Functional Adaptation

Dr.-Ing. Alison Agres

We investigate the change in the motion of the lower limb by altering the musculoskeletal tissue properties to reveal new treatment options.
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Visualization of the muscles and tendons of the lower limb using B-mode ultrasonography.
Depiction of the functional axes of the knee determined using the SARA methodology.

Acute musculoskeletal injuries and chronic musculoskeletal disorders often result from participation in high-demand activities, particularly during sports. These conditions lead to pathological changes in the soft tissues that enable skeletal movement, such as the muscles, tendons, ligaments, and cartilage, and ultimately, alterations in forward movement. Such modified gait patterns may arise from inherent tissue-level adaptations that occur soon after injury and surgical intervention. Current clinical assessments have a limited scope and are unable to objectively classify both post-surgery tissue status and to quantify active patient function. As a result, specific relationships between in vivo soft tissue properties and altered movement patterns remain unclarified in many high-incidence injury models.

With this in mind, the aims of this subgroup are to objectively assess both (1) changes in musculoskeletal tissue properties instigated by injury and disease and (2) the adaptive changes in lower extremity movement that coincide with these altered tissue properties. The central goal is to develop a comprehensive understanding of the relationship between these two aspects to improve clinical outcomes.

In order to achieve this, both pre-existing and newly developed methods have been employed to monitor tissue function. Sample projects include ultrasonography to evaluate linear Achilles tendon stiffness, as well as fluoroscopic assessment of the knee during both passive and active movements. Furthermore, this workgroup has developed validated kinematic methods and algorithms in order to more accurately determine joint centers and axes to monitor in vivo skeletal movement during motion analysis [1]. Applications of the OCST method developed within this group allow for significant reductions in soft tissue artefacts, and the PHMD algorithm automates gait cycle separation in patients with significantly pathological gait [2]. Finally, various types of functional assessments in the lower limb have been cross-checked and compared, e.g. active versus passive [3], single-limb and bilateral assessments [4]. These types of assessments are particularly interesting with the context of sports-related injuries that typically occur unilaterally, such as anterior/posterior cruciate ligament (ACL/PCL) or Achilles tendon ruptures and reconstructions.

The knowledge obtained from this work reveals the potential origins of functional anomalies that arise after treatment of musculoskeletal injury and disease. Together with our collaborators in the clinic and in sports science, we can make informed recommendations to optimize post-injury and post-surgery interventions.

Running projects:

  • "Joint Research Project: Understanding and Prevention of primary Osteoarthritis progression (OVERLOAD-PrevOP) financed by Federal Ministry of Education and Research, Support Code 01 EC1408A
  • "Basis for an understanding of cartilage degeneration: The meaning of passive and active joint laxity for the pathological kinematic of the knee" financed by the German Research Society, DU 298/20-1
  • "Adaptations in the muscle-tendon unit after Achilles tendon injury", contributions made possible by DFG funding through the Berlin-Brandenburg School of Regenerative Therapies GSC 203.

Clinical Partners:

  • Dr. med. Tobias Jung, Attending Physician (Oberarzt), Head of Knee Surgery and Sports Traumatology, Center for Musculoskeletal Surgery, CharitéUniversitätsmedizin Berlin.
  • Dr. med. Sebastian Manegold, Attending Physician (Oberarzt), Head of Foot and Ankle Surgery, Center for Musculoskeletal Surgery, CharitéUniversitätsmedizin Berlin.
  • Dr. med. Ralf Doyscher, Department of Sports Medicine, Institute for Sports Science at the Humboldt Universität zu Berlin
  • Dr. med. Benjamin Bartek, Center for Musculoskeletal Surgery, Charité- Universitätsmedizin Berlin

Scientific partners:

  • Dr. Rainald Ehrig, Zuse Institute Berlin (ZIB), Department of Computational Systems Biology
  • Univ. - Prof. Dr. Adamantios Arampatzis, Department of Training and Movement Science, Humboldt University of Berlin
  • Prof. Dr. William R. Taylor, Institute for Biomechanics, ETH Zurich, Switzerland



    Dr.-Ing. Heide Boeth

    Principal Investigator

    Dr.-Ing. Alison Agres

    Principal Investigator