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Article

Hamstring Muscle Stiffness in Athletes with and without Anterior Cruciate Ligament Reconstruction History: A Retrospective Study

by
Ersagun Kepir
1,*,
Furkan Demiral
2,
Esedullah Akaras
3,
Ahmet Emre Paksoy
4,
Buket Sevindik Aktas
5,
Bahar Yilmaz Cankaya
2,
Bilgehan Oztop
6,
Gokhan Yagiz
7,8,9,* and
Julian Andrew Owen
1
1
Institute for Applied Human Physiology, School of Psychology and Sport Sciences, Bangor University, Bangor LL57 2DG, UK
2
Department of Radiology, Faculty of Medicine, Ataturk University, 25240 Erzurum, Türkiye
3
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Erzurum Technical University, 25050 Erzurum, Türkiye
4
Department of Orthopaedic Surgery, Faculty of Medicine, Ataturk University, 25240 Erzurum, Türkiye
5
Faculty of Sport Sciences, Erzurum Technical University, 25050 Erzurum, Türkiye
6
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ataturk University, 25240 Erzurum, Türkiye
7
Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA
8
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Amasya University, 05100 Amasya, Türkiye
9
Department of Physical Therapy, Faculty of Health Sciences, Tokyo Metropolitan University, Tokyo 192-0397, Japan
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(15), 4370; https://doi.org/10.3390/jcm13154370
Submission received: 10 June 2024 / Revised: 13 July 2024 / Accepted: 16 July 2024 / Published: 26 July 2024
(This article belongs to the Special Issue Sports Injuries: Recent Advances in Prevention and Rehabilitation)
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Versions Notes

Abstract

:
Introduction: Sports requiring sprinting, jumping, and kicking tasks frequently lead to hamstring strain injuries (HSI). One of the structural risk factors of HSI is the increased passive stiffness of the hamstrings. Anterior cruciate ligament (ACL) injury history is associated with a 70% increase in the incidence of HSI, according to a recent meta-analysis. The same report recommended that future research should concentrate on the relationships between the HSI risk factors. Hence, the present study aimed to retrospectively compare changes in the passive stiffness of the hamstrings in athletes with and without ACL reconstruction history. Methods: Using ultrasound-based shear-wave elastography, the mid-belly passive muscle stiffness values of the biceps femoris long head, semimembranosus, and semitendinosus muscles were assessed and compared amongst athletes with and without a history of ACL reconstruction. Results: There were no significant differences in the biceps femoris long head (injured leg (IL): 26.19 ± 5.28 KPa, uninjured contralateral (UL): 26.16 ± 7.41 KPa, control legs (CL): 27.64 ± 5.58 KPa; IL vs. UL: p = 1; IL vs. CL: p = 1; UL vs. CL: p = 1), semimembranosus (IL: 24.35 ± 5.58 KPa, UL: 24.65 ± 8.35 KPa, CL: 22.83 ± 5.67 KPa; IL vs. UL: p = 1; IL vs. CL: p = 1; UL vs. CL, p = 1), or semitendinosus (IL: 22.45 ± 7 KPa, UL: 25.52 ± 7 KPa, CL: 22.54 ± 4.4 KPa; IL vs. UL: p = 0.487; IL vs. CL: p = 1; UL vs. CL, p = 0.291) muscle stiffness values between groups. Conclusions: The passive mid-muscle belly stiffness values of the biceps femoris long head, semitendinosus, and semimembranosus muscles did not significantly differ between previously injured and uninjured athletes; therefore, further assessment for other muscle regions of hamstrings may be necessary. To collect more comprehensive data related to the structural changes that may occur following ACL reconstructions in athletes, a future study should examine the passive stiffness of wider muscle regions from origin to insertion.

1. Introduction

Hamstring strain injuries (HSIs) are widespread in sports that include running, jumping, and kicking tasks [1,2,3,4,5,6,7,8,9,10], and epidemiologic data suggest that the incidence of these injuries has been increasing over time [11,12,13,14,15]. Hamstring strain re-injuries [2,15] are also more severe than the initial injury [12,15]. Together, these findings have led to much focus on injury prevention strategies for HSIs over the last two decades [15,16,17,18].
Regarding the HSI mechanism, the most vulnerable time is defined as the late swing phase of running for the hamstrings [19,20,21]. At this moment, hamstrings generate eccentric force to control the antagonist knee extensors and decelerate the tibia [22]. During the late swing phase of running, the positions of the hip and knee joints and eccentric tensile force elongate the hamstring muscles (biceps femoris: +9.5%, semitendinosus: +8.1%, semimembranosus +7.4%) [23]. Due to this stretching, HSIs frequently occur when the eccentric actions of the hamstring muscles’ fibers cannot withstand the increased tensile force [24].
Studies have defined various HSI risk factors and classified them as modifiable and non-modifiable [15,25,26]. For example, older age [27,28,29,30,31] and previous injuries, such as calf strains [32,33,34,35,36], knee injuries [37,38], ankle ligament injuries [39], and anterior cruciate ligament injuries [32,33], are defined as non-modifiable risk factors for HSIs [26]. Conversely, modifiable risk factors include, but are not restricted to, lower hamstring strength qualities [37,40,41,42], shorter single-leg hop distance [41], higher differences between countermovement jumps and non-countermovement jumps [43], increased electromyographic (EMG) activity of the gluteus medius muscle [44], lower EMG activity of the trunk muscles [45], elevated high-speed running exposure [46,47], thoracic bending at the front-swing phase of sprinting [48], increment in anterior pelvic tilt at the backswing phase of sprinting [48], and structural risk factors (such as shorter biceps femoris long head fascicle lengths (BFlh FL) [49], and increased passive stiffness of the hamstrings) [50]. Research on muscle structure, including the increased passive muscle stiffness of the hamstrings [26], has received great attention related to sports performance [51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74] and musculoskeletal injuries [49,50,75,76,77,78,79,80,81,82,83,84,85,86]. Besides this information, a recent meta-analytic study identified that an anterior cruciate ligament (ACL) injury history causes a 70% increment in the risk of HSI [26]. The same meta-analytic study [26] suggested that future studies should focus on interactions between risk factors for HSIs.
Previously, studies examining passive muscle stiffness were performed using old techniques, such as free oscillation [50], which measures whole knee flexors’ muscle and tendon units together and does not allow for the measurement of the stiffness of specific muscles. With advancements in technology, examining a specific muscle or tendon’s passive stiffness has become possible by using ultrasound shear-wave elastography, which is both valid and reliable [86,87,88,89,90,91]. In this way, gathering specific information on each hamstring muscle’s stiffness in athletes who have returned to play from HSIs can provide new insights into the hamstring injury rehabilitation process.
Previous retrospective studies examining muscle stiffness values after ACL reconstructions have found conflicting results in the literature [92,93]. Kuszewski et al. [93] reported a considerable increment in the stiffness of the hamstrings after ACL reconstructions by using passive knee extension in the supine position [94,95]. Contrarily, He et al. [92] found a decrease in the passive stiffness of the semimembranosus and semitendinosus muscles, but no change in the stiffness of the biceps femoris. However, both the studies were conducted on non-athletic groups [92,93]. Therefore, this study aimed to retrospectively examine the alterations in the hamstring muscles’ passive stiffness in athletes with and without ACL injury history. This study hypothesized that there would be an increment in the passive stiffness values of the hamstring muscles, especially in the semitendinosus, due to possible scar tissue after surgery.

2. Methodology

2.1. Research Design and Participants

A retrospective, comparative case–control study design was used in this study. Thirteen athletes with previous ACL injuries (time since the surgery, 13.8 ± 7.1 months) and ACL reconstruction surgery history (n = 13), as well as twenty previously uninjured athletes (n = 20), participated in this study. The previously injured legs of the athletes with ACL injury history constituted the injured legs group (n = 13). The uninjured legs of the athletes with ACL injury history constituted the internal control group (n = 13). Both legs of the injury-free athletes were used as the external control group (n = 40). Ethical approval was obtained from the Ataturk University Sport Sciences Ethics Committee on 23 November 2022 (Approval No: E-70400699-000-2200385479). According to the Declaration of Helsinki [96], participants received informed consent forms and read and signed them before their participation in the study. Data collection was completed between 23 November 2022 and 12 August 2023.
Athletes who fully returned to sports after an ACL reconstruction were included in the previously injured group. The inclusion criteria for the injured group were (a) aged between 18 and 35 years old, (b) having returned to pre-level sports competition after an ACL reconstruction surgery, and (c) semitendinosus graft being used in the reconstruction of the ACL (this criterion was for increasing the homogeneity of the surgical technique employed in the participants). The control group included participants between 18 and 35 years old without a known lower extremity injury history who participated in sports like the injured group. The injured group consisted of ten soccer players, two basketball players, and one skier. The non-injured group consisted of ten basketball players, four skiers, two soccer players, two biathletes, one tennis player, and one handball player. The injured group had received traditional physiotherapy procedures for ACL rehabilitation, while the others kept their daily routines. However, due to the nature of the retrospective research design, the details of the rehabilitation programs could not be recorded.

2.2. Sample Size

The present study calculated the required sample size using the G*Power software (version 3.9.7.1) for F tests/ANOVA: fixed effects. The effect size (Cohen’s d = 1.8) was adapted from a similar retrospective study [93] that mentioned higher hamstring muscle stiffness in participants with ACL injury history than in participants without ACL injury history. However, this study employed a smaller effect size of 0.8 to ensure greater statistical power. The other parameters used during the sample size calculations were a 0.05 alpha level, 80% statistical power, and two groups. The required total sample size was calculated as 16 (8 for the previously injured group and 8 for the uninjured group). However, this study recruited more participants (13 for the previously injured group and 20 for the uninjured group) to increase its statistical power.

2.3. Measurement Procedures

Before the assessment of the participants’ ages, physical characteristics (height (cm), height of the legs (cm), and body mass (kg)) and time since returning to sports after the ACL injury were recorded. The preferred kicking leg was accepted as the dominant leg.

2.4. Hamstring Muscles’ Passive Stiffness Measurements

Participants laid down on a medical bed in a prone position with zero degrees of hip and knee flexion without any voluntary muscle contractions (Figure 1). The ultrasound machine’s (Phillips EPIQ Elite, Phillips Ultrasound Systems, Amsterdam, The Netherlands) transducer (PureWave, eL18-4, Phillips Ultrasound Systems, Amsterdam, The Netherlands) was placed on the muscle belly (50% of the distance between the proximal and distal musculotendinous junctions) [91] parallel to the orientations of each BFlh, semimembranosus, and semitendinosus muscle. The probe was arranged parallel to the muscle fascicle orientations for more accurate results [87,97]. A slight and equal transducer pressure was applied during the measurements to avoid misinterpretations of the results [98]. The region of interest (ROI) was selected in the center of the BFlh, semimembranosus, and semitendinosus muscles [91]; three random elastograms were taken from the ROI; and the mean value was accepted as the muscle stiffness of each muscle. As a visual example, a biceps femoris long-head muscle stiffness measurement is illustrated in Figure 2. The measurements were repeated for both muscles of both legs in all participants by an experienced radiology clinician (the second author: FD). All the assessments were performed in the same room conditions (24 degrees Celsius) on the same medical bed.

2.5. Statistical Analyses

The one-way analysis of variance (ANOVA) was used to compare passive stiffness scores between the injured leg (n = 13), the uninjured contra-lateral leg (n = 13), and both legs together in the control group (n = 40). The homogeneity of variance between the groups was compared using Levene Statistics. The alpha value was set at 0.05 for the indicator of statistical significance. All the statistical analyses were performed via IBM SPSS Statistics, version 29.0.

3. Results

Thirteen athletes with an ACL injury history (age, 24 ± 4.2 years; body mass, 79.2 ± 9.5 kg; height, 176.5 ± 5.8 cm; time since the surgery, 13.8 ± 7.1 months) and twenty athletes without an ACL injury history (age, 19.7 ± 2.1 years; body mass, 75.6 ± 11.8 kg; height, 182.2 ± 9 cm) participated to this study. Eight ACL injuries occurred in the non-dominant leg, while five ACL injuries occurred in the dominant leg. Based on the one-way ANOVA, there were no significant differences in any passive stiffness scores of the BFlh, semimembranosus, or semitendinosus muscles between the injured legs and the uninjured contralateral legs, or between the injured legs and the control group’s legs (Table 1).

4. Discussion

This study aimed to retrospectively examine the alterations in the hamstring muscles’ passive stiffness in athletes with and without ACL injury history. The main findings of our study showed that there were no significant alterations in the passive stiffness of the BFlh, semimembranosus, or semitendinosus mid-muscle bellies between injured and non-injured limbs using ultrasound-based shear-wave elastography.
Changes in tissue (i.e., mechanical properties) may affect the passive tension and stiffness of muscles, causing them to exhibit higher values [86,99]. After lower-extremity injuries, higher stiffness has been observed in previous studies [86,93,100]. Considering possible scars in the surgery area, which can increase muscle stiffness [100,101,102], this study hypothesized a possible increment in muscle stiffness. However, the findings of previous retrospective studies examining muscle stiffness values after ACL reconstruction are conflicting in the literature [92,93]. Kuszewski et al. [93] reported a considerable increase in the stiffness of the hamstrings after ACL reconstruction by using passive knee extension in the supine position [94,95]. Conversely, He et al. [92] suggested decreases in passive stiffness of the semimembranosus and semitendinosus muscles, but no change in the stiffness of the biceps femoris using 11 mm central elastograms via shear-wave elastography. These contradictory findings might be caused by differences between these two techniques [92,93]. The technique of Kuszewski et al. [93] measured whole knee flexor muscles and tendons together, which indicated an increase in the whole knee flexor properties together. However, He et al. [92] measured the stiffness of the hamstrings within an 11 mm circle located at the muscle bellies of the hamstrings. Therefore, increased stiffness may be detected at the distal regions of the hamstrings, which may be logical when considering that the semitendinosus tendon grafts are usually taken from the distal tendons for ACL surgeries [103,104]. This may suggest that increased stiffness may be detected around the distal tendons in consideration of previous observations, suggesting increased tendon values after tendon injuries [100]. Muscle stiffness values can be affected by measurement depths and the size of range of interest values [105]. Regarding our findings of no difference in passive hamstring stiffness after ACL injury, our measurements consisted of three smaller (3 mm) points only in the blue-colored area (Figure 2). However, the shear-wave elastography used in this study included a color-mapping mechanism to show the stiffness differences of the structures, with the blue color representing the lowest stiffness values in the tissue. The assessor of this study took all the measurements as small points from the blue-colored areas of the muscle bellies, as shown in Figure 2, which is a limitation of this study in terms of detecting the stiffness of whole muscles. Overall, this study’s strength is that it was conducted on athletes, as compared to previous relevant studies. Despite this, this study suggests that rehabilitation specialists and coaches may consider employing elastography to monitor the healing process of soft tissues after sports injuries.
In addition to the depth and size of the range of interest [105], hamstring muscle stiffness results may be influenced by muscle size [91], sex [106], sports profession [91,107], pelvic tilt type [108], hip and knee positions [109], injury and scar status [100,101,102], the assessor of the shear-wave elastography [110], age [111,112], and genetic factors [111,113]. Moreover, there may be differences in the measurement algorithms of the ultrasound-based shear wave elastography; for example, the values of the BFlh passive muscle belly stiffness at rest have been stated to be 4.5 kPa [114], 9.91 kPa (this study), 10.54–15.72 [115], 10.8 kPa [116], 11.3–11.7 kPa [117], 11.57 kPa, [118], 14.43–16.27 kPa [119], 15.74–19.01 kPa [90], 16.47–19.87 kPa [120], and 16.9–24.7 kPa [91] by different studies in the literature. Hence, a wider study comparing the measurement values of the commercially available devices is necessary in order to clarify different results in the literature. Among the factors mentioned above, the assessor of the shear-wave elastography [110] may be necessary to mention for this study. Despite our measurements being performed by a radiologist, this study did not include a reliability study, which can be considered one of the study’s major limitations, requiring cautious interpretation of our outcomes.
Among the other limitations is the fact that retrospective studies do not permit conclusions about the cause and effect of the outcome measures. An additional limitation of this research design is that it did not gather detailed information about the healing process after injury, nor about treatment and rehabilitation after ACL injuries. Additionally, the assessor was not blinded to the participants’ groups, which is another limitation of this study. As mentioned above, the lack of reliable analyses (only muscle belly stiffness was analyzed) and the lack of assessor-blinded status are other limitations of this study, which add accountable confounding factors to the results. Moreover, the pressure which was applied by the assessor is unknown and was not measured before the study, which is another important limitation of this study. Furthermore, conducting this study with only male participants is another limitation which decreases its generalizability, considering the higher rate of ACL injuries in females [121]. A future study on females should focus on the same topic as this study. Additionally, a randomized controlled study should observe the effectiveness of rehabilitation programs in improving muscle stiffness by applying repeated measures.

5. Conclusions

This study aimed to retrospectively compare the alterations in the hamstring muscles’ passive stiffness in athletes with and without a history of ACL injury. However, no significant differences were observed between previously injured and uninjured athletes’ passive mid-muscle belly stiffness values of the biceps femoris long head, semitendinosus, or semimembranosus muscles. A future study should investigate the passive stiffness of larger areas in the muscles from origin to insertion in order to gather broader data with which to illuminate structural alterations after ACL reconstructions in athletes. Rehabilitation specialists should consider employing elastography to monitor the healing process of soft tissues after sports injuries.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jcm13154370/s1.

Author Contributions

Conceptualization, E.K., G.Y. and J.A.O.; Methodology, E.K., G.Y. and J.A.O.; Software, E.K.; Formal analysis, E.K. and G.Y.; Investigation, E.K.; Resources, F.D., E.A., A.E.P., B.Y.C., B.S.A. and B.O.; Data curation, E.K., F.D., E.A., A.E.P., B.Y.C., B.S.A. and B.O.; Writing—original draft, E.K. and G.Y.; Writing—review & editing, G.Y. and J.A.O.; Visualization, E.K.; Supervision, G.Y. and J.A.O. All authors have read and agreed to the published version of the manuscript.

Funding

This study did not receive any specific funding. However, the Ministry of National Education of the Republic of Türkiye funds the first author, Kepir, for his postgraduate studies. This funder did not play any role at any stage of the preparation of this study and manuscript.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Ataturk University Sport Sciences Ethics Committee on 23 November 2022 (Approval No: E-70400699-000-2200385479).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data is contained within the article or Supplementary Material. The data presented in this study are available in Manuscript-Supplementary.xlsx.

Acknowledgments

The Ministry of National Education of the Republic of Türkiye funds the first author, Kepir, for his postgraduate studies. This study did not receive any specific funding. A version of this study will also be published as a chapter of Kepir’s PhD thesis.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Brooks, J.H.; Fuller, C.W.; Kemp, S.P.; Reddin, D.B. Epidemiology of injuries in English professional rugby union: Part 1 match injuries. Br. J. Sports Med. 2005, 39, 757–766. [Google Scholar] [CrossRef]
  2. Ekstrand, J.; Hägglund, M.; Waldén, M. Injury incidence and injury patterns in professional football: The UEFA injury study. Br. J. Sports Med. 2011, 45, 553–558. [Google Scholar] [CrossRef] [PubMed]
  3. Feeley, B.T.; Kennelly, S.; Barnes, R.P.; Muller, M.S.; Kelly, B.T.; Rodeo, S.A.; Warren, R.F. Epidemiology of National Football League Training Camp Injuries from 1998 to 2007. Am. J. Sports Med. 2008, 36, 1597–1603. [Google Scholar] [CrossRef] [PubMed]
  4. Opar, D.A.; Drezner, J.; Shield, A.; Williams, M.; Webner, D.; Sennett, B.; Kapur, R.; Cohen, M.; Ulager, J.; Cafengiu, A.; et al. Acute hamstring strain injury in track-and-field athletes: A 3-year observational study at the Penn Relay Carnival. Scand. J. Med. Sci. Sports 2014, 24, e254–e259. [Google Scholar] [CrossRef]
  5. Orchard, J.W.; Seward, H.; Orchard, J.J. Results of 2 decades of injury surveillance and public release of data in the Australian Football League. Am. J. Sports Med. 2013, 41, 734–741. [Google Scholar] [CrossRef]
  6. Dorn, T.W.; Schache, A.G.; Pandy, M.G. Muscular strategy shift in human running: Dependence of running speed on hip and ankle muscle performance. J. Exp. Biol. 2012, 215, 1944–1956. [Google Scholar] [CrossRef] [PubMed]
  7. Rahnama, N.; Lees, A.; Bambaecichi, E. Comparison of muscle strength and flexibility between the preferred and non-preferred leg in English soccer players. Ergonomics 2005, 48, 1568–1575. [Google Scholar] [CrossRef]
  8. Schache, A.G.; Blanch, P.D.; Dorn, T.W.; Brown, N.A.; Rosemond, D.; Pandy, M.G. Effect of running speed on lower limb joint kinetics. Med. Sci. Sports Exerc. 2011, 43, 1260–1271. [Google Scholar] [CrossRef] [PubMed]
  9. Walsh, M.; Boling, M.C.; McGrath, M.; Blackburn, J.T.; Padua, D.A. Lower extremity muscle activation and knee flexion during a jump-landing task. J. Athl. Train. 2012, 47, 406–413. [Google Scholar] [CrossRef]
  10. Chu, S.K.; Rho, M.E. Hamstring Injuries in the Athlete: Diagnosis, Treatment, and Return to Play. Curr. Sports Med. Rep. 2016, 15, 184–190. [Google Scholar] [CrossRef]
  11. Ekstrand, J.; Bengtsson, H.; Waldén, M.; Davison, M.; Khan, K.M.; Hägglund, M. Hamstring injury rates have increased during recent seasons and now constitute 24% of all injuries in men’s professional football: The UEFA Elite Club Injury Study from 2001/02 to 2021/22. Br. J. Sports Med. 2022, 57, 292–298. [Google Scholar] [CrossRef] [PubMed]
  12. Ekstrand, J.; Krutsch, W.; Spreco, A.; van Zoest, W.; Roberts, C.; Meyer, T.; Bengtsson, H. Time before return to play for the most common injuries in professional football: A 16-year follow-up of the UEFA Elite Club Injury Study. Br. J. Sports Med. 2020, 54, 421–426. [Google Scholar] [CrossRef] [PubMed]
  13. Ekstrand, J.; Gillquist, J. Soccer injuries and their mechanisms: A prospective study. Med. Sci. Sports Exerc. 1983, 15, 267–270. [Google Scholar] [CrossRef]
  14. Seward, H.; Orchard, J.; Hazard, H.; Collinson, D. Football injuries in Australia at the élite level. Med. J. Aust. 1993, 159, 298–301. [Google Scholar] [CrossRef]
  15. Opar, D.A.; Williams, M.D.; Shield, A.J. Hamstring strain injuries: Factors that lead to injury and re-injury. Sports Med. 2012, 42, 209–226. [Google Scholar] [CrossRef]
  16. Arnason, A.; Andersen, T.E.; Holme, I.; Engebretsen, L.; Bahr, R. Prevention of hamstring strains in elite soccer: An intervention study. Scand. J. Med. Sci. Sports 2008, 18, 40–48. [Google Scholar] [CrossRef]
  17. Petersen, J.; Thorborg, K.; Nielsen, M.B.; Budtz-Jørgensen, E.; Hölmich, P. Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: A cluster-randomized controlled trial. Am. J. Sports Med. 2011, 39, 2296–2303. [Google Scholar] [CrossRef] [PubMed]
  18. van der Horst, N.; Smits, D.W.; Petersen, J.; Goedhart, E.A.; Backx, F.J. The preventive effect of the nordic hamstring exercise on hamstring injuries in amateur soccer players: A randomized controlled trial. Am. J. Sports Med. 2015, 43, 1316–1323. [Google Scholar] [CrossRef]
  19. Liu, H.; Garrett, W.E.; Moorman, C.T.; Yu, B. Injury rate, mechanism, and risk factors of hamstring strain injuries in sports: A review of the literature. J. Sport Health Sci. 2012, 1, 92–101. [Google Scholar] [CrossRef]
  20. Kenneally-Dabrowski, C.J.B.; Brown, N.A.T.; Lai, A.K.M.; Perriman, D.; Spratford, W.; Serpell, B.G. Late swing or early stance? A narrative review of hamstring injury mechanisms during high-speed running. Scand. J. Med. Sci. Sports 2019, 29, 1083–1091. [Google Scholar] [CrossRef]
  21. Chumanov, E.S.; Heiderscheit, B.C.; Thelen, D.G. Hamstring musculotendon dynamics during stance and swing phases of high-speed running. Med. Sci. Sports Exerc. 2011, 43, 525–532. [Google Scholar] [CrossRef] [PubMed]
  22. Kujala, U.M.; Orava, S.; Järvinen, M. Hamstring injuries. Current trends in treatment and prevention. Sports Med. 1997, 23, 397–404. [Google Scholar] [CrossRef] [PubMed]
  23. Thelen, D.; Chumanov, E.; Hoerth, D.; Best, T.; Swanson, S.; Li, L.; Youn, M.; Heiderscheit, B.C. Hamstring Muscle Kinematics during Treadmill Sprinting. Med. Sci. Sports Exerc. 2005, 37, 108–114. [Google Scholar] [CrossRef] [PubMed]
  24. Roig Pull, M.; Ranson, C. Eccentric muscle actions: Implications for injury prevention and rehabilitation. Phys. Ther. Sport 2007, 8, 88–97. [Google Scholar] [CrossRef]
  25. Clark, R.A. Hamstring injuries: Risk assessment and injury prevention. Ann. Acad. Med. Singap. 2008, 37, 341–346. [Google Scholar] [CrossRef] [PubMed]
  26. Green, B.; Bourne, M.N.; van Dyk, N.; Pizzari, T. Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport. Br. J. Sports Med. 2020, 54, 1081. [Google Scholar] [CrossRef] [PubMed]
  27. Arnason, A.; Sigurdsson, S.B.; Gudmundsson, A.; Holme, I.; Engebretsen, L.; Bahr, R. Risk factors for injuries in football. The Am. J. Sports Med. 2004, 32, 5–16. [Google Scholar] [CrossRef] [PubMed]
  28. Dauty, M.; Menu, P.; Fouasson-Chailloux, A. Cutoffs of isokinetic strength ratio and hamstring strain prediction in professional soccer players. Scand. J. Med. Sci. Sports 2018, 28, 276–281. [Google Scholar] [CrossRef] [PubMed]
  29. Engebretsen, A.H.; Myklebust, G.; Holme, I.; Engebretsen, L.; Bahr, R. Intrinsic risk factors for hamstring injuries among male soccer players: A prospective cohort study. Am. J. Sports Med. 2010, 38, 1147–1153. [Google Scholar] [CrossRef]
  30. Fousekis, K.; Tsepis, E.; Poulmedis, P.; Athanasopoulos, S.; Vagenas, G. Intrinsic risk factors of non-contact quadriceps and hamstring strains in soccer: A prospective study of 100 professional players. Br. J. Sports Med. 2011, 45, 709–714. [Google Scholar] [CrossRef]
  31. Henderson, G.; Barnes, C.A.; Portas, M.D. Factors associated with increased propensity for hamstring injury in English Premier League soccer players. J. Sci. Med. Sport 2010, 13, 397–402. [Google Scholar] [CrossRef] [PubMed]
  32. Bourne, M.N.; Opar, D.A.; Williams, M.D.; Shield, A.J. Eccentric knee flexor strength and risk of hamstring injuries in rugby union: A prospective study. Am. J. Sports Med. 2015, 43, 2663–2670. [Google Scholar] [CrossRef] [PubMed]
  33. Opar, D.; Williams, M.; Timmins, R.; Hickey, J.; Duhig, S.; Shield, A. Eccentric hamstring strength and hamstring injury risk in Australian footballers. Med. Sci. Sports Exerc. 2015, 47, 857–865. [Google Scholar] [CrossRef] [PubMed]
  34. Orchard, J.; Seward, H.; Orchard, J.; Driscoll, T. The speed-fatigue trade off in hamstring aetiology: Analysis of 2011 AFL injury data. Sport Health 2012, 30, 53. [Google Scholar]
  35. Orchard, J.W. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am. J. Sports Med. 2001, 29, 300–303. [Google Scholar] [CrossRef] [PubMed]
  36. Sugiura, Y.; Saito, T.; Sakuraba, K.; Sakuma, K.; Suzuki, E. Strength deficits identified with concentric action of the hip extensors and eccentric action of the hamstrings predispose to hamstring injury in elite sprinters. J. Orthop. Sports Phys. Ther. 2008, 38, 457–464. [Google Scholar] [CrossRef] [PubMed]
  37. Freckleton, G.; Cook, J.; Pizzari, T. The predictive validity of a single leg bridge test for hamstring injuries in Australian Rules Football Players. Br. J. Sports Med. 2014, 48, 713–717. [Google Scholar] [CrossRef]
  38. Verrall, G.M.; Slavotinek, J.P.; Barnes, P.G.; Fon, G.T.; Spriggins, A.J. Clinical risk factors for hamstring muscle strain injury: A prospective study with correlation of injury by magnetic resonance imaging. Br. J. Sports Med. 2001, 35, 435–440. [Google Scholar] [CrossRef] [PubMed]
  39. Malliaropoulos, N.; Bikos, G.; Meke, M.; Vasileios, K.; Valle, X.; Lohrer, H.; Maffulli, N.; Padhiar, N. Higher frequency of hamstring injuries in elite track and field athletes who had a previous injury to the ankle-a 17 years observational cohort study. J. Foot Ankle Res. 2018, 11, 7. [Google Scholar] [CrossRef]
  40. De Vos, R.-J.; Reurink, G.; Goudswaard, G.-J.; Moen, M.H.; Weir, A.; Tol, J.L. Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not. Br. J. Sports Med. 2014, 48, 1377–1384. [Google Scholar] [CrossRef]
  41. Goossens, L.; Witvrouw, E.; Vanden Bossche, L.; De Clercq, D. Lower eccentric hamstring strength and single leg hop for distance predict hamstring injury in PETE students. Eur. J. Sport Sci. 2015, 15, 436–442. [Google Scholar] [CrossRef] [PubMed]
  42. Schuermans, J.; Van Tiggelen, D.; Danneels, L.; Witvrouw, E. Susceptibility to hamstring injuries in soccer: A prospective study using muscle functional magnetic resonance imaging. Am. J. Sports Med. 2016, 44, 1276–1285. [Google Scholar] [CrossRef]
  43. Venturelli, M.; Schena, F.; Zanolla, L.; Bishop, D. Injury risk factors in young soccer players detected by a multivariate survival model. J. Sci. Med. Sport 2011, 14, 293–298. [Google Scholar] [CrossRef] [PubMed]
  44. Smith, M.M.F.; Bonacci, J.; Mendis, M.D.; Christie, C.; Rotstein, A.; Hides, J.A. Gluteus medius activation during running is a risk factor for season hamstring injuries in elite footballers. J. Sci. Med. Sport 2017, 20, 159–163. [Google Scholar] [CrossRef]
  45. Schuermans, J.; Danneels, L.; Van Tiggelen, D.; Palmans, T.; Witvrouw, E. Proximal neuromuscular control protects against hamstring injuries in male soccer players: A prospective study with electromyography time-series analysis during maximal sprinting. Am. J. Sports Med. 2017, 45, 1315–1325. [Google Scholar] [CrossRef] [PubMed]
  46. Duhig, S.; Shield, A.J.; Opar, D.; Gabbett, T.J.; Ferguson, C.; Williams, M. Effect of high-speed running on hamstring strain injury risk. Br. J. Sports Med. 2016, 50, 1536–1540. [Google Scholar] [CrossRef] [PubMed]
  47. Ruddy, J.D.; Pollard, C.W.; Timmins, R.G.; Williams, M.D.; Shield, A.J.; Opar, D.A. Running exposure is associated with the risk of hamstring strain injury in elite Australian footballers. Br. J. Sports Med. 2018, 52, 919–928. [Google Scholar] [CrossRef] [PubMed]
  48. Schuermans, J.; Van Tiggelen, D.; Palmans, T.; Danneels, L.; Witvrouw, E. Deviating running kinematics and hamstring injury susceptibility in male soccer players: Cause or consequence? Gait Posture 2017, 57, 270–277. [Google Scholar] [CrossRef] [PubMed]
  49. Timmins, R.G.; Bourne, M.N.; Shield, A.J.; Williams, M.D.; Lorenzen, C.; Opar, D.A. Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): A prospective cohort study. Br. J. Sports Med. 2016, 50, 1524–1535. [Google Scholar] [CrossRef]
  50. Watsford, M.L.; Murphy, A.J.; McLachlan, K.A.; Bryant, A.L.; Cameron, M.L.; Crossley, K.M.; Makdissi, M. A prospective study of the relationship between lower body stiffness and hamstring injury in professional Australian rules footballers. Am. J. Sports Med. 2010, 38, 2058–2064. [Google Scholar] [CrossRef]
  51. Abe, T.; Fukashiro, S.; Harada, Y.; Kawamoto, K. Relationship between sprint performance and muscle fascicle length in female sprinters. J. Physiol. Anthropol. Appl. Human Sci. 2001, 20, 141–147. [Google Scholar] [CrossRef] [PubMed]
  52. Abe, T.; Kojima, K.; Stager, J.M. Skeletal muscle mass and muscular function in master swimmers is related to training distance. Rejuvenation Res. 2014, 17, 415–421. [Google Scholar] [CrossRef] [PubMed]
  53. Abe, T.; Loenneke, J.P.; Thiebaud, R.S. Morphological and functional relationships with ultrasound measured muscle thickness of the lower extremity: A brief review. Ultrasound 2015, 23, 166–173. [Google Scholar] [CrossRef] [PubMed]
  54. Akima, H.; Kano, Y.; Enomoto, Y.; Ishizu, M.; Okada, M.; Oishi, Y.; Katsuta, S.; Kuno, S. Muscle function in 164 men and women aged 20—84 yr. Med. Sci. Sports Exerc. 2001, 33, 220–226. [Google Scholar] [CrossRef] [PubMed]
  55. Brechue, W.F.; Abe, T. The role of FFM accumulation and skeletal muscle architecture in powerlifting performance. Eur. J. Appl. Physiol. 2002, 86, 327–336. [Google Scholar] [CrossRef] [PubMed]
  56. Freilich, R.J.; Kirsner, R.L.; Byrne, E. Isometric strength and thickness relationships in human quadriceps muscle. Neuromuscul. Disord. 1995, 5, 415–422. [Google Scholar] [CrossRef] [PubMed]
  57. Fukunaga, T.; Miyatani, M.; Tachi, M.; Kouzaki, M.; Kawakami, Y.; Kanehisa, H. Muscle volume is a major determinant of joint torque in humans. Acta Physiol. Scand. 2001, 172, 249–255. [Google Scholar] [CrossRef] [PubMed]
  58. Fukunaga, T.; Roy, R.R.; Shellock, F.G.; Hodgson, J.A.; Day, M.K.; Lee, P.L.; Kwong-Fu, H.; Edgerton, V.R. Physiological cross-sectional area of human leg muscles based on magnetic resonance imaging. J. Orthop. Res. 1992, 10, 928–934. [Google Scholar] [CrossRef] [PubMed]
  59. Fukunaga, T.; Roy, R.R.; Shellock, F.G.; Hodgson, J.A.; Edgerton, V.R. Specific tension of human plantar flexors and dorsiflexors. J. Appl. Physiol. (1985) 1996, 80, 158–165. [Google Scholar] [CrossRef]
  60. Ikai, M.; Fukunaga, T. Calculation of muscle strength per unit cross-sectional area of human muscle by means of ultrasonic measurement. Int. Z. Angew. Physiol. 1968, 26, 26–32. [Google Scholar] [CrossRef]
  61. Ikebukuro, T.; Kubo, K.; Okada, J.; Yata, H.; Tsunoda, N. The relationship between muscle thickness in the lower limbs and competition performance in weightlifters and sprinters. Jpn. J. Phys. Fit. Sports Med. 2011, 60, 401–411. [Google Scholar]
  62. Kumagai, K.; Abe, T.; Brechue, W.; Ryushi, T.; Takano, S.; Mizuno, M. Sprint performance is related to muscle fascicle length in male 100-m sprinters. J. Appl. Physiol. 2000, 88, 811–816. [Google Scholar] [CrossRef] [PubMed]
  63. Lieber, R.L. Skeletal muscle structure and function. In Inplications for Rehabilitation and Sports Medicine; Williams and Wilkins: Maryland, MD, USA, 1992. [Google Scholar]
  64. Lieber, R.L.; Fridén, J. Functional and clinical significance of skeletal muscle architecture. Muscle Nerve 2000, 23, 1647–1666. [Google Scholar] [CrossRef] [PubMed]
  65. Mangine, G.T.; Fukuda, D.H.; LaMonica, M.B.; Gonzalez, A.M.; Wells, A.J.; Townsend, J.R.; Jajtner, A.R.; Fragala, M.S.; Stout, J.R.; Hoffman, J.R. Influence of gender and muscle architecture asymmetry on jump and sprint performance. J. Sports Sci. Med. 2014, 13, 904–911. [Google Scholar] [PubMed]
  66. Mangine, G.T.; Fukuda, D.H.; Townsend, J.R.; Wells, A.J.; Gonzalez, A.M.; Jajtner, A.R.; Bohner, J.D.; LaMonica, M.; Hoffman, J.R.; Fragala, M.S.; et al. Sprinting performance on the Woodway Curve 3.0TM is related to muscle architecture. Eur. J. Sport Sci. 2015, 15, 606–614. [Google Scholar] [CrossRef] [PubMed]
  67. Maughan, R.J.; Watson, J.S.; Weir, J. Strength and cross-sectional area of human skeletal muscle. J. Physiol. 1983, 338, 37–49. [Google Scholar] [CrossRef] [PubMed]
  68. Moreau, N.G.; Simpson, K.N.; Teefey, S.A.; Damiano, D.L. Muscle architecture predicts maximum strength and is related to activity levels in cerebral palsy. Phys. Ther. 2010, 90, 1619–1630. [Google Scholar] [CrossRef]
  69. Narici, M.V.; Landoni, L.; Minetti, A.E. Assessment of human knee extensor muscles stress from in vivo physiological cross-sectional area and strength measurements. Eur. J. Appl. Physiol. Occup. Physiol. 1992, 65, 438–444. [Google Scholar] [CrossRef] [PubMed]
  70. Nasirzade, A.; Ehsanbakhsh, A.; Ilbeygi, S.; Sobhkhiz, A.; Argavani, H.; Aliakbari, M. Relationship between sprint performance of front crawl swimming and muscle fascicle length in young swimmers. J. Sports Sci. Med. 2014, 13, 550–556. [Google Scholar]
  71. Nasirzadeh, A.; Sadeghi, H.; Sobhkhiz, A.; Mohammadian, K.; Nikouei, A.; Baghaian, M.; Fattahi, A. Multivariate analysis of 200-m front crawl swimming performance in young male swimmers. Acta Bioeng. Biomech. 2015, 17, 137–143. [Google Scholar] [CrossRef]
  72. Nimphius, S.; McGuigan, M.R.; Newton, R.U. Changes in muscle architecture and performance during a competitive season in female softball players. J. Strength Cond. Res. 2012, 26, 2655–2666. [Google Scholar] [CrossRef]
  73. Shephard, R.J.; Bouhlel, E.; Vandewalle, H.; Monod, H. Muscle mass as a factor limiting physical work. J. Appl. Physiol. (1985) 1988, 64, 1472–1479. [Google Scholar] [CrossRef]
  74. Yagiz, G.; Akaras, E.; Kubis, H.-P.; Owen, J.A. The Effects of Resistance Training on Architecture and Volume of the Upper Extremity Muscles: A Systematic Review of Randomised Controlled Trials and Meta-Analyses. Appl. Sci. 2022, 12, 1593. [Google Scholar] [CrossRef]
  75. Hides, J.; Frazer, C.; Blanch, P.; Grantham, B.; Sexton, C.; Mendis, M.D. Clinical utility of measuring the size of the lumbar multifidus and quadratus lumborum muscles in the Australian football league setting: A prospective cohort study. Phys. Ther. Sport 2020, 46, 186–193. [Google Scholar] [CrossRef]
  76. Hides, J.A.; Brown, C.T.; Penfold, L.; Stanton, W.R. Screening the lumbopelvic muscles for a relationship to injury of the quadriceps, hamstrings, and adductor muscles among elite Australian Football League players. J. Orthop. Sports Phys. Ther. 2011, 41, 767–775. [Google Scholar] [CrossRef]
  77. Hides, J.A.; Stanton, W.R. Can motor control training lower the risk of injury for professional football players? Med. Sci. Sports Exerc. 2014, 46, 762–768. [Google Scholar] [CrossRef]
  78. Hides, J.A.; Stanton, W.R. Predicting football injuries using size and ratio of the multifidus and quadratus lumborum muscles. Scand. J. Med. Sci. Sports 2017, 27, 440–447. [Google Scholar] [CrossRef]
  79. Hides, J.A.; Stanton, W.R.; Mendis, M.D.; Franettovich Smith, M.M.; Sexton, M.J. Small Multifidus Muscle Size Predicts Football Injuries. Orthop. J. Sports Med. 2014, 2, 2325967114537588. [Google Scholar] [CrossRef]
  80. Jeon, J.Y.; Kang, H.W.; Kim, D.Y.; Kim, Y.T.; Lee, D.Y.; Lee, D.-O. Relationship between calf muscle cross-sectional area and ankle fracture. Foot Ankle Surg. 2020, 27, 860–864. [Google Scholar] [CrossRef]
  81. Lindström, M.; Strandberg, S.; Wredmark, T.; Felländer-Tsai, L.; Henriksson, M. Functional and muscle morphometric effects of ACL reconstruction. A prospective CT study with 1 year follow-up. Scand. J. Med. Sci. Sports 2013, 23, 431–442. [Google Scholar] [CrossRef]
  82. Mangine, G.T.; Hoffman, J.R.; Gonzalez, A.M.; Jajtner, A.R.; Scanlon, T.; Rogowski, J.P.; Wells, A.J.; Fragala, M.S.; Stout, J.R. Bilateral differences in muscle architecture and increased rate of injury in national basketball association players. J. Athl. Train. 2014, 49, 794–799. [Google Scholar] [CrossRef] [PubMed]
  83. Shida, N.; Yagiz, G.; Yamada, T. The Effects of Exergames on Muscle Architecture: A Systematic Review and Meta-Analysis. Appl. Sci. 2021, 11, 10325. [Google Scholar] [CrossRef]
  84. Yagiz, G.; Akaras, E.; Kubis, H.-P.; Owen, J.A. Heterogeneous effects of eccentric training and nordic hamstring exercise on the biceps femoris fascicle length based on ultrasound assessment and extrapolation methods: A systematic review of randomised controlled trials with meta-analyses. PLoS ONE 2021, 16, e0259821. [Google Scholar] [CrossRef]
  85. Yagiz, G.; Dayala, V.K.; Williams, K.; Owen, J.A.; Kubis, H.-P. Alterations in biceps femoris long head fascicle length, Eccentric hamstring strength qualities and single-leg hop distance throughout the ninety minutes of TSAFT90 simulated football match. PLoS ONE 2022, 17, e0278222. [Google Scholar] [CrossRef]
  86. Yagiz, G.; Fredianto, M.; Ulfa, M.; Ariani, I.; Agustin, A.D.; Shida, N.; Moore, E.W.; Kubis, H.P. A retrospective comparison of the biceps femoris long head muscle structure in athletes with and without hamstring strain injury history. PLoS ONE 2024, 19, e0298146. [Google Scholar] [CrossRef]
  87. Eby, S.F.; Song, P.; Chen, S.; Chen, Q.; Greenleaf, J.F.; An, K.N. Validation of shear wave elastography in skeletal muscle. J. Biomech. 2013, 46, 2381–2387. [Google Scholar] [CrossRef]
  88. Le Sant, G.; Ates, F.; Brasseur, J.L.; Nordez, A. Elastography Study of Hamstring Behaviors during Passive Stretching. PLoS ONE 2015, 10, e0139272. [Google Scholar] [CrossRef]
  89. Nin, D.Z.; Pain, M.T.G.; Lim, Y.H.; Kong, P.W. Hamstring Muscle Architecture and Viscoelastic Properties: Reliability and Retrospective Comparison between Previously Injured and Uninjured Athletes. J. Mech. Med. Biol. 2021, 21, 2150007. [Google Scholar] [CrossRef]
  90. Šarabon, N.; Kozinc, Ž.; Podrekar, N. Using shear-wave elastography in skeletal muscle: A repeatability and reproducibility study on biceps femoris muscle. PLoS ONE 2019, 14, e0222008. [Google Scholar] [CrossRef] [PubMed]
  91. Yagiz, G.; Shida, N.; Kuruma, H.; Furuta, M.; Morimoto, K.; Yamada, M.; Uchiyama, T.; Kubis, H.P.; Owen, J.A. Rugby Players Exhibit Stiffer Biceps Femoris, Lower Biceps Femoris Fascicle Length to Knee Extensors, and Knee Flexors to Extensors Muscle Volume Ratios Than Active Controls. Int. J. Sports Physiol. Perform. 2023, 18, 1030–1037. [Google Scholar] [CrossRef] [PubMed]
  92. He, X.; Qiu, J.; Cao, M.; Ho, Y.C.; Leong, H.T.; Fu, S.C.; Ong, M.T.; Fong, D.T.; Yung, P.S. Effects of Deficits in the Neuromuscular and Mechanical Properties of the Quadriceps and Hamstrings on Single-Leg Hop Performance and Dynamic Knee Stability in Patients After Anterior Cruciate Ligament Reconstruction. Orthop. J. Sports Med. 2022, 10, 23259671211063893. [Google Scholar] [CrossRef]
  93. Kuszewski, M.T.; Gnat, R.; Szlachta, G.; Kaczyńska, M.; Knapik, A. Passive stiffness of the hamstrings and the rectus femoris in persons after an ACL reconstruction. Phys. Sportsmed. 2019, 47, 91–95. [Google Scholar] [CrossRef]
  94. Davis, D.S.; Ashby, P.E.; McCale, K.L.; McQuain, J.A.; Wine, J.M. The effectiveness of 3 stretching techniques on hamstring flexibility using consistent stretching parameters. J. Strength Cond. Res. 2005, 19, 27–32. [Google Scholar] [CrossRef]
  95. Kuszewski, M.; Gnat, R.; Saulicz, E. Stability training of the lumbo-pelvo-hip complex influence stiffness of the hamstrings: A preliminary study. Scand. J. Med. Sci. Sports 2009, 19, 260–266. [Google Scholar] [CrossRef]
  96. Association, W.M. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA 2013, 310, 2191–2194. [Google Scholar] [CrossRef]
  97. Brandenburg, J.E.; Eby, S.F.; Song, P.; Zhao, H.; Brault, J.S.; Chen, S.; An, K.N. Ultrasound elastography: The new frontier in direct measurement of muscle stiffness. Arch. Phys. Med. Rehabil. 2014, 95, 2207–2219. [Google Scholar] [CrossRef]
  98. Kot, B.C.; Zhang, Z.J.; Lee, A.W.; Leung, V.Y.; Fu, S.N. Elastic modulus of muscle and tendon with shear wave ultrasound elastography: Variations with different technical settings. PLoS ONE 2012, 7, e44348. [Google Scholar] [CrossRef] [PubMed]
  99. Nakao, G.; Kodesho, T.; Kato, T.; Yokoyama, Y.; Saito, Y.; Ohsaki, Y.; Watanabe, K.; Katayose, M.; Taniguchi, K. Relationship between shear elastic modulus and passive muscle force in human hamstring muscles using a Thiel soft-embalmed cadaver. J. Med. Ultrason. 2023, 50, 275–283. [Google Scholar] [CrossRef] [PubMed]
  100. Frankewycz, B.; Henssler, L.; Weber, J.; Silva, N.; Koch, M.; Jung, E.M.; Docheva, D.; Alt, V.; Pfeifer, C.G. Changes of Material Elastic Properties during Healing of Ruptured Achilles Tendons Measured with Shear Wave Elastography: A Pilot Study. Int. J. Mol. Sci. 2020, 21, 3427. [Google Scholar] [CrossRef]
  101. DeJong, H.; Abbott, S.; Zelesco, M.; Spilsbury, K.; Martin, L.; Sanderson, R.; Ziman, M.; Kennedy, B.F.; Wood, F.M. A Novel, Reliable Protocol to Objectively Assess Scar Stiffness Using Shear Wave Elastography. Ultrasound. Med. Biol. 2020, 46, 1614–1629. [Google Scholar] [CrossRef] [PubMed]
  102. Tsai, W.Y.; Hsueh, Y.Y.; Chen, P.Y.; Hung, K.S.; Huang, C.C. High-Frequency Ultrasound Elastography for Assessing Elastic Properties of Skin and Scars. IEEE Trans. Ultrason. Ferroelectr. Freq. Control 2022, 69, 1871–1880. [Google Scholar] [CrossRef] [PubMed]
  103. Eriksson, K.; Larsson, H.; Wredmark, T.; Hamberg, P. Semitendinosus tendon regeneration after harvesting for ACL reconstruction. Knee Surg. Sports Traumatol. Arthrosc. 1999, 7, 220–225. [Google Scholar] [CrossRef] [PubMed]
  104. Stevanović, V.; Blagojević, Z.; Petković, A.; Glišić, M.; Sopta, J.; Nikolić, V.; Milisavljević, M. Semitendinosus tendon regeneration after anterior cruciate ligament reconstruction: Can we use it twice? Int. Orthop. 2013, 37, 2475–2481. [Google Scholar] [CrossRef] [PubMed]
  105. Dulgheriu, T.; Muntean, D.; Solomon, C.; Dudea, S.M. Comparison of Ultrasound Elastography Values between: Different Machines, Transducers, Acquisition Depths, Roi Diameters and Examiners, on a Biological Tissue in Vitro Study—Preliminary Results. Ultrasound Med. Biol. 2022, 48, S27. [Google Scholar] [CrossRef]
  106. McPherson, A.L.; Nagai, T.; Schilaty, N.D.; Hale, R.; Hewett, T.E.; Bates, N.A. High school male basketball athletes exhibit greater hamstring muscle stiffness than females as assessed with shear wave elastography. Skelet. Radiol. 2020, 49, 1231–1237. [Google Scholar] [CrossRef] [PubMed]
  107. Avrillon, S.; Lacourpaille, L.; Hug, F.; Le Sant, G.; Frey, A.; Nordez, A.; Guilhem, G. Hamstring muscle elasticity differs in specialized high-performance athletes. Scand. J. Med. Sci. Sports 2020, 30, 83–91. [Google Scholar] [CrossRef]
  108. Nakamura, M.; Hasegawa, S.; Umegaki, H.; Nishishita, S.; Kobayashi, T.; Fujita, K.; Tanaka, H.; Ibuki, S.; Ichihashi, N. The difference in passive tension applied to the muscles composing the hamstrings—Comparison among muscles using ultrasound shear wave elastography. Man. Ther. 2016, 24, 1–6. [Google Scholar] [CrossRef]
  109. Miyamoto, N.; Hirata, K.; Kanehisa, H. Effects of hamstring stretching on passive muscle stiffness vary between hip flexion and knee extension maneuvers. Scand. J. Med. Sci. Sports 2017, 27, 99–106. [Google Scholar] [CrossRef] [PubMed]
  110. Paluch, Ł.; Nawrocka-Laskus, E.; Wieczorek, J.; Mruk, B.; Frel, M.; Walecki, J. Use of Ultrasound Elastography in the Assessment of the Musculoskeletal System. Pol. J. Radiol. 2016, 81, 240–246. [Google Scholar] [CrossRef]
  111. Eby, S.F.; Cloud, B.A.; Brandenburg, J.E.; Giambini, H.; Song, P.; Chen, S.; LeBrasseur, N.K.; An, K.N. Shear wave elastography of passive skeletal muscle stiffness: Influences of sex and age throughout adulthood. Clin. Biomech. 2015, 30, 22–27. [Google Scholar] [CrossRef] [PubMed]
  112. Kennedy, P.; Barnhill, E.; Gray, C.; Brown, C.; van Beek, E.J.R.; Roberts, N.; Greig, C.A. Magnetic resonance elastography (MRE) shows significant reduction of thigh muscle stiffness in healthy older adults. Geroscience 2020, 42, 311–321. [Google Scholar] [CrossRef]
  113. Miyamoto, N.; Miyamoto-Mikami, E.; Hirata, K.; Kimura, N.; Fuku, N. Association analysis of the ACTN3 R577X polymorphism with passive muscle stiffness and muscle strain injury. Scand. J. Med. Sci. Sports 2018, 28, 1209–1214. [Google Scholar] [CrossRef] [PubMed]
  114. Freitas, S.R.; Radaelli, R.; Oliveira, R.; Vaz, J.R. Hamstring Stiffness and Strength Responses to Repeated Sprints in Healthy Nonathletes and Soccer Players with versus without Previous Injury. Sports Health 2023, 15, 824–834. [Google Scholar] [CrossRef]
  115. Lee, Y.; Kim, M.; Lee, H. The Measurement of Stiffness for Major Muscles with Shear Wave Elastography and Myoton: A Quantitative Analysis Study. Diagnostics 2021, 11, 524. [Google Scholar] [CrossRef]
  116. Alfuraih, A.M.; Alhowimel, A.; Alghanim, S.; Khayat, Y.; Aljamaan, A.; Alsobayel, H.I. The Association between Tensiomyography and Elastography Stiffness Measurements in Lower Limb Skeletal Muscles. Sensors 2022, 22, 1206. [Google Scholar] [CrossRef]
  117. Ham, S.; Kim, S.; Choi, H.; Lee, Y.; Lee, H. Greater Muscle Stiffness during Contraction at Menstruation as Measured by Shear-Wave Elastography. Tohoku J. Exp. Med. 2020, 250, 207–213. [Google Scholar] [CrossRef] [PubMed]
  118. Liu, J.; Wang, K.; Wu, J.; Miao, H.; Qian, Z.; Ren, L.; Ren, L. In Vivo Assessment of Lower Limb Muscle Stress State Based on Shear Wave Elastography. IEEE Access 2020, 8, 122185–122196. [Google Scholar] [CrossRef]
  119. Cornelson, S.M.; Ruff, A.N.; Wells, C.; Sclocco, R.; Kettner, N.W. Sonographic measures and sensory threshold of the normal sciatic nerve and hamstring muscles. J. Ultrasound. 2022, 25, 47–57. [Google Scholar] [CrossRef] [PubMed]
  120. Vatovec, R.; Marušič, J.; Marković, G.; Šarabon, N. Effects of Nordic hamstring exercise combined with glider exercise on hip flexion flexibility and hamstring passive stiffness. J. Sports Sci. 2021, 39, 2370–2377. [Google Scholar] [CrossRef]
  121. Sanders, T.L.; Maradit Kremers, H.; Bryan, A.J.; Larson, D.R.; Dahm, D.L.; Levy, B.A.; Stuart, M.J.; Krych, A.J. Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study. Am. J. Sports Med. 2016, 44, 1502–1507. [Google Scholar] [CrossRef]
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Figure 1. Participants’ position on a medical bed during the shear-wave elastography measurements.
Figure 1. Participants’ position on a medical bed during the shear-wave elastography measurements.
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Figure 2. An example of the semimembranosus muscle stiffness measurement using ultrasound-based shear-wave elastography.
Figure 2. An example of the semimembranosus muscle stiffness measurement using ultrasound-based shear-wave elastography.
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Table 1. Differences in the passive stiffness of BFlh, semitendinosus, and semimembranosus muscle between injured thighs, uninjured contralateral thighs, and control thighs (kPa).
Table 1. Differences in the passive stiffness of BFlh, semitendinosus, and semimembranosus muscle between injured thighs, uninjured contralateral thighs, and control thighs (kPa).
Injured Thighs (n = 13) (mean ± SD)Uninjured Contralateral Thighs (n = 13) (Mean ± SD)Control Thighs (n = 40) (Mean ± SD)p-Values
-Injured vs. Contralateral
-Injured vs. Control
-Contralateral vs. Control
BFlh26.19 ± 5.2826.16 ± 7.4127.64 ± 5.58Injured vs. contralateral: p = 1
Injured vs. control: p = 1
Contralateral vs. control: p = 1
Semimembranosus24.35 ± 5.5824.65 ± 8.3522.83 ± 5.67Injured vs. contralateral: p = 1
Injured vs. control: p = 1
Contralateral vs. control: p = 1
Semitendinosus22.45 ± 725.52 ± 722.54 ± 4.4Injured vs. contralateral: p = 0.487
Injured vs. control: p = 1
Contralateral vs. control: p = 0.291
Abbreviations. BFlh, biceps femoris long head; SD, standard deviation.
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Kepir, E.; Demiral, F.; Akaras, E.; Paksoy, A.E.; Sevindik Aktas, B.; Yilmaz Cankaya, B.; Oztop, B.; Yagiz, G.; Owen, J.A. Hamstring Muscle Stiffness in Athletes with and without Anterior Cruciate Ligament Reconstruction History: A Retrospective Study. J. Clin. Med. 2024, 13, 4370. https://doi.org/10.3390/jcm13154370

AMA Style

Kepir E, Demiral F, Akaras E, Paksoy AE, Sevindik Aktas B, Yilmaz Cankaya B, Oztop B, Yagiz G, Owen JA. Hamstring Muscle Stiffness in Athletes with and without Anterior Cruciate Ligament Reconstruction History: A Retrospective Study. Journal of Clinical Medicine. 2024; 13(15):4370. https://doi.org/10.3390/jcm13154370

Chicago/Turabian Style

Kepir, Ersagun, Furkan Demiral, Esedullah Akaras, Ahmet Emre Paksoy, Buket Sevindik Aktas, Bahar Yilmaz Cankaya, Bilgehan Oztop, Gokhan Yagiz, and Julian Andrew Owen. 2024. "Hamstring Muscle Stiffness in Athletes with and without Anterior Cruciate Ligament Reconstruction History: A Retrospective Study" Journal of Clinical Medicine 13, no. 15: 4370. https://doi.org/10.3390/jcm13154370

APA Style

Kepir, E., Demiral, F., Akaras, E., Paksoy, A. E., Sevindik Aktas, B., Yilmaz Cankaya, B., Oztop, B., Yagiz, G., & Owen, J. A. (2024). Hamstring Muscle Stiffness in Athletes with and without Anterior Cruciate Ligament Reconstruction History: A Retrospective Study. Journal of Clinical Medicine, 13(15), 4370. https://doi.org/10.3390/jcm13154370

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