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Changes in tissue composition and load response after transtibial amputation indicate biomechanical adaptation

Changes in tissue composition and load response after transtibial amputation indicate biomechanical adaptation
Changes in tissue composition and load response after transtibial amputation indicate biomechanical adaptation
Despite the potential for biomechanical conditioning with prosthetic use, the soft tissues of residual limbs following lower-limb amputation are vulnerable to damage. Imaging studies revealing morphological changes in these soft tissues have not distinguished between superficial and intramuscular adipose distribution, despite the recognition that intramuscular fat levels indicate reduced tolerance to mechanical loading. Furthermore, it is unclear how these changes may alter tissue tone and stiffness, which are key features in prosthetic socket design. This study was designed to compare the morphology and biomechanical response of limb tissues to mechanical loading in individuals with and without transtibial amputation, using magnetic resonance imaging in combination with tissue structural stiffness. The results revealed higher adipose infiltrating muscle in residual limbs than in intact limbs (residual: median 2.5% (range 0.2-8.9%); contralateral: 1.7% (0.1-5.1%); control: 0.9% (0.4-1.3%)), indicating muscle atrophy and adaptation post-amputation. The intramuscular adipose content correlated negatively with daily socket use, although there was no association with time post-amputation. Residual limbs were significantly stiffer than intact limbs at the patellar tendon site, which plays a key role in load transfer across the limb-prosthesis interface. The tissue changes following amputation can have relevance in the clinical understanding of prosthetic socket design variables and soft tissue damage risk in this vulnerable group.
Infiltrating adipose, Magnetic resonance imaging, Muscle atrophy, Remodelling, Transtibial amputation
0090-6964
Bramley, Jennifer Louise
102c61c2-fb86-4efb-ae98-053d46207f53
Worsley, Peter
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Bader, D.L.
e7086f10-f647-47b5-b2a5-42fef92cc049
Everitt, Chris
62cd944b-84a2-441e-bab7-1e85e9156bcf
Darekar, Angela
f7b566e5-3568-4c27-aed9-a5275f7a5cf5
King, Leonard
7442bd3c-ed4c-46aa-9d9b-1898a113c740
Dickinson, Alexander
10151972-c1b5-4f7d-bc12-6482b5870cad
Bramley, Jennifer Louise
102c61c2-fb86-4efb-ae98-053d46207f53
Worsley, Peter
6d33aee3-ef43-468d-aef6-86d190de6756
Bader, D.L.
e7086f10-f647-47b5-b2a5-42fef92cc049
Everitt, Chris
62cd944b-84a2-441e-bab7-1e85e9156bcf
Darekar, Angela
f7b566e5-3568-4c27-aed9-a5275f7a5cf5
King, Leonard
7442bd3c-ed4c-46aa-9d9b-1898a113c740
Dickinson, Alexander
10151972-c1b5-4f7d-bc12-6482b5870cad

Bramley, Jennifer Louise, Worsley, Peter, Bader, D.L., Everitt, Chris, Darekar, Angela, King, Leonard and Dickinson, Alexander (2021) Changes in tissue composition and load response after transtibial amputation indicate biomechanical adaptation. Annals of Biomedical Engineering. (doi:10.31224/osf.io/b3y4h).

Record type: Article

Abstract

Despite the potential for biomechanical conditioning with prosthetic use, the soft tissues of residual limbs following lower-limb amputation are vulnerable to damage. Imaging studies revealing morphological changes in these soft tissues have not distinguished between superficial and intramuscular adipose distribution, despite the recognition that intramuscular fat levels indicate reduced tolerance to mechanical loading. Furthermore, it is unclear how these changes may alter tissue tone and stiffness, which are key features in prosthetic socket design. This study was designed to compare the morphology and biomechanical response of limb tissues to mechanical loading in individuals with and without transtibial amputation, using magnetic resonance imaging in combination with tissue structural stiffness. The results revealed higher adipose infiltrating muscle in residual limbs than in intact limbs (residual: median 2.5% (range 0.2-8.9%); contralateral: 1.7% (0.1-5.1%); control: 0.9% (0.4-1.3%)), indicating muscle atrophy and adaptation post-amputation. The intramuscular adipose content correlated negatively with daily socket use, although there was no association with time post-amputation. Residual limbs were significantly stiffer than intact limbs at the patellar tendon site, which plays a key role in load transfer across the limb-prosthesis interface. The tissue changes following amputation can have relevance in the clinical understanding of prosthetic socket design variables and soft tissue damage risk in this vulnerable group.

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More information

Submitted date: 16 April 2021
Accepted/In Press date: 20 August 2021
e-pub ahead of print date: 27 September 2021
Published date: 27 September 2021
Additional Information: Acknowledgments The authors would like to thank the following for their financial support: JLB: the University of Southampton’s Institute for Life Sciences (IfLS), and EPSRC Doctoral Training Program (ref EP/N509747/1). PRW, DLB: the EPSRC-NIHR “Medical Device and Vulnerable Skin Network” (ref EP/N02723X/1), ASD: the Royal Academy of Engineering, UK, (ref RF/130). Ethics Committee approval for this protocol was granted by the University of Southampton (ERGO ID: 29696 and 41864). We would like to thank all of the individuals who participated in this study.
Keywords: Infiltrating adipose, Magnetic resonance imaging, Muscle atrophy, Remodelling, Transtibial amputation

Identifiers

Local EPrints ID: 451240
URI: http://eprints.soton.ac.uk/id/eprint/451240
ISSN: 0090-6964
PURE UUID: ed2c1fa1-e18b-491a-807f-68be4d238dff
ORCID for Jennifer Louise Bramley: ORCID iD orcid.org/0000-0003-0414-3984
ORCID for Peter Worsley: ORCID iD orcid.org/0000-0003-0145-5042
ORCID for Alexander Dickinson: ORCID iD orcid.org/0000-0002-9647-1944

Catalogue record

Date deposited: 14 Sep 2021 20:59
Last modified: 24 Nov 2021 02:41

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Contributors

Author: Jennifer Louise Bramley ORCID iD
Author: Peter Worsley ORCID iD
Author: D.L. Bader
Author: Chris Everitt
Author: Angela Darekar
Author: Leonard King

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