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Recombinant human bone morphogenetic protein-2 delivered in an injectable calcium phosphate paste accelerates osteotomy-site healing in a nonhuman primate model.

BACKGROUND: In recent clinical trials demonstrating the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) for the acceleration of bone-healing, investigators used carriers requiring open surgery for administration. In this study, we used a nonhuman primate fibular osteotomy model to evaluate injectable rhBMP-2/carrier formulations that can be administered in closed fractures. METHODS: The fibular osteotomy model was first characterized by evaluating surgically harvested fibular segments containing untreated osteotomy sites (controls) from seventy adult male Cynomolgus monkeys at eight weeks (twenty-four monkeys), ten weeks (thirty-four), twelve weeks (six), and fourteen weeks (six). Fibular segments, from twenty-four animals, in which an osteotomy had not been performed served as normal controls (intact). The contralateral limb of twenty-four of the animals was then used to evaluate the effect of rhBMP-2 administered, three hours after the osteotomy, in eight carrier formulations (buffer, calcium phosphate paste, and hyaluronan gel, hyaluronan paste, and gelatin foam formulated with and without tricalcium phosphate granules). Each carrier was used in three monkeys. At ten weeks, the fibulae with the treated osteotomy sites were harvested and were compared with the contralateral, untreated osteotomized fibulae (paired control). The most promising carrier, calcium phosphate paste (alpha bone substitute material, or alpha-BSM), was then evaluated in eleven additional animals. The outcomes included the findings on radiographs made weekly until the time of fibular harvest, the callus area, the biomechanical properties, and the histologic findings. RESULTS: Radiographic and histologic studies confirmed complete bridging of the control osteotomy sites in most animals by fourteen weeks. The mean torsional stiffness and maximum torque of the control osteotomy sites were 42.7% and 53.7%, 55.2% and 60.4%, 66.7% and 66.4% of the mean torsional stiffness and maximum torque of the intact fibulae at eight, ten, and twelve weeks, respectively, but they were not substantially different from the mean torsional stiffness and maximum torque of the intact fibulae at fourteen weeks (82.3% and 79.8%). In the carrier screening study, outcome measures of healing were more consistently enhanced in the rhBMP-2/alpha-BSM-treated osteotomy sites. In the confirmatory study, the mean callus area, torsional stiffness, and maximum torque were 86%, 72%, and 68% greater in the rhBMP-2/alpha-BSM-treated osteotomy sites than in the paired-control osteotomy sites at ten weeks (p < 0.001). The torsional stiffness and maximum torque in the rhBMP-2/alpha-BSM-treated osteotomy sites were equal to those in the intact fibulae, whereas those parameters in the paired-control osteotomy sites were only 55% and 58%, respectively, of the torsional stiffness and maximum torque of the intact fibulae. Histologic analysis confirmed complete osseous bridging of the rhBMP-2/alpha-BSM-treated osteotomy sites but incomplete bridging of the paired-control osteotomy sites at ten weeks. CONCLUSIONS: A single percutaneous injection of rhBMP-2/alpha-BSM accelerates the healing of fibular osteotomy sites in nonhuman primates by approximately 40% compared with the healing of untreated osteotomy sites.

Animals↗

Muscle function in chronic compartment syndrome of the leg.

Chronic compartment syndrome (CCS) is a recognized cause of recurrent leg pain in the exercising patient. Decreased muscle function has been implied in this condition. This study compared the ankle dorsiflexion torque of 10 CCS patients with that of 18 control subjects during 20 repeated, maximal, isokinetic contractions at 60 degrees/sec. Peak torque, relative peak torque, and endurance data were collected. Results showed significantly lower peak torque and relative peak torque in the CCS group (p < or = 0.05), supporting the implication of muscle weakness in CCS. Paradoxically, endurance was significantly higher in the CCS group (p < or = 0.01), and there was a significant (p < or = 0.01), negative correlation (r = -0.50) between peak torque and endurance. The relationship between the findings and CCS is discussed. Strengthening may be useful in very mild cases or in postfasciotomy patients.

Adult↗

The effect of nontraumatic immobilization on ankle dorsiflexion stiffness in rats.

Experimental evidence supports the general conclusion that 6 or more weeks of immobilization will cause joint contractures due to changes in the capsules of animals whose limbs have been traumatized. There is controversy whether contractures will form in 6 weeks in limbs which are free of trauma. The purpose of this study was to determine if range of motion would be lost in ankle joints of rats following nontraumatic immobilization of the hindlimb for 2 or 6 weeks. The right hindlimb of each animal was immobilized in a plaster cast for 2 or 6 weeks with the left hindlimb serving as a matched control (N = 8). Nonimmobilized rats served as additional controls (N = 4). Following 2 or 6 weeks of immobilization, each rat was sacrificed and the lower leg removed at the knee. An electrogoniometer measured the change in dorsiflexion as torque was applied in increasing increments to the ankle. Load-deformation tests were performed to determine: 1) torque to end range of dorsiflexion, 2) joint excursion with application of 3.57 mNm torque for 2.5 seconds, and 3) joint excursion with prolonged application of 3.57 mNm torque. Only the group casted for 6 weeks demonstrated a significant (p < 0.05) decrease in both degrees of dorsiflexion and joint compliance. The group casted for 6 weeks required five times more torque to achieve end range than the other groups and had a 70% decrease in ankle dorsiflexion when a fixed torque of 3.57 mNm was applied. No significant differences were noted among the remaining groups. These findings suggest that in nontraumatically immobilized joints of rats, dense connective tissue remodels in such a way that mobility is unaffected after 2 weeks, but becomes quite limited by 6 weeks.

Animals↗

Propulsion technique in hand rim wheelchair ambulation.

Six male subjects took part in a pilot study on a stationary wheelchair ergometer. They propelled the ergometer at a speed of 0.55, 0.83, 1.11 and 1.39 m/s. The speed increased every 3 min. Inertia and friction force were adjusted proportional to body weight. Every third minute 750 samples of the torque and velocity signals were digitized at a sampling rate of 100 Hz. From the signals mean external power output (Pmean), peak power (Ppeak), mean torque (Mmean) and peak torque (Mpeak), work/cycle, 'time-to-peak torque' (TTP), cycle duration (CT), push time (PT) and recovery time (RT) were determined in relation to mean velocity (speed). For the mean velocity range studied, analysis of variance (P less than 0.05) revealed significant increments in Ppeak, Mpeak, Pmean, Mmean and work/cycle with increasing mean velocity, whereas CT and PT showed a significant decrease. TTP showed a decrease with speed which, however, was not statistically significant. The RT showed no significant variation as well. Our previous research into propulsion techniques mainly focused on movement frequency and timing and was conducted during wheelchair ambulation on a motor driven treadmill. Despite considerable interindividual variation in terms of movement pattern, current and previous studies showed similar trends in the timing pattern (cycle, push, recovery duration) with respect to speed. Theoretical considerations regarding variations in peak torque and work/cycle with respect to velocity are supported by the current results. Both torque and work/cycle are important technique parameters and of relevance in speed regulation. The data also suggest that wheelchair ambulation can be validly simulated and studied with the special purpose wheelchair ergometer.(ABSTRACT TRUNCATED AT 250 WORDS)

Ergonomics↗

Effectiveness of cemented rescue screws for anterior cervical plate fixation.

OBJECT: Among the various ways to optimize the fixation of bone implants is to use bone cement, for example, in a total hip prosthesis. No data exist, however, concerning the effectiveness of cemented rescue screws for anterior cervical plate fixation. The aim of this study was to investigate whether cemented rescue screws increase fixation strength in comparison with uncemented standard screws. METHODS: Six cervical spine segments (C4-7) were explanted during routine autopsy studies from fresh human cadavers. Bone mineral density (BMD) was measured for each vertebral body (VB) using quantitative computerized tomography scanning, and 24 VBs were dissected from the segments. Two initial pilot holes were drilled into each VB parallel to the sagittal plane. Based on their BMD, the specimens were assigned to one of two groups in which torque and pullout force were tested. The test was begun with standard screws and was repeated with cannulated slotted rescue screws into which bone cement was injected. The mean values of peak torque and pullout forces resulting from the left and right measurements were used for statistical analysis. A t-test was performed to determine the effect of screw type on peak torque and pullout force. Moment correlation coefficients were calculated to determine the effect of BMD on peak torque and pullout force for each type of screw. The mean insertional peak torque was 67.1 N/cm for the standard screw and 102.6 N/cm for the cemented screw (p < 0.05). The mean pullout force was 526.9 N for standard osteoporosis screws and 531.5 N for cemented screws (p > 0.05). The effect of increased holding strength as measured by peak torque and pullout force was more pronounced in the presence of low bone density. CONCLUSIONS: Cemented rescue screws that have been inserted into a fatigued pilot hole in the cervical VB strengthen the screw-bone interface compared with the strength initially conferred by a standard screw.

Autopsy↗

Compensatory advantages of toe walking.

OBJECTIVES: The study's hypothesis is that toe walking requires less peak muscle strength distally about the ankle and knee compared with normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal muscle weakness. DESIGN: Motion analysis and force platform data were collected in able-bodied subjects during toe walking and normal walking. Sagittal plane joint torques reflecting muscle force requirements and joint powers reflecting nonisometric muscle contraction were compared between the two conditions using paired t tests, applying a Bonferroni correction for multiple comparisons. SETTING: A gait laboratory. SUBJECTS: Seventeen able-bodied adults, 9 of whom were ballet dancers. MAIN OUTCOME MEASURES: Peak hip, knee, and ankle joint torque and power variables during walking. RESULTS: Peak ankle plantarflexor torque and ankle power generation during terminal stance and preswing were reduced (p<.001), as compared with normal heel-toe walking. The normal ankle dorsiflexor torque at initial contact-and the knee extensor torque and knee power generation during loading response were all essentially absent during toe walking. Hip extensor torque and hip power generation during the loading response phase were greater for toe walking (p<.001). CONCLUSION: Toe walking may require less ankle plantarflexor, ankle dorsiflexor, and knee extensor strength than normal heel-toe walking and thus may have compensatory advantages for patients with upper motor neuron injury and distal lower extremity weakness.

Adult↗

Mechanical analysis of the Nautilus leg curl machine.

The present study assessed the capability of the Nautilus leg curl machine to reflect changes in the isokinetic resistance torque offered to the user commensurate with the human torque pattern generated by the knee flexor muscle group. An averaged isokinetic torque pattern was determined from the exercise machine and from a subject pool (N = 20) of physically active men performing prone knee flexion at two angular velocities (30 degrees/s and 60 degrees/s). The torque patterns of the exercise machine and the subject pool were expressed mathematically. Analysis of the linear regression coefficients established that the resistance torque pattern of the exercise machine was not similar to that of the subject pool (p less than .001). It was concluded that the present exercise machine system did not adequately alter the weight-stack load to provide a resistive torque suited to the biomechanical capabilities of the knee flexors under the two isokinetic conditions studied.

Adult↗

Isokinetic and isometric measurement of strength of external rotation and abduction of the shoulder.

The strength of active external rotation and of abduction of the shoulder when the humerus was in the plane of the scapula (30 degrees of horizontal flexion anterior to the coronal plane) was measured isokinetically and isometrically in thirty-nine normal volunteers, who were stratified by age and sex. The angles at which peak torque was produced were similar when tested isokinetically and isometrically; these angles were similar for external rotation (at 60 and 30 degrees of internal rotation) and for abduction (at 30 and 60 degrees of abduction). Isometric peak torque was greater than slow-speed (90 degrees per second) isokinetic peak torque, which in turn was greater than fast-speed (210 degrees per second) isokinetic peak torque. There were highly significant differences in strength, measured isokinetically and isometrically, between younger and older men and between older men and older women. The variability of normal values for torque was similar in each group. Repeat testing demonstrated a high reliability of isokinetic measurements and of isometric measurements at angles within the range of the production of peak torque. Complete testing was performed in four normal volunteers before and after a block of the suprascapular nerve. The supraspinatus and infraspinatus components of the rotator cuff contributed a variable proportion to the total strength of abduction (25 to 50 per cent) and external rotation (50 to 75 per cent) throughout the range of motion. This study demonstrated that both isokinetic and isometric testing in the scapular plane are valid methods for measurement of the strength of external rotation and abduction of the shoulder. The data support standardization of the positions for testing the strength of motions of the shoulder: isometric strength of external rotation should be measured in the scapular plane with the shoulder in 45 degrees of abduction and 45 degrees of internal rotation; isometric strength of abduction, in the scapular plane with the shoulder in 45 degrees of abduction; and isokinetic strength of external rotation and abduction, in the scapular plane at 90 degrees per second.

Adult↗

Influence of concentric resistance training on concentric and eccentric strength.

This study investigated the effects of isokinetic concentric training on isokinetic concentric and eccentric torque outputs. Sixteen female subjects (mean age in years +/- SE = 21 +/- 1) were randomly assigned to either a training or a control group. Concentric and eccentric torques of the right knee extensors were assessed at 1.05rad.s-1 using a KinCom isokinetic dynamometer system. Each test consisted of a set of four maximal concentric and four maximal eccentric contractions of the knee extensors. The peak and average torques for each contraction were calculated using the computer software supplied by the KinCom manufacturer. On a separate day, after abstaining from heavy exercise for at least 12 hours, a single cross-sectional image of the thigh at midfemur was obtained using computer tomography (CT) scanning. From this image, cross-sectional area of the quadriceps femoris group was calculated using the computer software associated with the General Electric 9800 CT Scanning System. Training group subjects trained three days weekly for six weeks on a Cybex II+ isokinetic dynamometer, completing five sets of ten maximal effort knee extensions at an angular velocity of 1.05rad.s-1. Each set of exercise was separated by two minutes of self-selected recovery. Torque outputs were monitored daily to ensure that adequate recovery was provided between sets of exercise, and to document changes in strength as the program progressed. Significant (p less than .01) increases in peak and average concentric torque (11% and 12%, respectively), peak and average eccentric torque (18% and 21%, respectively), and muscle cross-sectional area (3.2%) were observed for training group subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Neural circuits mediating visual flight control in flies. I. Quantitative comparison of neural and behavioral response characteristics.

The motion-sensitive horizontal cells in the lobula plate of the fly are assumed to play a key role in the sensory control of yaw torque generated by the flying animal during course-stabilization maneuvers and the fixation of objects. This inference results from comparisons of electrophysiological data obtained from blowflies (Calliphora erythrocephala) and behavioral data obtained mainly from houseflies (Musca domestica) and fruitflies (Drosophila melanogaster). Apart from few exceptions, the compatibility of these physiological and behavioral data has not been critically tested. In the present study, the responses of the equatorial horizontal cell HSE of Calliphora and the yaw torque responses of Calliphora and Musca were recorded under identical visual stimulation with moving periodic gratings. The goal of the experiments was to obtain electrophysiological and behavioral data on Calliphora, on the one hand, and behavioral data on Calliphora and Musca, on the other hand, that allow direct comparisons between the physiological properties of the HSE and the visually induced torque responses in both species. The dependence of the HSE responses and the yaw torque responses on the direction, contrast frequency, and brightness of a moving periodic grating were evaluated quantitatively. The results of the electrophysiological recordings and torque measurements are in close agreement and thus represent strong evidence that the horizontal cells are, in fact, involved in yaw torque control in both species. Measurements of the cellular and behavioral responses as function of the stimulus position in the visual field, however, reveal differences between the spatial sensitivity of the horizontal cells and the sensory input to the motor system.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Isokinetic and isometric testing of knee musculature in patients with rheumatoid arthritis with mild knee involvement.

This study sought to determine if weakness and poor endurance of quadriceps and hamstring muscles are present in rheumatoid arthritis (RA) patients with minimally involved knees; determine if there is an abnormal hamstring/quadriceps ratio or abnormal torque curves in RA patients; and begin to evaluate the feasibility of isokinetic (IK) exercise in RA patients. Sixteen RA patients with minimally involved knees and 16 matched control subjects were tested bilaterally with a Cybex II dynamometer. Torque values in the RA group were significantly less (78% for isokinetic and 81% for isometric). The hamstring/quadriceps torque ratio was significantly higher in the RA patients than in the controls: 66.8% vs 61.7%. There was no significant difference in endurance between the two groups. In the RA patients the angle at which peak torque occurred shifted later in the range of motion (37.4 degrees) compared with the control subjects (28.7 degrees). Except for IK torque of hamstring muscles in the control group, there was no significant difference in the torque values between the right and left sides in RA patients or control subjects. The findings suggested that even in RA patients with minimally involved joints, muscle weakness was present; exercise of quadriceps should be emphasized since in RA patients quadriceps were weaker than hamstrings; and isokinetic testing is feasible in selected patients with RA.

Adult↗

Elongation and preload stress in dental implant abutment screws.

A common problem associated with dental implant restorations is loosening of screws that retain the prosthesis to the implant. A method was developed to determine initial preload on UCLA-type abutment screws by measuring elongation after applying known tightening torques with a digital torque gauge. Loosening torque was also measured after tightening to 32 N-cm torque for gold alloy abutment screws and 20 N-cm for titanium abutment screws. Gold alloy and titanium abutment screws were each used to secure a gold UCLA hexed abutment to a titanium implant. Stresses and forces were calculated from the elongation measurements for three regions of each screw. Elongation of the screws after applying the manufacturer's recommended tightening torques were within the elastic range. Induced stresses were 57.5% and 56% of the yield strengths for gold alloy and titanium, respectively. Tightening of screws beyond recommended levels may be possible without producing plastic deformation. At manufacturer's recommended torques, mean preload was 468.2 (+/- 57.9) N using gold alloy screws and 381.5 (+/- 72.9) N with titanium screws.

Dental Abutments↗

Would revision arthroplasty be facilitated by extracorporeal shock wave lithotripsy? An evaluation including whole bone strength in dogs.

Extracorporeal shock-wave lithotripsy has been proposed as a modality to facilitate the removal of bone cement during revision arthroplasty; however, concomitant cortical microfractures have been reported. The current study examines the effect on whole bone strength of extracorporeal shock-wave lithotripsy directed at the cement-bone complex. Canine femora were subjected to manual cement extraction or lithotripsy followed by manual cement extraction. Contralateral femora served as controls. Torsional fractures were created, and maximum torque, maximum angular displacement, and energy capacity to failure were determined. Although cement extraction alone reduced mean torque by 6.6% and failed to reduce mean torque angle or mean energy capacity, the combination of lithotripsy and cement extraction reduced mean torque by 7.3%, mean torque angle by 14.3%, and mean energy capacity by 18.3%. No statistical significance was demonstrated between the two groups in torque, angle, or energy capacity. At magnitudes and numbers of shock waves previously shown to significantly reduce cement-bone interface mechanical strength, lithotripsy exposure had a minimal and insignificant effect on whole bone strength.

Animals↗

Twitch interpolation of the elbow flexor muscles at high forces.

We investigated factors affecting maximal voluntary torque and the assessment of the level of voluntary drive in the elbow flexor muscles. First, the effective compliance of the system was tested by using single, paired, and trains of four stimuli to measure voluntary activation. At high voluntary torques the responses to all these stimuli were identical, suggesting that single stimuli are adequate for estimating voluntary drive. Second, the contribution of torque from synergist elbow flexor muscles was assessed. In attempted maximal voluntary contractions (MVCs), the voluntary activation of brachioradialis (median 91.5%, range 68.9-100%) was lower than for biceps brachii (median 99.1%, range 78.5-100%; P < 0.01). This suggests extra torque may be generated by brachioradialis during elbow flexion, beyond the torque where biceps brachii is maximally activated. Finally, lengthening of the elbow flexors occurred during MVCs, due to slight shoulder movements. This would allow force to increase independently of an increase in voluntary drive.

Adult↗

Mechanical contribution of the fibula to torsion stiffness in the lower extremity.

The role of the fibula in rotational stability of the lower extremity, taking into account the intact knee joint and tibia, to the best of our knowledge, has not been investigated. A cadaver study was designed to determine the torque transfer down the lower extremity, with and without the fibula. Six fresh, frozen human cadaver legs were used. The knee joint was left intact and the foot disarticulated. An external rotation up to 5 degrees , coupled with axial compression, was applied to the femur passing through the knee joint in extension and down the lower extremity to the fixed distal end, where torque (N m) was measured via a load cell. Each specimen was further tested with the fibula, cut 4 cm from the distal end, and finally with the entire fibula disarticulated at the proximal end and removed. To achieve 5 degrees rotation, torques reached 1.82 N m (SD, 0.66 N m). When the fibula was cut, the torque reduced a small yet significant amount of 5%. With the entire fibula removed, the torque reduction was significant and more pronounced at 11%. The fibula provided a small yet significant role in torsion stability. From this study, where the biomechanical characteristics of the fibula is explicated, it is hoped that this information will have use in further understanding the biomechanical role of the fibula, especially, in relation to the altered mechanics associated with lower limb pathology involving a deficient fibula.

Aged↗

Biomechanical evaluation of the interfacial strength of a chemically modified sandblasted and acid-etched titanium surface.

The functional capacity of osseointegrated dental implants to bear load is largely dependent on the quality of the interface between the bone and implant. Sandblasted and acid-etched (SLA) surfaces have been previously shown to enhance bone apposition. In this study, the SLA has been compared with a chemically modified SLA (modSLA) surface. The increased wettability of the modSLA surface in a protein solution was verified by dynamic contact angle analysis. Using a well-established animal model with a split-mouth experimental design, implant removal torque testing was performed to determine the biomechanical properties of the bone-implant interface. All implants had an identical cylindrical shape with a standard thread configuration. Removal torque testing was performed after 2, 4, and 8 weeks of bone healing (n = 9 animals per healing period, three implants per surface type per animal) to evaluate the interfacial shear strength of each surface type. Results showed that the modSLA surface was more effective in enhancing the interfacial shear strength of implants in comparison with the conventional SLA surface during early stages of bone healing. Removal torque values of the modSLA-surfaced implants were 8-21% higher than those of the SLA implants (p = 0.003). The mean removal torque values for the modSLA implants were 1.485 N m at 2 weeks, 1.709 N m at 4 weeks, and 1.345 N m at 8 weeks; and correspondingly, 1.231 N m, 1.585 N m, and 1.143 N m for the SLA implants. The bone-implant interfacial stiffness calculated from the torque-rotation curve was on average 9-14% higher for the modSLA implants when compared with the SLA implants (p = 0.038). It can be concluded that the modSLA surface achieves a better bone anchorage during early stages of bone healing than the SLA surface; chemical modification of the standard SLA surface likely enhances bone apposition and this has a beneficial effect on the interfacial shear strength.

Biocompatible Materials↗

Neurostimulation systems: assessment of magnetic field interactions associated with 1.5- and 3-Tesla MR systems.

PURPOSE: To evaluate magnetic field interactions at 1.5- and 3-Tesla for implantable pulse generators (IPGs) and radiofrequency (RF) receivers used for implantable neurostimulation systems. MATERIALS AND METHODS: Measurements of magnetically induced displacement force and torque were determined for 10 devices (seven IPGs, three RF receivers) used for neurostimulation systems. Displacement force and torque were assessed at various positions in 1.5- and 3-Tesla MR systems using standardized techniques. RESULTS: Four IPGs exhibited force ratios (magnetic attraction force/device weight) greater than 1.0, with the overall magnitude of the force ratio increasing significantly when comparing the 1.5-Tesla to the 3-Tesla MR system. Of the seven IPGs tested, one exhibited a torque ratio (magnetic induced torque/product of the device weight and length) greater than 1.0. The RF receivers displayed relatively strong magnetic field interactions at both 1.5- and 3-Tesla, exhibiting force and torque ratios greater than 1.0. CONCLUSIONS: The neurostimulation implants tested exhibited varying degrees of magnetic field interactions, with four of the seven IPGs and the three RF receivers exhibiting at least one MR-induced force or torque value greater than the effect of gravity. These findings have important implications for patients with these implants who are referred for MRI examinations.

Deep Brain Stimulation↗

Plasticity of dynamic muscle performance with strength training in elderly humans.

Data are scarce relating to the plasticity with strength training of dynamic muscle performance in older humans. Hence, we investigated alterations in the torque-velocity relation with strength training in old age, and their origin. Knee extension and leg-press exercises were performed three times per week for 14 weeks. Maximal isokinetic knee extension torque was assessed during concentric and eccentric muscle actions. Agonist-antagonist muscle activation was assessed using electromyography. Vastus lateralis muscle architecture was examined in vivo using ultrasonography. Training increased concentric torque by 22-37% (P < 0.01), but failed to alter eccentric torque (P > 0.05). Increased agonist muscle activation, increased muscle fascicle lengths, and greater elastic energy recovered from tendinous structures may explain the adaptations during concentric actions, whereas the failure of eccentric torque to increase might be explained by the preservation of eccentric force with aging and an underloading of the eccentric movement phase during training. These findings may have important implications for dynamic muscle performance in old age.

Adaptation, Physiological↗