Pringels Lauren, Stouthandel Michael, Van Hoof Tom, Martens Manuel, Chevalier Amelie, Burssens Arne, Wezenbeek Evi, Vanden Bossche Luc
Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
Scand J Med Sci Sports. 2023 Nov;33(11):2230-2238. doi: 10.1111/sms.14467. Epub 2023 Aug 22.
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.
跟腱扭转可增强拉伸强度，但由于拉伸负荷时内部压力更大，高度扭转也可能是跟腱病的一个风险因素。然而，缺乏支持这一假设依据的证据。因此，我们旨在研究跟腱扭转类型对腱内压力的影响。将18条人类新鲜冷冻尸体下肢安装在测试装置中，通过超声引导在跟腱中部区域插入微型压力导管。在模拟直膝小腿伸展和离心足跟下降过程中测量腱内压力。然后仔细解剖跟腱并将其分为I型（最少）、II型（中度）和III型（极度）扭转。在所检查的跟腱中，发现9条为I型扭转（50%），9条为II型（50%），无III型。发现在两种运动过程中，跟腱的腱内压力均随踝关节背屈呈指数增加（p < 0.001），且II型扭转跟腱的这种增加幅度大于I型扭转跟腱（p < 0.05）。本研究提供了首个生物力学数据，以支持这一假设，即在跟腱高度扭转的运动员中，例如在小腿伸展和离心足跟下降等运动过程中，跟腱中部区域将承受更多的内部压力。这种现象是否也与跟腱病风险升高有关，需要进一步的前瞻性研究。
