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Introduction: The effect of chronic patellar tendinopathy on tissue function and integrity is currently unclear and underinvestigated. The aim of this cohort comparison was to examine morphological, material, and mechanical properties of the patellar tendon and to extend earlier findings by measuring the ability to store and return elastic energy in symptomatic tendons. Methods: Seventeen patients with chronic (>3 months, VISA-P < 80), inferior pole patellar tendinopathy (24 4 years; male = 12, female = 5) were carefully matched to controls (25 3 years) for training status, pattern, and history of loading of the patellar tendon. Individual knee extension force, patellar tendon stiffness, stress, strain, Youngs modulus, hysteresis, and energy storage capacity, were obtained with combined dynamometry, ultrasonography, magnetic resonance imaging, and electromyography. Results: Anthropometric parameters did not differ between groups. VISA-P scores ranged from 28 to 78 points, and symptoms had lasted from 10 to 120 months before testing. Tendon proximal cross-sectional area was 61% larger in the patellar tendinopathy group than in the control group. There were no differences between groups in maximal voluntary isometric knee extension torque (p = 0.216; d < 0.31) nor in tensile tendon force produced during isometric ramp contractions (p = 0.185; d < 0.34). Similarly, tendon strain (p = 0.634; d < 0.12), hysteresis (p = 0.461; d < 0.18), and strain energy storage (p = 0.656; d < 0.36) did not differ between groups. However, patellar tendon stiffness (19%; p = 0.007; d < 0.74), stress (27%; p< 0.002; d < 0.90) and Youngs modulus (32%; p = 0.001; d < 0.94) were significantly lower in tendinopathic patients compared to healthy controls. Discussion: In this study, we observed lower stiffness in affected tendons. However, despite the substantial structural and histological changes occurring with tendinopathy, the tendon capacity to store and dissipate energy did not differ significantly. (VLID)5346698

Equivocal findings exist on isokinetic and Nordic hamstring exercise testing of eccentric hamstring strength capacity. Here, we propose a critical comparison of the mechanical output of hamstring muscles as assessed with either a dynamometer (IKD) or a Nordic hamstring device (NHD). Twentyfive volunteers (26 3 years) took part in a counterbalanced repeatedmeasures protocol on both devices. Eccentric peak torque, work, angle of peak torque, bilateral strength ratios, and electromyography activity of the biceps femoris long head, semitendinosus and gastrocnemius muscles were assessed. There was a very poor correlation in eccentric peak torque between the devices (r < 0.58), with a systematic and proportional bias toward lower torque values on the IKD (28%) and a high typical error (19%) in IKD and NHD measurements comparison. Furthermore, participants performed a higher total eccentric work on IKD, reached peak torques at greater knee extension angles, and showed a greater sidetoside strength difference compared to the Nordic hamstring exercise. Gastrocnemius muscle activity was lower during the Nordic hamstring exercise. Reliability was low for work on NHD and for angle of peak torque and bilateral strength ratios on either device. We conclude that the evaluation of eccentric knee flexor strength depends on the testing conditions and even under standardized procedures, the IKD and NHD measure a different trait. Both tests have limitations in terms of assessing strength differences within an individual, and measurements of the angle of peak torque or sidetoside differences in eccentric knee flexor strength revealed low reliability and should be considered with caution. (VLID)4593241

This article aims to (a) describe the study design of a 6year followup multidisciplinary research project on aging, (b) report the psychosocial characteristics of the sample in detail, and (c) evaluate agingrelated changes of health, physical activity, and psychosocial characteristics in 10 youngold (age at pretest: M SD = 63.2 1.5) and 12 oldold (age at pretest: M SD = 69 2) individuals. Both age groups consist of individuals displaying a high health status, a high extent of physical activity, high levels of psychosocial properties in the dimensions of wellbeing, life satisfaction, selfconcept, body image, selfesteem, and selfefficacy, as well as a low general depression index. Psychosocial characteristics demonstrated a stable pattern over a period of nearly 6 years in both age groups with the exceptions of physical activity, satisfaction with children, general depression, and selfefficacy. Furthermore, physical selfconcept decreased in oldold adults, whereas the youngolds showed no change. We assume that a high psychosocial status and a physically active lifestyle play an important role for mastering aging successfully in two life phases, each of which has its own challenges for older individuals. The decline in the physical selfconcept of oldolds is interpreted as a first sign of subjective aging. Its association with losses in physical performance should be addressed in future studies. Finally, agingrelated changes should be monitored on an individual level in order to capture the complex dynamic of aging that is not considered in analyses of betweenperson differences or averages. (VLID)3598458

This study analyzes longterm changes in muscle strength, muscle architecture, and patellar tendon mechanical properties in a specific sample of physically active elderly people. Twentytwo participants were reexamined from a former 12weeklong skiing intervention study: 11 from the intervention group (IG: 7 , 4 ; 67 3 years) and 11 from the control group (CG: 6 , 5 ; 66 4 years). Muscle architecture, strength endurance, maximum torque, and tendon properties were analyzed three times within 6 months, and again 6 years later in a followup test. No changes in either group could be observed between June 2009 and April 2015 in any parameter. This can be interpreted positively because no agerelated decreases were found. Although our participants were physically active from the very beginning (>150 min/wk), it must be noted that the intensity of the physical activity was too low to provoke physiological improvements in leg strength or muscle/tendon morphology. (VLID)3598450

Introduction: During running and jumping activities, elastic energy is utilized to enhance muscle mechanical output and efficiency. However, training-induced variations in tendon spring-like properties remain under-investigated. The present work extends earlier findings on sport-specific profiles of tendon stiffness and cross-sectional area to examine whether years of distinct loading patterns are reflected by tendons' ability to store and return energy. Methods:Ultrasound scans were performed to examine the morphological features of knee extensor and plantar flexor muscle-tendon units in elite ski jumpers, distance runners, water polo players, and sedentary controls. Tendon strain energy and hysteresis were measured with combined motion capture, ultrasonography, and dynamometry. Results: Apart from the fractional muscle-to-tendon cross-sectional area ratio being lower in the knee extensors of ski jumpers (−31%) and runners (−33%) than in water polo players, no difference in the considered muscle-tendon unit morphological features was observed between groups. Similarly, no significant difference in tendon energy storage or energy return was detected between groups. In contrast, hysteresis was lower in the patellar tendon of ski jumpers (−33%) and runners (−30%) compared to controls, with a similar trend for the Achilles tendon (significant interaction effect and large effect sizes η2 = 0.2). Normalized to body mass, the recovered strain energy of the patellar tendon was ~50% higher in ski jumpers than in water polo players and controls. For the Achilles tendon, recovered strain energy was ~40% higher in ski jumpers and runners than in controls. Discussion: Advantageous mechanical properties related to tendon spring-like function are observed in elite athletes whose sport require effective utilization of elastic energy. However, the mechanisms underpinning the better tendon capacity of some athletes to retain elastic energy could not be ascribed to intrinsic or morphological features of the lower limb muscle-tendon unit.

Introduction: During running and jumping activities, elastic energy is utilized to enhance muscle mechanical output and efficiency. However, training-induced variations in tendon spring-like properties remain under-investigated. The present work extends earlier findings on sport-specific profiles of tendon stiffness and cross-sectional area to examine whether years of distinct loading patterns are reflected by tendons' ability to store and return energy. Methods: Ultrasound scans were performed to examine the morphological features of knee extensor and plantar flexor muscle-tendon units in elite ski jumpers, distance runners, water polo players, and sedentary controls. Tendon strain energy and hysteresis were measured with combined motion capture, ultrasonography, and dynamometry. Results: Apart from the fractional muscle-to-tendon cross-sectional area ratio being lower in the knee extensors of ski jumpers (31%) and runners (33%) than in water polo players, no difference in the considered muscle-tendon unit morphological features was observed between groups. Similarly, no significant difference in tendon energy storage or energy return was detected between groups. In contrast, hysteresis was lower in the patellar tendon of ski jumpers (33%) and runners (30%) compared to controls, with a similar trend for the Achilles tendon (significant interaction effect and large effect sizes 2 = 0.2). Normalized to body mass, the recovered strain energy of the patellar tendon was 50% higher in ski jumpers than in water polo players and controls. For the Achilles tendon, recovered strain energy was 40% higher in ski jumpers and runners than in controls. Discussion: Advantageous mechanical properties related to tendon spring-like function are observed in elite athletes whose sport require effective utilization of elastic energy. However, the mechanisms underpinning the better tendon capacity of some athletes to retain elastic energy could not be ascribed to intrinsic or morphological features of the lower limb muscle-tendon unit. (VLID)1773031

The present study aimed to determine whether distinct sets of tendon properties are seen in athletes engaged in sports with contrasting requirements for tendon function and structural integrity. Patellar and Achilles tendon morphology and force-deformation relation were measured by combining ultrasonography, electromyography and dynamometry in elite ski jumpers, distance runners, water polo players and sedentary individuals. Tendon cross-sectional area normalized to body mass2/3 was smaller in water polo players than in other athletes (patellar and Achilles tendon; -28 to -24%) or controls (patellar tendon only; -9%). In contrast, the normalized cross-sectional area was larger in runners (patellar tendon only; +26%) and ski jumpers (patellar and Achilles tendon; +21% and +13%, respectively) than in controls. Tendon stiffness normalized to body mass2/3 only differed in ski jumpers, compared to controls (patellar and Achilles tendon; +11% and +27%, respectively) and to water polo players (Achilles tendon only; +23%). Tendon size appears as an adjusting variable to changes in loading volume and/or intensity, possibly to preserve ultimate strength or fatigue resistance. However, uncoupled morphological and mechanical properties indicate that functional requirements may also influence tendon adaptations. Hans-Peter Wiesinger, Florian Rieder, Alexander Kösters, Erich Müller

The present study was conducted to assess test-retest reproducibility of explosive strength measurements during single-joint isometric knee extension using the IsoMed 2000 dynamometer. Thirty-one physically active male subjects (mean age: 23.7 years) were measured on two occasions separated by 4872 h. The intraclass correlation coefficient (ICC 2,1) and the coefficient of variation (CV) were calculated for (i) maximum torque (MVC), (ii) the peak rate of torque development (RTDpeak) as well as for (iii) the average rate of torque development (RTD) and the impulse taken at several predefined time intervals (030 to 0300 ms); thereby explosive strength variables were derived in two conceptually different versions: on the one hand from the MVC-trial (version I), on the other hand from the trial showing the RTDpeak (version II). High ICC-values (0.800.99) and acceptable CV-values (1.98.7%) could be found for MVC as well as for the RTD and the impulse taken at time intervals of 100 ms, regardless of whether version I or II was used. In contrast, measurements of the RTDpeak as well as the RTD and the impulse taken during the very early contraction phase (i.e. RTD/impulse030ms and RTD/impulse050ms) showed clearly weaker reproducibility results (ICC: 0.530.84; CV: 7.316.4%) and gave rise to considerable doubts as to clinical usefulness, especially when derived using version I. However, if there is a need to measure explosive strength for earlier time intervals in practice, it is, in view of stronger reproducibility results, recommended to concentrate on measures derived from version II, which is based on the RTDpeak-trial. (VLID)2148551

The aim of this study was to investigate the effect of alpine skiing on patellar tendon properties in patients with total knee arthroplasty (TKA). Thirty-one adults (70.4 ± 4.7 years) with unilateral TKA were recruited 2.7 ± 0.9 years after surgery and assigned to an intervention (IG) or a control group (CG). The IG underwent a 12-week guided skiing program. Tendon stiffness, Young's modulus, and cross-sectional area (CSA) were measured before and after the intervention. In both groups, mean tendon CSA was 28% (P

This study investigated the effectiveness of recreational skiing as an intervention to improve quadriceps muscle architecture, strength, and antagonistic co-activation in patients with unilateral total knee arthroplasty (TKA). Hence, patients with TKA were assigned to either an intervention group (IG) or control group (CG). The IG completed a 12-week guided skiing program whereas the CG was instructed not to change their daily routines for the same period and was not allowed to ski. Before, after the intervention/after an 8-week retention period m. rectus femoris (RF) cross-sectional area (CSA), m. vastus lateralis muscle thickness, fascicle length, and pennation angle were measured with ultrasonography, while isometric (90° knee angle) knee extension, flexion torque and m. biceps femoris co-activation were assessed on an isokinetic dynamometer in 26 patients. There were significant and stable increases in RF CSA for the operated (10%; P 0.05). There were no significant effects for other parameters (all P > 0.05). Overall, the skiing intervention was successful in increasing muscle mass in TKA older patients.

Animal studies suggest that regular exposure to whole-body vibration (WBV) induces an anabolic response in bone and tendon. However, the effects of this type of intervention on human tendon properties and its influence on the muscle-tendon unit function have never been investigated. The aim of this study was to investigate the effect of WBV training on the patellar tendon mechanical, material and morphological properties, the quadriceps muscle architecture and the knee extension torque–angle relationship. Fifty-five subjects were randomized into either a vibration, an active control, or an inactive control group. The active control subjects performed isometric squats on a vibration platform without vibration. Muscle and tendon properties were measured using ultrasonography and dynamometry. Vibration training induced an increase in proximal (6.3%) and mean (3.8%) tendon cross-sectional area, without any appreciable change in tendon stiffness and modulus or in muscle architectural parameters. Isometric torque at a knee angle of 90° increased in active controls (6.7%) only and the torque–angle relation remained globally unchanged in all groups. The present protocol did not appreciably alter knee extension torque production or the musculo-tendinous parameters underpinning this function. Nonetheless, this study shows for the first time that WBV elicits tendon hypertrophy in humans.

Introduction: In vivo measurements have been used in the past two decades to investigate the effects of increased loading on tendon properties, yet the current understanding of tendon macroscopic changes to training is rather fragmented, limited to reports of tendon stiffening, supported by changes in material properties and/or tendon hypertrophy. The main aim of this review was to analyze the existing literature to gain further insights into tendon adaptations by extracting patterns of dose-response and time-course. Methods: PubMed/Medline, SPORTDiscus, and Google Scholar databases were searched for studies examining the effect of training on material, mechanical, and morphological properties via longitudinal or cross-sectional designs. Results: Thirty-five of 6440 peer-reviewed articles met the inclusion criteria. The key findings were i) the confirmation of a nearly systematic adaptation of tendon tissue to training, ii) the important variability in the observed changes in tendon properties between and within studies, and iii) the absence of a consistent incremental pattern regarding the dose-response or the time-course relation of tendon adaptation within the first months of training. However, long-term (years) training was associated with a larger tendon cross-sectional area, without any evidence of differences in material properties. Our analysis also highlighted several gaps in the existing literature, which may be addressed in future research. Conclusions: In line with some cross-species observations about tendon design, tendon cross-sectional area allegedly constitutes the ultimate adjusting parameter to increased loading. We propose here a theoretical model placing tendon hypertrophy and adjustments in material properties as parts of the same adaptive continuum (VLID)1661663