Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zürich, Switzerland.
Ann Biomed Eng. 2021 Jan;49(1):7-28. doi: 10.1007/s10439-020-02635-5. Epub 2020 Oct 6.
The critical clinical and scientific insights achieved through knowledge of in vivo musculoskeletal soft tissue strains has motivated the development of relevant measurement techniques. This review provides a comprehensive summary of the key findings, limitations, and clinical impacts of these techniques to quantify musculoskeletal soft tissue strains during dynamic movements. Current technologies generally leverage three techniques to quantify in vivo strain patterns, including implantable strain sensors, virtual fibre elongation, and ultrasound. (1) Implantable strain sensors enable direct measurements of tissue strains with high accuracy and minimal artefact, but are highly invasive and current designs are not clinically viable. (2) The virtual fibre elongation method tracks the relative displacement of tissue attachments to measure strains in both deep and superficial tissues. However, the associated imaging techniques often require exposure to radiation, limit the activities that can be performed, and only quantify bone-to-bone tissue strains. (3) Ultrasound methods enable safe and non-invasive imaging of soft tissue deformation. However, ultrasound can only image superficial tissues, and measurements are confounded by out-of-plane tissue motion. Finally, all in vivo strain measurement methods are limited in their ability to establish the slack length of musculoskeletal soft tissue structures. Despite the many challenges and limitations of these measurement techniques, knowledge of in vivo soft tissue strain has led to improved clinical treatments for many musculoskeletal pathologies including anterior cruciate ligament reconstruction, Achilles tendon repair, and total knee replacement. This review provides a comprehensive understanding of these measurement techniques and identifies the key features of in vivo strain measurement that can facilitate innovative personalized sports medicine treatment.
通过对活体肌肉骨骼软组织应变的了解而获得的关键临床和科学见解，促使相关测量技术得以发展。本综述全面总结了这些技术的关键发现、局限性和临床影响，这些技术可用于量化动态运动中的肌肉骨骼软组织应变。目前的技术通常利用三种技术来量化活体应变模式，包括可植入应变传感器、虚拟纤维伸长和超声。(1)可植入应变传感器能够以高精度和最小的伪影直接测量组织应变，但具有高度侵入性，目前的设计在临床上不可行。(2)虚拟纤维伸长法跟踪组织附着点的相对位移，以测量深层和浅层组织的应变。然而，相关的成像技术通常需要暴露在辐射下，限制了可进行的活动，并且只能量化骨对骨的组织应变。(3)超声方法可安全、非侵入性地对软组织变形进行成像。然而，超声只能对浅层组织成像，并且测量受到组织的面外运动的干扰。最后，所有的活体应变测量方法都受到其确定肌肉骨骼软组织结构松弛长度的能力的限制。尽管这些测量技术存在许多挑战和局限性，但对活体软组织应变的了解已经导致许多肌肉骨骼病理学的临床治疗得到改善，包括前交叉韧带重建、跟腱修复和全膝关节置换。本综述全面了解了这些测量技术，并确定了活体应变测量的关键特征，这些特征可以促进创新的个性化运动医学治疗。
