Biomechanical properties of the patellar tendon in children with heritable connective tissue disorders
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Hereditary connective tissue disorders (HCTDs), such as classic Ehlers–Danlos syndrome (cEDS) and Marfan syndrome (MS) share overlapping features like hypermobility and tissue fragility. In clinical practice it remains a challenge to distinguish children and adolescents with HCTD from healthy children. The purpose of this study was to investigate the biomechanical properties of the patellar tendon and joint laxity (Beighton score) in children with HCTDs (n = 7) compared to healthy controls (n = 14).
The mechanical properties of the patellar tendon were assessed using simultaneous force and ultrasonographic measurements during isometric ramp contractions. Ultrasonography was also used to measure tendon dimensions. The HCTD children were matched with 2 healthy controls with regard to age, body mass index (BMI), sex and physical activity level.
The HCTD children had a greater degree of joint laxity (P < 0.01). Although, the patellar tendon dimensions did not differ significantly between the two groups, the HCTD children showed a tendency toward a larger patellar tendon cross-sectional area (CSA) (35%, P = 0.19). Moreover, stiffness did not differ between the two groups, but secant modulus was 27% lower in children with a HCTD (P = 0.05) at common force and 34% lower at maximum force (P = 0.02).
The present study demonstrates for the first time that children with HCTDs have lower material properties (modulus) of their patellar tendon, which may be indicative of general impairment of connective tissue mechanics related to their increased joint laxity.
KeywordsHereditary connective tissue disorders Tendon biomechanics Joint hypermobility Patellar tendon mechanics
Hereditary connective tissue disorders
Classic Ehlers–Danlos syndrome
Magnetic resonance imaging
Body mass index
The present study was supported by Center for Healthy Aging (Nordea Foundation), University of Copenhagen, Lundbeck Foundation, Novo Nordisk Foundation, Danish Rheumatism Association, and the Danish Medical Research Council. RBS was supported by the Danish Council for Independent Research: Medical Sciences (DFF—1333-00052A).
CC conceived of the study, participated in its design and coordination and drafted the manuscript; SPM and HH participated in the design and interpretation of the data; JKJ and RN participated in the design and coordination of the study and performed the measurement; RBS participated in the design of the study and performed the statistical analysis; MK conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
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