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Degenerative changes of the tendon can be asymptomatic.
Two mechanisms could account for an increase of tendon stiffness: a) changes of the tendon material (i.e., increase of Young's modulus) and b) changes of the tendon morphological properties (i.e., increase of cross-sectional area) [24,28-31].
However, using ultrasound images instead of MRI for the manual segmentation [38,39,43,44], intervention-induced changes of the tendon CSA might have been undetected or overrated, since the reliability of this manual segmentation method was reported to be poor [45].
Therefore, an effective bone wrapping algorithm is needed to further improve the tendon network model by representing more realistic geometrical changes of the tendon components whilst moving around bones.
It is noteworthy that the predicted length changes of the tendon components are all well within the ranges found in a previous in vitro experimental study using 7 cadaveric hands by Garcia-Elias et al. [ 24].
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In 1931, Codman originally described degenerative changes of the tendons that initiate rotator cuff tears (Codman and Akerson 1931).
Regarding the variables analyzed in the selected 5 studies, all the authors focused on the description of morphological and histological changes of the tendons involved through imaging or arthroscopy, mainly concentrating their studies on the existence of tears, tendinopathies or inflammatory processes [ 16, 21– 23].
Strain was defined as the length change of the tendon and aponeurosis of all structures distal to the analyzed points to the rest length × 100 (Stafilidis and Arampatzis 2007).
The results showed that iatrogenic bursitis after carrageenan subacromial injections was associated with marked changes of the supraspinatus tendon.
On the 23rd day post injection, the scanning was conducted again to trace the vascular changes of the Achilles tendon.
In order to assess the impact of mechanical loading on tendon adaptation, the effect sizes of the intervention-induced changes (i.e., changes to baseline) of the tendon stiffness, Young's modulus, and CSA for each study were calculated.
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