Ultrasonography of the Patellar Tendon and Achilles Tendon in Children Adolescent and Adults
Condition: Obesity, Childhood; Obesity; Tendon Thickening
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      The aim of the current study is to evaluate the Patellar tendon and Achilles tendon
      structures among children, adolescents and adults with different weight status. That in order
      to improve our understanding on the impact of acute and overused loads on tendon structure;
      and, in developing strategies to reduce tendon's injuries following physical exercises.
    

Detailed description: 
      Studies showed that the probability of tendon abnormalities is higher in obese subjects
      compared to normal weight peer. Adiposity has been recognized as a risk factor for
      alterations in load- bearing tendons; and, different impact of loading exercises on tendon
      structure has been reported for obese individuals compared to normal weight individuals. The
      aim of the current study is to evaluate the Patellar tendon and Achilles tendon structures
      among children, adolescents and adults with different weight status. That in order to improve
      our understanding on the impact of acute and overused loads on tendon structure; and, in
      developing strategies to reduce tendon's injuries following physical exercises.

      Tendon structure would be evaluated with UTC-imaging ultrasound device. UTC imaging allows
      for three-dimensional imaging of the tendon, semi- quantification of structure, and
      calculation of tendon dimensions. The resultant UTC analysis quantify the tendon into four
      echo types (I-IV) based on the stability of pixel brightness over contiguous images allowing
      inferences to be made on the alignment of tendon bundles. Briefly, echo types I and II
      correspond with relatively high stability in gray-scale pixel brightness over contiguous
      images due to one resulting US signal transmission. These echo types correspond with aligned
      fibrillar structure (AFS) within the tendon. Echo types III and IV are generated by multiple
      signal transmission that interfere as a consequence of multiple interfaces. These echo types
      represent a disorganized amorphous fibrillar structure that has non parallel ﬁber
      arrangement. For this study, the relative percentage and (muscle cross section area (mCSA) of
      these parameters were the main outcomes investigated. A linear-array US transducer
      (SmartProbe, A 10- megahertz (MHz) linear-array transducer, USA) mounted within a customized
      tracking device with motor drive and built-in acoustic stand off pad (UTC Tracker, UTC
      Imaging, Netherlands) was placed on the skin, perpendicular to the long axis of the tendon
      (Achilles or patellar), ensuring that the calcaneus or inferior pole of the patella was
      visible. Coupling gel was applied between the transducer, standoff pad, and skin to ensure
      maximum contact. Once a clear transverse image of the tendon and bony landmark was
      established, the motor drive automatically moved the transducer over the length of the tendon
      capturing a transverse grayscale US image every 0.2 mm over a distance of 12 cm. By
      compounding these images, a gray-scale US image data block is rendered that allows the tendon
      to be viewed in three planes: transverse, sagittal, and coronal (UTC2010, UTC Imaging). From
      this data block, each tendon was classified as either normal or pathological.

      Each participant would be measured at both Achilles tendons and both Patellar tendons (total
      time 10min) while prone position (for the Achilles tendon) and in sitting position (for
      Patellar tendon). Each screening is for 45sec.

        -  Participants in different ages and different weight status would be measured for tendon
           structure

        -  Tendon structure would be evaluated following single and multiple (up to 12 weeks)
           aerobic and anaerobic exercises.
    

Intervention name(s): Impact of physical activity on tendons
Intervention type(s): Other
Intervention description(s): Single vs. multiple (up to 12 weeks) of different types of physical exercises (aerobic vs. anaerobic activities).
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: Ultrasound; Achilles tendon; Patellar tendon; obesity