Savarese E, Bisicchia S, Amendola A. Bilateral spontaneous concurrent rupture of the patellar tendon in a healthy man: case report and review of the litera ture. Musculoskelet Surg. 2010;94(2):81e88.

Allison K, Vicenzino B, Wrigley TV, Grimaldi A, Hodges PW, Bennell KL. Hip abductor muscle weakness in individuals with gluteal tendinopathy. Med Sci Sports Exerc. 2016;48(3):346e352.

Maganaris CN, Paul JP. In vivo human tendon mechanical properties. J Physiol. ;521(1):307e313.

Pearson SJ, Onambele GN. Influence of time of day on tendon compliance and estimations of voluntary activation levels. Muscle Nerve. 2006;33(6):792e800.

Komi PV. Physiological and biomechanical correlates of muscle function: effects of muscle structure and stretch-shortening cycle on force and speed. Exerc Sport Sci Rev. 1984;12(1):81e122.

Liu SH, Al-Shaikh RA, Panossian V, Finerman GA, Lane JM. Estrogen affects the cellular metabolism of the anterior cruciate ligament A potential explanation for female athletic injury. Am J Sports Med. 1997;25(5):704e709.

Hopkins JT, Brown TN, Christensen L, Palmieri-Smith RM. DeŞcits in peroneal latency and electromechanical delay in patients with functional ankle insta- bility. J Orthop Res. 2009;27(12):1541e1546.

Blackburn JT, Bell DR, Norcross MF, Hudson JD, Engstrom LA. Comparison of hamstring neuromechanical properties between healthy males and females and the influence of musculotendinous stiffness. J Electromyogr Kinesiol. 2009;19(5):362e369.

Klauser AS, Miyamoto H, Bellmann-Weiler R, Feuchtner GM, Wick MC, Jaschke WR. Sonoelastography: musculoskeletal applications. Radiology. 2014;272(3):622e633.

Drakonaki E, Allen G, Wilson D. Ultrasound elastography for musculoskeletal applications. Br J Radiol. 2012;85(1019):1435e1445.

Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control. 2004;51(4):396e409.

Shiina T, Nightingale KR, Palmeri ML, et al. WFUMB guidelines and recom- mendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41(5):1126e1147.

Szczepanek-Parulska E, Woli nski K, Stangierski A, et al. Comparison of diag- nostic value of conventional ultrasonography and shear wave elastography in the prediction of thyroid lesions malignancy. PLoS One. 2013;8(11):e81532.

Onamb el e GN, Burgess K, Pearson SJ. Gender-speciŞc in vivo measurement of the structural and mechanical properties of the human patellar tendon. J Orthop Res. 2007;25(12):1635e1642.

Kubo K, Kanehisa H, Fukunaga T. Gender differences in the viscoelastic prop- erties of tendon structures. Eur J Appl Physiol. 2003;88(6):520e526.

Burgess KE, Graham-Smith P, Pearson SJ. Effect of acute tensile loading on gender-speciŞc tendon structural and mechanical properties. J Orthop Res. 2009;27(4):510e516.

Morrison SM, Dick TJ, Wakeling JM. Structural and mechanical properties of the human Achilles tendon: sex and strength effects. J Biomech. 2015;48(12): 3530e3533.

Burgess K, Pearson SJ, Breen L, Onamb el e G. Tendon structural and mechanical properties do not differ between genders in a healthy community-dwelling elderly population. J Orthop Res. 2009;27(6):820e825.

O'Brien TD, Reeves ND, Baltzopoulos V, Jones DA, Maganaris CN. Mechanical properties of the patellar tendon in adults and children. J Biomech. 2010;43(6): 1190e1195.

Muraoka T, Muramatsu T, Fukunaga T, Kanehisa H. Elastic properties of human Achilles tendon are correlated to muscle strength. J Appl Physiol (1985). 2005;99(2):665e669.

Marangoz _I, Aktug ZB, Çelenk Ç, Top E, Eroglu H, Akil M. The comparison of the pulmonary functions of the individuals having regular exercises and sedentary individuals. Biomed Res. 2016;27(2):357e359.

Brophy R, Silvers HJ, Gonzales T, Mandelbaum BR. Gender influences: the role of leg dominance in ACL injury among soccer players. Br J Sports Med. 2010;44(10):694e697.

Ranasinghe C, Gamage P, Katulanda P, Andraweera N, Thilakarathne S, Tharanga P. Relationship between body mass index (BMI) and body fat percentage, estimated by bioelectrical impedance, in a group of Sri Lankan adults: a cross sectional study. BMC Public Health. 2013;13(1):797.

Douketis JD, Paradis G, Keller H, Martineau C. Canadian guidelines for body weight classiŞcation in adults: application in clinical practice to screen for overweight and obesity and to assess disease risk. CMAJ. 2005;172(8): 995e998.

Pincivero D, Lephart S, Karunakara R. Reliability and precision of isokinetic strength and muscular endurance for the quadriceps and hamstrings. I Int J Sports Med. 1997;18(2):113e117.

Abate M, Gravare-Silbernagel K, Siljeholm C, et al. Pathogenesis of tendino- pathies: inflammation or degeneration? Arthritis Res Ther. 2009;11(3):235.

Heinemeier K, Kjaer M. In vivo investigation of tendon responses to mechanical loading. J Musculoskelet Neuronal Interact. 2011;11(2):115e123.

Reeves ND, Maganaris CN, Ferretti G, Narici MV. Influence of 90-day simulated microgravity on human tendon mechanical properties and the effect of resis- tive countermeasures. J Appl Physiol (1985). 2005;98(6):2278e2286.

Uldbjerg N, Ulmsten U. The physiology of cervical ripening and cervical dila- tation and the effect of abortifacient drugs. Baillieres Clin Obstet Gynaecol. 1990;4(2):263e282.

Wentorf FA, Sudoh K, Moses C, Arendt EA, Carlson CS. The effects of estrogen on material and mechanical properties of the intra-and extra-articular knee structures. Am J Sports Med. 2006;34(12):1948e1952.

Hart DA, Archambault JM, Kydd A, Reno C, Frank CB, Herzog W. Gender and neurogenic variables in tendon biology and repetitive motion disorders. Clin Orthop Relat Res. 1998;351:44e56.

Hama H, Yamamuro T, Takeda T. Experimental studies on connective tissue of the capsular ligament: influences of aging and sex hormones. Acta Orthop Scand. 1976;47(5):473e479.

Warren DY, Panossian V, Hatch JD, Liu SH, Finerman GA. Combined effects of estrogen and progesterone on the anterior cruciate ligament. Clin Orthop Relat Res. 2001;383:268e281.

Yoo JH, Yi SR, Kim JH. The geometry of patella and patellar tendon measured on knee MRI. Surg Radiol Anat. 2007;29(8):623e628.

Cilli F, Khan M, Fu F, Wang JH-C. Prostaglandin E2 affects proliferation and collagen synthesis by human patellar tendonŞbroblasts. Clin J Sport Med. 2004;14(4):232e236.

Battery L, Maffulli N. Inflammation in overuse tendon injuries. Sports Med Arthrosc. 2011;19(3):213e217.

Vesentini S, Redaelli A, Gautieri A. Nanomechanics of collagen microŞbrils. Muscles Ligaments Tendons J. 2013;3(1):23e34.

Kawakami Y, Kubo K, Kanehisa H, Fukunaga T. Effect of series elasticity on isokinetic torqueeangle relationship in humans. Eur J Appl Physio. 2002;87(4- 5):381e387.

Abate M, Oliva F, Schiavone C, Salini V. Achilles tendinopathy in amateur runners: role of adiposity (Tendinopathies and obesity). Muscles Ligaments Tendons J. 2012;2(1):44e48.

Wearing SC, Hooper SL, Grigg NL, Nolan G, Smeathers JE. Overweight and obesity alters the cumulative transverse strain in the Achilles tendon imme- diately following exercise. J Bodyw Mov Ther. 2013;17(3):316e321.

Seynnes OR, Kamandulis S, Kairaitis R, et al. Effect of androgenic-anabolic steroids and heavy strength training on patellar tendon morphological and mechanical properties. J Appl Physiol (1985). 2013;115(1):84e89.

Kongsgaard M, Reitelseder S, Pedersen TG, et al. Region speciŞc patellar tendon hypertrophy in humans following resistance training. Acta Physiol (Oxf). 2007;191(2):111e121.