TY - JOUR
T1 - In muscle lengthening surgery multiple aponeurotomy does not improve intended acute effects and may counter-indicate
T2 - An assessment by finite element modelling
AU - Yucesoy, Can A.
AU - Şeref-Ferlengez, Zeynep
AU - Huijing, Peter A.
N1 - Funding Information:
This work was supported by (1) The Turkish Academy of Sciences (TÜBA) under the Distinguished Young Scientist Award to Can A. Yucesoy and (2) Bog˘azic¸i University Research Fund under grants 04HX102 to Can A. Yucesoy and 04S101 to Ata Akın. The authors acknowledge the contribution of Marijan Rekveld to the development of the concepts studied presently.
PY - 2013/1
Y1 - 2013/1
N2 - The goal was to assess the effects of multiple aponeurotomy on mechanics of muscle with extramuscular myofascial connections. Using finite element modelling, effects of combinations of the intervention carried out at a proximal (P), an intermediate (I) and a distal (D) location were studied: (1) Case P, (2) Case P-I, (3) Case P-D and (4) Case P-I-D. Compared to Case P, the effects of multiple interventions on muscle geometry and sarcomere lengths were sizable for the distal population of muscle fibres: e.g. at high muscle length (1) summed gap lengths between the cut ends of aponeurosis increased by 16, 25 and 27% for Cases P-I, P-D and P-I-D, respectively, (2) characteristic substantial sarcomere shortening became more pronounced (mean shortening was 26, 29, 30 and 31% for Cases P, P-I, P-D and P-I-D, respectively) and (3) fibre stresses decreased (mean stress equalled 0.49, 0.39, 0.38 and 0.33 for Cases P, P-I, P-D and P-I-D, respectively). In contrast, no appreciable effects were shown for the proximal population. The overall change in sarcomere length heterogeneity was limited. Consequently, the effects of multiple aponeurotomy on muscle length-force characteristics were marginal: (1) a limited reduction in active muscle force (maximal 'muscle weakening effect' remained between 5 and 11%) and (2) an even less pronounced change in slack to optimum length range of force exertion (maximal 'muscle lengthening effect' distally was 0.2% for Case P-I-D) were shown. The intended effects of the intervention were dominated by the one intervention carried out closer to the tendon suggesting that aponeurotomies done additionally to that may counter-indicated.
AB - The goal was to assess the effects of multiple aponeurotomy on mechanics of muscle with extramuscular myofascial connections. Using finite element modelling, effects of combinations of the intervention carried out at a proximal (P), an intermediate (I) and a distal (D) location were studied: (1) Case P, (2) Case P-I, (3) Case P-D and (4) Case P-I-D. Compared to Case P, the effects of multiple interventions on muscle geometry and sarcomere lengths were sizable for the distal population of muscle fibres: e.g. at high muscle length (1) summed gap lengths between the cut ends of aponeurosis increased by 16, 25 and 27% for Cases P-I, P-D and P-I-D, respectively, (2) characteristic substantial sarcomere shortening became more pronounced (mean shortening was 26, 29, 30 and 31% for Cases P, P-I, P-D and P-I-D, respectively) and (3) fibre stresses decreased (mean stress equalled 0.49, 0.39, 0.38 and 0.33 for Cases P, P-I, P-D and P-I-D, respectively). In contrast, no appreciable effects were shown for the proximal population. The overall change in sarcomere length heterogeneity was limited. Consequently, the effects of multiple aponeurotomy on muscle length-force characteristics were marginal: (1) a limited reduction in active muscle force (maximal 'muscle weakening effect' remained between 5 and 11%) and (2) an even less pronounced change in slack to optimum length range of force exertion (maximal 'muscle lengthening effect' distally was 0.2% for Case P-I-D) were shown. The intended effects of the intervention were dominated by the one intervention carried out closer to the tendon suggesting that aponeurotomies done additionally to that may counter-indicated.
KW - multiple aponeurotomies
KW - muscle length-force characteristics
KW - myofascial force transmission
KW - sarcomere length distributions
KW - surgical muscle lengthening
KW - the finite element analysis
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U2 - 10.1080/10255842.2011.599803
DO - 10.1080/10255842.2011.599803
M3 - Article
C2 - 21806415
AN - SCOPUS:84872524437
SN - 1025-5842
VL - 16
SP - 12
EP - 25
JO - Computer Methods in Biomechanics and Biomedical Engineering
JF - Computer Methods in Biomechanics and Biomedical Engineering
IS - 1
ER -