Background: Achilles tendinopathy is a common debilitating running related injury. Achilles tendon loading force has been hypothesized as a contributor to Achilles tendinopathy. Loading force through the Achilles tendon during running is impacted by many factors such as footwear and foot strike pattern. Achilles tendon biomechanical (Achilles tendon cross-sectional area, thickness, echogenicity, stiffness, and T2*) responses to loading forces are variable and measurable in vivo. These responses impact the physiologic function of the tendon. Aims: 1) To evaluate baseline Achilles tendon biomechanical characteristics associated with a runner's habitual foot strike pattern. 2) To evaluate single running bout Achilles tendon biomechanical changes to varied forces in runners while maintaining their habitual foot strike pattern. This will be accomplished using minimalist and cushioned running shoes. Methods: 29 recreational runners were recruited. Runners completed two separate 5.3 km running sessions wearing alternating shoe types (cushioned and minimalist) at a pace of 3.15 m/s. Prior to running each day, participants had 32 retroreflective markers placed upon them for motion analysis collection. Additionally, participants had their Achilles tendon imaged via ultrasound pre and post run. On a separate day 24 of the participants underwent an ultrashort echo time (UTE) MRI imaging session of their Achilles tendon. Results: Achilles tendon stiffness was 20% greater in non-rear foot strike runners when compared with rear foot strike runners (p = 0.0166). Achilles tendon CSA, thickness, echogenicity, and T2* were not different between running groups (p > 0.05). Both foot strike pattern groups experienced significant Achilles tendon CSA and thickness decreases from pre to post run in minimalist and cushioned shoes (p < 0.05). Both running groups in cushioned shoes and the non-heel strike runners in minimalist shoes experienced significant increases in Achilles tendon echogenicity from pre to post run. Only non-rear foot strike runners had a significant increase in Achilles tendon stiffness while running in cushioned shoes (p = 0.03). Conclusions: The Achilles tendons of non-rear foot strike runners were significantly stiffer than those of rear foot strike runners. This Achilles tendon characteristic may be attributable to differences in Achilles tendon loading force while running but needs further research. Both groups of runners experienced multiple single running bout Achilles tendon changes as measured via ultrasound. Although loading forces varied within groups in different shoes and between foot strike pattern groups, all Achilles tendon changes were similar regardless of loading forces from pre to post run.

Carpal tunnel syndrome (CTS) is a peripheral median neuropathy that is commonly characterized by thickening and fibrosis of the subsynovial connective tissue (SSCT) surrounding finger flexor tendons. The degenerative process affecting SSCT can be initiated with excessive relative motion between the tendon and SSCT that ruptures interconnecting collagen. We used colour Doppler ultrasound to evaluate flexor digitorum superficialis tendon motion at two movement speeds with palmar compression, forearm compression, and partial ischemia (via brachial blood pressure cuff). Partial ischemia decreased SSCT displacement (22.9 ± 3.3 mm vs. 22.0 ± 3.3 mm; p = 0.015) while tendon displacement did not change. There was also a trend for increased relative tendon-SSCT displacement and shear strain index (SSI – relative displacement normalized to tendon displacement), which suggested partial ischemia might increase the strain in collagen that connects tendon and SSCT. Forearm compression decreased tendon displacement (28.5 ± 4.1 mm vs. 27.0 ± 4.6 mm; p = 0.043) while SSCT displacement also trended to decrease (24.0 ± mm vs. 22.5 mm; p = 0.059). With a lack of change in relative tendon-SSCT displacement and SSI, maintaining flexion-extension range of motion may have meant that forearm compression strained the musculotendinous unit at a location where SSCT was uncompromised. Palmar compression did not significantly affect any dependent motion variables, which suggested palmar compressive forces likely do not affect tendon-SSCT shear injury risk. The fast movement speed increased relative tendon-SSCT displacement and SSI while decreasing mean velocity ratio (MVR), which suggested greater tendon-SSCT shear strain in all baseline and compression conditions. Previously, increased relative tendon-SSCT displacement with fast movement speed was only shown in cadaveric investigations, but we confirmed this effect is transferable in an in vivo model. We induced ischemia proximally and found a reduction in SSCT displacement at the distal carpal tunnel. This finding suggests that the vascular network integrated within SSCT may play a role in altering tendon-SSCT excursion, independent of other external mechanical factors previously shown to increase relative motion and potential shear injury risk. Overall, this thesis showed that external mechanical compression at the palm or forearm likely do not negatively affect relative tendon-SSCT motion and that local ischemia and carpal tunnel blood flow should be considered when evaluating tendon and SSCT motion in relation to CTS development and progression. / Thesis / Master of Science (MSc)

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<p>Increased muscle stiffness helps prevent excessive movement that can lead to ligament and soft-tissue damage. There is empirical evidence suggesting that muscles are important in preventing injuries caused by excessive translational movements. Very little is known, however, on how our muscles provide translational stiffness. This thesis uses complementary theoretical (Chapters 2 and 3) and experimental (Chapter 4) techniques to address how muscles provide translational joint stiffness.</p> <p>In Chapters 2 and 3, we used an elastic energy approach to successfully derive equations that quantify muscular contributions to joint stiffness. From the equations, we were able to determine how the geometric orientation and mechanical properties of an individual muscle allows it to provide translational stiffness. In Chapter 4, using the techniques developed in the previous chapters, we test the notion that the nervous system is responsive to translational loading.</p> <p>From these works, several important discoveries were found. We are the first to find that muscles with large squared projections (alignment) over a degree-of-freedom are well suited to provide translational stiffness. Further, by explicitly describing the interactions between the translational and rotational stiffnesses we found that ignoring these interactions resulted in an overestimation of principal stiffnesses. This has large implication for stability analyses, where such overestimations could suggest that an unsafe task is actually safe. Experimentally, we found that the nervous system is responsive to translational loading. This was accomplished through increased activity of muscle well suited to provide translational stiffness.</p> <p>Collectively, the works presented provide much needed knowledge on the role muscle play in stabilizing and protecting our joints. This thesis provides a strong foundation for continued joint stiffness, stability, and impedance research.</p> / Doctor of Science (PhD)

With the increasing need for commercial and residential buildings, post-tensioned (PT) flat plates have become a preferred choice for floor systems, because of the numerous advantages over non-prestressed slabs such as better efficiency, reduced slab self-weight, as well as crack and deflection control. To improve the competitive advantage of PT flat plates through improved economy and performance, a study was undertaken. This study investigated the performance and behavior of three one-third scale models of a nine-panel two-way unbonded post-tensioned flat plate. One of the slabs had conventional reinforcement with uniform-banded tendon layout, another had conventional reinforcement with banded-banded tendon layout while the last had banded-banded tendon layout reinforced with steel fiber. The specimens were loaded to service limit state, factored load and then to failure, using a whiffle tree loading system that approximated a uniformly distributed load. Experimental results were compared to analytical results from finite element and yield line analysis. The performance of the banded-banded specimens was very similar to the uniform-banded specimens at service and factored load. The failure loads for all specimens were considerably higher than the design factored load of 197 psf. Steel fiber was able to replace conventional reinforcement and the performance of the specimens with steel fibers was satisfactory, and comparable to their corresponding conventional reinforced specimens at service and factored limit state. Analytical results from finite element analysis showed a fairly reasonable agreement with experimental results. The results from the experimental tests showed that the use of steel fiber in post-tensioned flat plates is a viable and safe technology that will lead to improved performance and economy. The experimental results seem to indicate that the requirement of conventional reinforcement may be unnecessary in the negative moment regions and also in the positive moment region if the tensile stress is not more than 3√(f'c ) in this region. ACI 318-19 code design recommendations were provided for design of banded-banded PT system and SFRC post-tensioned flat plate. Additional testing should be conducted before SFRC post-tensioned flat plates are incorporated in the ACI 318 code (ACI 318, 2019) with a maximum allowable tensile stress of 6√(f'c). / Doctor of Philosophy / Over the years, the use of post-tensioned flat plates as flooring system has increased and became popular in residential and commercial buildings. Post-tensioned flat plates are a type of concrete structural slabs typically used for flooring in high-rise building because of the numerous advantages over non-prestressed slabs such as better efficiency, reduced slab self-weight, as well as smaller crack and deflection. This type of slab typically consists of high strength steel strands called tendons, which are stretched to compress the concrete slab in both directions. To improve the performance of this type of slabs a research study was performed. This study investigated the performance and behavior of three one-third scale models of a nine-panel two-way post-tensioned flat plate. One of the slabs was strengthened with conventional steel bars and the tendon layout was uniform-banded tendon, another had conventional steel bar with banded-banded tendon layout while the last had banded-banded tendon layout reinforced with steel fiber. Actual load that will act on the slab when in use was applied and then this load was increased by a factor as specified in the building code, before loading the slab to the point where it cannot carry any more load. Results from the load test were compared to results obtain from analytical software package. The performance of the specimens that had banded-banded tendon layout was very similar to the specimens that had uniform-banded tendon layout, at actual operational load when in use. The failure loads for all specimens were considerably higher than the load they were designed for. The results suggest that steel fiber is a good alternative to conventional steel bars. The results from the load tests suggest that steel fiber can be used to strengthen post-tensioned flat plates which will lead to better performance and reduced cost.

Tendon injuries are a significant cause of morbidity in performance horses with superficial digital flexor tendon injury reported to represent up to 43% of overall Thoroughbred racehorse injuries. Natural repair is slow and results in inferior structural organization and biomechanical properties and, therefore, reinjury is common. The inability of tendon to regenerate after injury, or to heal with mechanical properties comparable to the original tissue, is likely attributable to low vascularity and cellularity of the tissue, low number of resident progenitor cells, and healing under weight-bearing conditions. Strategies to improve tendon healing have focused on enhancing the metabolic response of tenocytes, modulating the organization of the newly synthesized extracellular matrix, or administering progenitor cells to enhance repair. Significant research effort has been directed at the use of adult mesenchymal stem cells as a source of progenitor cells for equine tendon repair and recent clinical applications have utilized adult autologous stem cells derived either from adipose tissue or bone marrow aspirates. Isolation of a homogenous population of stem cells from bone marrow is time-consuming, and there is much variation in cell numbers, cell viability and growth rates among samples. Recently, a population of progenitor cells has been isolated from equine flexor tendons, thus providing an alternative source of progenitor cells from the target tissue for therapeutic intervention. The interaction between cells and the extracellular matrix (ECM) is an important factor in regulation of cell function. Proliferation, migration, differentiation and gene expression of many cell types are altered by adhesion to and interaction with matrix proteins and the extracellular environment. Tendon progenitor cells reside within a niche that comprises primarily parallel collagen fibers, and this niche plays an important role in regulating their function and differentiation. Culture conditions replicating this environment could be beneficial for both cell growth and matrix gene expression. The objectives of the study were to compare cell growth kinetics and biosynthetic capabilities of bone marrow mesenchymal stem cells (BMMSCs) and tendon derived progenitor cells (TPCs) cultured on commercially available bovine, highly purified bovine, porcine, and rattus collagen sources and standard tissue culture surfaces. We hypothesized that collagen type I matrix would preferentially support TPC proliferation and up regulate gene expression for collagens and organizational components of tendon and therefore provide a culture system and progenitor cell type with advantages over the current practice of BMMSC expansion on standard cell culture plastic surfaces. Cells were isolated from 6 young adult horses, expanded, and cultured on collagen-coated tissue culture plates, and no collagen control for 7 days. Samples were analyzed for cell number on days 4 and 7, and for mRNA expression of collagen type I, collagen type III, cartilage oligomeric matrix protein (COMP), and decorin on day 7. Glycosaminoglycan (GAG) synthesis was analyzed on day 7. Differences of cell number between collagen groups and cell type, and in gene expression and GAG synthesis between collagen groups and cell types, were evaluated by use of mixed-model repeated measures ANOVA. Pair-wise comparisons were made on significant differences identified with ANOVA using Tukey's post hoc test. Statistical significance was set at P<0.05. A statistical significant (P=0.05) increase in cell number for TPCs grown on rattus collagen versus control on day 4 was observed. No difference in GAG synthesis or expression of collagen type I, collagen type III, COMP or decorin mRNA was observed between collagen groups and non-collagen controls for either cell type on day 7. TPCs cultured on all collagen types yielded more cells than similarly cultured BMMSCs on day 4, but only porcine collagen was superior on day 7. TPCs synthesized more GAG than BMMSCs when cultured on control surfaces only. BMMSCs expressed more collagen type I mRNA when cultured on control, porcine and highly-purified collagen, and more collagen type III when cultured on control, porcine, highly-purified collagen, and rattus collagen, than TPCs. Tendon-progenitor cells expressed significantly more COMP when cultured on control and all collagen types, and decorin when cultured on porcine, highly purified bovine and bovine collagen when compared to BMMSCs. The results of this study revealed an advantage to culturing TPCs on randomly organized rattus collagen during the early growth phase. The beneficial effects of collagen-coated surfaces on cell proliferation is likely related to increased surface area for attachment and expansion provided by the random collagen matrix, and/or collagen-cell interactions. Tendon progenitor cells showed superior growth kinetics and expression of the matrix organizational components, COMP and decorin, than similarly cultured BMMSCs that expressed more collagen types III and I. TPCs synthesize more GAG compared to BMMSCs when cultured on plastic surfaces and there was no induction by collagen. Tendon progenitor cells should be considered as an alternative source of progenitor cells for injured equine tendons. Further in vitro studies characterizing factors that influence gene expression of both cell types is warranted. / Master of Science

Lesions of the distal deep digital flexor tendon (DDFT) are frequently diagnosed using magnetic resonance imaging (MRI) in horses with foot pain. The prognosis for horses with DDFT lesions to return to previous levels of performance is poor. Treatment options are limited; consisting of conservative therapy, desmotomy of the accessory ligament of the deep digital flexor tendon, injection of the digital sheath or navicular bursa, navicular bursoscopy or intralesional injection. Intralesional injection of biologic therapeutics shows promise in tendon healing, with increased number of experimental and clinical studies finding positive results. However, accurate injection of DDFT lesions within the hoof is difficult and requires general anesthesia. The Hallmarq open, low-field MRI unit was used to develop an MRI-guided technique to inject structures within the hoof. This procedure has been previously reported for injecting the collateral ligaments of the distal interphalangeal joint. Four clinical cases of deep digital flexor tendinopathy have been treated with MRI-guided injections using a similar technique. The aim of this study was to evaluate accuracy of a technique for injection of the deep digital flexor tendon within the hoof using MRI-guidance, which could be performed in standing patients. We hypothesized that injection of the DDFT within the hoof could be accurately guided using open low-field MRI to target either the lateral or medial lobe at a specific location. Ten cadaver limbs were positioned in an open, low-field MRI unit to mimic a standing horse. Each DDFT lobe was assigned to have a proximal (adjacent to the proximal aspect of the navicular bursa) or distal (adjacent to the navicular bone) injection. A titanium needle was inserted into each tendon lobe, guided by T1-weighted transverse images acquired simultaneously during injection. Oil-based colored dye was injected as a marker. Post-injection MRI and gross sections were assessed by three blinded investigators experienced in equine MRI. The success of injection as evaluated on gross section was 85% (70% proximal, 100% distal). The success of injection as evaluated by MRI was 65% (60% proximal, 70% distal). There was no significant difference between the success of injecting the medial versus lateral lobe. The major limitation of this study was the use of cadaver limbs with normal tendons. The authors concluded that injection of the DDFT within the hoof is possible using MRI guidance. Future work should be focused on using the techniqe in live horses with tendon lesions, and more clinical studies are needed to determine the most efficacious biologic therapeutic for tendon healing. / Master of Science