Correlation between the shear modulus measured by elastography (SSI) and tangent modulus from tensile tests of in vitro fresh-frozen human tendons

Assessing the mechanical properties of tendons in vivo allows for quantifying the degree of pathology and tracking functional improvements. The Supersonic Shearwave Imaging (SSI) technique is a state-of-the-art method for analyzing musculoskeletal tissues in vivo. This technique estimates tissue stiffness as the shear elastic modulus mu [kPa]. However, only a few studies have validated the accuracy of SSI-estimated shear modulus against the gold standard for in vitro material testing, the tensile test. This study compared the SSI-measured shear elastic modulus (mu) with the tangent modulus (Etan) obtained from mechanical tensile tests for human Achilles (AT) and patellar tendons (PT). The sample comprised eleven fresh-frozen human Achilles tendons and five fresh-frozen human patellar tendons from cadavers that were not degraded by formalin or ionizing radiation. The tendons were tested in a tensile machine, and elastography videos were collected and segmented every 5% of the total experiment time. The absolute mu values estimated from both instruments presented an up to 20-fold difference. However, a strong significant positive correlation was found between mu and Etan for both tendons (range AT: R = 0.9765-0.9972 and PT: R = 0.8719-0.9782). The two resulting curves (mu and Etan) as a function of strain (epsilon) were normalized by their maxima for visually comparing stiffness x strain profiles. In conclusion, despite the inaccurate absolute values, SSI has been shown to measure relative changes in human Achilles and patellar tendon stiffness. This study endorses future clinical use of SSI to provide in vivo estimations of human tendons' mechanical properties.