Regional Strain Variations in the Human Patellar Tendon

Purpose: Characteristics of localized tendon strain in vivo are largely unknown. The present study examines local tendon strain between the deep, middle, and surface structures at the proximal and distal aspects of the patellar tendon during ramped isometric contractions. Methods: Male subjects (age 28.0 +/- 6.3 yr) were examined for patellar tendon excursion (anterior, midsection, and posterior) during ramped isometric voluntary contractions using real-time B-mode ultrasonography and dynamometry. Regional tendon excursion measurements were compared using an automated pixel tracking method. Strain was determined from the tendon delta length normalized to initial/resting segment length. Results: Strain increased from 10% to 100% of force for all regions. Significantly greater mean strain was seen for the anterior proximal region compared to the posterior and mid layer of the tendon (7.5% +/- 1.1% vs 3.7% +/- 0.5% vs 5.5% +/- 1.0%; P < 0.05). Similarly, the distal posterior region showed greater mean strain compared to the mid and anterior regions (7.9% +/- 0.6% vs 5.0% +/- 0.6% vs 5.4% +/- 0.6%; P < 0.05). Relative changes in strain differences from 50% to 100% of force for the proximal region were greatest for the anterior to midline regions (4.6% +/- 0.6% and 5.6% +/- 0.6%, respectively) and those for the distal region were also greatest for the anterior to midline regions (4.4% +/- 0.2% and 5.3% +/- 0.2%, respectively). The largest mean strain for the proximal region was at the anterior layer (7.5% +/- 1.1%) and that for the distal tendon region was at the posterior layer (7.9% +/- 0.9%). Conclusions: This study shows significant regional differences in strain during ramped isometric contractions for the patellar tendon. Lower proximal strains in the posterior tendon compared to the anterior region may be associated with the suggestion of stress shielding as an etiological factor in insertional tendinopathy.