Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?
Achilles tendon
injuries
patellar tendon
soldiers
ultrasound
Journal
Scandinavian journal of medicine & science in sports
ISSN: 1600-0838
Titre abrégé: Scand J Med Sci Sports
Pays: Denmark
ID NLM: 9111504
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
09
02
2020
revised:
01
08
2020
accepted:
26
08
2020
pubmed:
5
9
2020
medline:
4
5
2021
entrez:
5
9
2020
Statut:
ppublish
Résumé
Aiming to investigate whether Achilles tendon (AT) structure and patellar tendon (PT) structure are risk factors for musculoskeletal injuries in combat soldiers, 168 participants were recruited from an infantry commander's course. The AT and PT were examined pre-course using UTC to capture the structure of four echo-type fibers (I-IV). All injuries were assessed by military physicians pre-course and throughout the 14-week course. Soldiers who were injured during the course had a significantly higher pre-course prevalence of AT and PT echo-type III and echo-type IV compared to soldiers that were not injured during the course. Variables that were found to be associated with injured/non-injured participants were echo-type III + IV of the PT (OR = 1.44, 95% CI = 1.24-1.68) and echo-type III of the AT (OR = 1.69, 95% CI = 1.35-2.12). ROC analyses showed that the best model, exhibiting both high sensitivity and low specificity, was that participants with PT echo-type III + IV > 10% or AT echo-type III >8.5% had the highest risk of being injured during the course. In conclusions, the tendon structure at the beginning of high-intensity activity or physical training program might be a risk factor for subsequent injury during the course. Soldiers and high-level athletes should be aware of the cutoff points for fiber types in tendon structure that might put them at high risk for future injury. At-risk soldiers/athletes should be provided with an intervention program before they start their training program, with the aim of improving the tendon structure and preventing subsequent injury.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
205-214Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Halvarsson A, Hagman I, Tegern M, et al. Self-reported musculoskeletal complaints and injuries and exposure of physical workload in Swedish soldiers serving in Afghanistan. PLoS One. 2018;13(4):e0195548.
Pope R, Orr R. Incidence rates for work health and safety incidents and injuries in Australian Army reserve vs full time soldiers, and a comparison of reporting systems. J Mil Veteran Health. 2017;25(2):16-25.
The IDF Conference for Medical and Combat Fitness Issues the IDF Conference. Wingate, Israel; 2012.
Linenger JM, West LA. Epidemiology of soft-tissue/musculoskeletal injury among U.S. Marine recruits undergoing basic training. Mil Med. 1992;157(9):491-493.
Milgrom C, Finestone A, Zin D, et al. Cold weather training: a risk factor for Achilles paratendinitis among recruits. Foot Ankle Int. 2003;24(5):398-401.
Owens BD, Wolf JM, Seelig AD, et al. Risk factors for lower extremity tendinopathies in military personnel. Orthop J Sports Med. 2013;1(1):2325967113492707.
Lovalekar M, Perlsweig KA, Keenan KA, et al. Epidemiology of musculoskeletal injuries sustained by Naval Special Forces Operators and students. J Sci Med Sport. 2017;20(Suppl 4):S51-S56.
Biancalana A, Velloso LA, Taboga SR, et al. Implications of obesity for tendon structure, ultrastructure and biochemistry: a study on Zucker rats. Micron. 2012;43(2-3):463-469.
Abate M, Di Gregorio P, Schiavone C, et al. Platelet rich plasma in tendinopathies: how to explain the failure. Int J Immunopathol Pharmacol. 2012;25(2):325-334.
Heinemeier KM, Kjaer M. In vivo investigation of tendon responses to mechanical loading. J Musculoskelet Neuronal Interact. 2011;11(2):115-123.
Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nat Rev Rheumatol. 2010;6(5):262-268.
Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416.
Rabin A, Kozol Z, Finestone AS. Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study. J Foot Ankle Res. 2014;7(1):48.
Taanila H, Suni JH, Kannus P, et al. Risk factors of acute and overuse musculoskeletal injuries among young conscripts: a population-based cohort study. BMC Musculoskelet Disord. 2015;16:104.
Teyhen DS, Shaffer SW, Butler RJ, et al. What risk factors are associated with musculoskeletal injury in US Army Rangers? A prospective prognostic study. Clin Orthop Relat Res. 2015;473(9):2948-2958.
Visnes H, Bahr R. Training volume and body composition as risk factors for developing jumper's knee among young elite volleyball players. Scand J Med Sci Sports. 2013;23(5):607-613.
Docking SI, Rosengarten SD, Cook J. Achilles tendon structure improves on UTC imaging over a 5-month pre-season in elite Australian football players. Scand J Med Sci Sports. 2016;26(5):557-563.
Docking SI, Cook J. Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC). Scand J Med Sci Sports. 2016;26(6):675-683.
Esmaeili A, Stewart AM, Hopkins WG, et al. Effects of training load and leg dominance on Achilles and patellar tendon structure. Int J Sports Physiol Perform. 2017;12(Suppl 2):S2122-S2126.
Rabello LM, van den Akker-Scheek I, Kuipers IF, et al. Bilateral changes in tendon structure of patients diagnosed with unilateral insertional or midportion achilles tendinopathy or patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2020;28(5):1631-1638.
Waugh CM, Alktebi T, de Sa A, et al. Impact of rest duration on Achilles tendon structure and function following isometric training. Scand J Med Sci Sports. 2018;28(2):436-445.
Maciel Rabello L, Zwerver J, Stewart RE, et al. Patellar tendon structure responds to load over a 7-week preseason in elite male volleyball players. Scand J Med Sci Sports. 2019;29(7):992-999.
Mersmann F, Bohm S, Schroll A, et al. Muscle and tendon adaptation in adolescent athletes: a longitudinal study. Scand J Med Sci Sports. 2017;27(1):75-82.
Rosengarten SD, Cook JL, Bryant AL, et al. Australian football players' Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study. Br J Sports Med. 2015;49(3):183-187.
van Schie HT, de Vos RJ, de Jonge S, et al. Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. Br J Sports Med. 2010;44(16):1153-1159.
Docking SI, Ooi CC, Connell D. Tendinopathy: is imaging telling us the entire story? J Orthop Sports Phys Ther. 2015;45(11):842-852.
Gaida JE, Ashe MC, Bass SL, et al. Is adiposity an under-recognized risk factor for tendinopathy? A systematic review. Arthritis Rheum. 2009;61(6):840-849.
Masci L, Spang C, van Schie HT, et al. Achilles tendinopathy-do plantaris tendon removal and Achilles tendon scraping improve tendon structure? A prospective study using ultrasound tissue characterisation. BMJ Open Sport Exerc Med. 2015;1(1):e000005.
Docking SI, Rosengarten SD, Daffy J, et al. Structural integrity is decreased in both Achilles tendons in people with unilateral Achilles tendinopathy. J Sci Med Sport. 2015;18(4):383-387.
Stanley LE, Lucero A, Mauntel TC, et al. Achilles tendon adaptation in cross-country runners across a competitive season. Scand J Med Sci Sports. 2018;28(1):303-310.
van Ark M, Docking SI, van den Akker-Scheek I, et al. Does the adolescent patellar tendon respond to 5 days of cumulative load during a volleyball tournament? Scand J Med Sci Sports. 2016;26(2):189-196.
Steinberg N, Eliakim A, Elbaz L, et al. Achilles tendon tissue structure in children with overweight and children with obesity. Phys Occup Ther Pediatr. 2020;40(3):330-344.
Nye NS, Pawlak MT, Webber BJ, et al. Description and rate of musculoskeletal injuries in Air Force Basic Military Trainees, 2012-2014. J Athl Train. 2016;51(11):858-865.
Bansbach HM, Lovalekar MT, Abt JP, et al. Military personnel with self-reported ankle injuries do not demonstrate deficits in dynamic postural stability or landing kinematics. Clin Biomech (Bristol, Avon). 2017;47:27-32.
Schwartz O, Kanevsky B, Kutikov M, et al. Medical attrition from commanders training in the Israeli Defense Forces (IDF): a cross-sectional study on 23,841 soldiers. Mil Med. 2018;183(9-10):e363-e369.
van Schie HT, Bakker EM, Jonker AM, et al. Computerized ultrasonographic tissue characterization of equine superficial digital flexor tendons by means of stability quantification of echo patterns in contiguous transverse ultrasonographic images. Am J Vet Res. 2003;64(3):366-375.
McAuliffe S, McCreesh K, Culloty F, et al. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis. Br J Sports Med. 2016;50(24):1516-1523.
Visnes H, Tegnander A, Bahr R. Ultrasound characteristics of the patellar and quadriceps tendons among young elite athletes. Scand J Med Sci Sports. 2015;25(2):205-215.
Cook JL, Rio E, Purdam CR, et al. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016;50(19):1187-1191.
Seynnes OR, Erskine RM, Maganaris CN, et al. Training-induced changes in structural and mechanical properties of the patellar tendon are related to muscle hypertrophy but not to strength gains. J Appl Physiol (1985). 2009;107(2):523-530.
Abate M, Verna S, Di Gregorio P, et al. Sonographic findings during and after platelet rich plasma injections in tendons. Muscles Ligaments Tendons J. 2014;4(1):29-34.
Biancalana A, Veloso LA, Gomes L. Obesity affects collagen fibril diameter and mechanical properties of tendons in Zucker rats. Connect Tissue Res. 2010;51(3):171-178.
Azevedo LB. Biomechanical variables associated with Achilles tendinopathy in runners. Br J Sports Med. 2009;43(4):288-292.
O'Neill S, Barry S, Watson P. Plantarflexor strength and endurance deficits associated with mid-portion Achilles tendinopathy: the role of soleus. Phys Ther Sport. 2019;37:69-76.
Theisen A, Day J. Chronic ankle instability leads to lower extremity kinematic changes during landing tasks: a systematic review. Int J Exerc Sci. 2019;12(1):24-33.
Mahieu NN, Witvrouw E, Stevens V, et al. Intrinsic risk factors for the development of Achilles tendon overuse injury: a prospective study. Am J Sports Med. 2006;34(2):226-235.
Arnason A, Sigurdsson SB, Gudmundsson A, et al. Risk factors for injuries in football. Am J Sports Med. 2004;32(1 Suppl):5S-16S.
Murphy DF, Connolly DA, Beynnon BD. Risk factors for lower extremity injury: a review of the literature. Br J Sports Med. 2003;37(1):13-29.
Dvorak J, Junge A. Football injuries and physical symptoms. A review of the literature. Am J Sports Med. 2000;28(5 Suppl):S3-9.
Faude O, Junge A, Kindermann W, et al. Risk factors for injuries in elite female soccer players. Br J Sports Med. 2006;40(9):785-790.
Nilstad A, Andersen TE, Bahr R, et al. Risk factors for lower extremity injuries in elite female soccer players. Am J Sports Med. 2014;42(4):940-948.
Brinkman RE, Evans TA. History of ankle sprain as a risk factor of future lateral ankle sprain in athletes. J Sport Rehabil. 2011;20(3):384-388.
Green B, Bourne MN, van Dyk N, et al. Recalibrating the risk of hamstring strain injury (HSI) - A 2020 systematic review and meta-analysis of risk factors for index and recurrent HSI in sport. Br J Sports Med. 2020. https://doi.org/10.1136/bjsports-2019-100983
Wiggins AJ, Grandhi RK, Schneider DK, et al. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2016;44(7):1861-1876.
Comin J, Cook JL, Malliaras P, et al. The prevalence and clinical significance of sonographic tendon abnormalities in asymptomatic ballet dancers: a 24-month longitudinal study. Br J Sports Med. 2013;47(2):89-92.
Wezenbeek E, Mahieu N, Willems TM, et al. What does normal tendon structure look like? New insights into tissue characterization in the Achilles tendon. Scand J Med Sci Sports. 2017;27(7):746-753.
Rudavsky A, Cook JL, Docking S. Proximal patellar tendon pathology can develop during adolescence in young ballet dancers-A 2-year longitudinal study. Scand J Med Sci Sports. 2018;28(9):2035-2041.
Hulin BT, Gabbett TJ, Lawson DW, et al. The acute:chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. Br J Sports Med. 2016;50(4):231-236.