Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-07-2016 | Ankle

Real-time sonoelastography as novel follow-up method in Achilles tendon surgery

Authors: A. Busilacchi, M. Olivieri, S. Ulisse, R. Gesuita, E. Skrami, T. Lording, F. Fusini, A. Gigante

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2016

Abstract

Purpose

To evaluate the sonoelastographic features of Achilles tendon healing after percutaneous treatment using real-time sonoelastography, a new tool able to quantify deformation in biological tissues.

Methods

Patients with atraumatic Achilles tendon ruptures, treated with a percutaneous technique, were assessed. Sonoelastographic evaluations were performed at the myotendinous junction, tendon body/lesion site and osteotendinous junction, both for the operated and contralateral side, at 40 days, 6 months and 1 year after surgery. Using standard regions of interest, the “strain index” (SI) was calculated as an indicator of tendon elasticity. Clinical outcomes were assessed by the ATRS questionnaire at 6 months and 1 year post-operatively and correlated with sonoelastographic findings. Sixty healthy tendons from 30 volunteers were used to provide a healthy control range.

Results

Twenty-five patients were recruited for this study. The SI in treated tendons showed progressive stiffening over time, especially at myotendinous junction and at the site of the sutured lesion, resulting in significantly higher stiffness than both the contralateral tendon and healthy volunteers. Peak thickness of treated tendons occurred at 6 months, with a tendency to reduce at 1 year, while never achieving a normal physiological state. Greatest remodelling was seen at the lesion site. The contralateral tendon showed significant thickening at the myotendinous and osteotendinous junctions. The SI of the contralateral tendon was found to be stiffer than physiological values found in the control group. ATRS score improved significantly between 6 months and 1 year, being negatively correlated with the SI (p < 0.001).

Conclusion

RTSE showed that operatively treated Achilles tendons become progressively stiffer during follow-up, while the ATRS score improved. From a biomechanical point of view, at 1 year after surgery Achilles tendons did not show a “restitutio ad integrum”. Real-time sonoelastography provides more qualitative and quantitative details in the diagnostics and follow-up of Achilles tendon conditions as the post-operative evolution of the repairing tissue.

Level of evidence

Diagnostic and therapeutic study, Level III.

Aubry S, Risson JR, Barbier-Brion B, Tatu L, Vidal C, Kastler B (2011) Transient elastography of calcaneal tendon: preliminary results and future prospects. J Radiol 92(5):421–427CrossRefPubMed

Aubry S, Risson JR, Kastler A, Barbier-Brion B, Siliman G, Runge M, Kastler B (2013) Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography. Skelet Radiol 42(8):1143–1150CrossRef

Carmont MR, Silbernagel KG, Nilsson-Helander K, Mei-Dan O, Karlsson J, Maffulli N (2013) Cross cultural adaptation of the Achilles tendon total rupture score with reliability, validity and responsiveness evaluation. Knee Surg Sports Traumatol Arthrosc 21(6):1356–1360CrossRefPubMed

Chen XM, Cui LG, He P, Shen WW, Qian YJ, Wang JR (2013) Shear wave elastographic characterization of normal and torn achilles tendons: a pilot study. J Ultrasound Med 32(3):449–455PubMed

de Palma L, Gigante A, Rapali S (1998) I processi riparativi delle lesioni tendinee. In: “Progressi in Medicina e Chirurgia del piede” -Il piede nello sport-, vol 7. Aulo Gaggi Editor, Bologna, pp 13–23

de Palma L, Marinelli M, Meme L, Pavan M (2004) Immunohistochemistry of the enthesis organ of the human Achilles tendon. Foot Ankle Int 25(6):414–418PubMed

de Palma L, Santucci A, Sabetta SP (1994) Anatomia della regione calcaneare, vol 3. Progressi in Medicina e Chirurgia del piede - Fratture del Calcagno

De Zordo T, Chhem R, Smekal V, Feuchtner G, Reindl M, Fink C, Faschingbauer R, Jaschke W, Klauser AS (2010) Real-time sonoelastography: findings in patients with symptomatic achilles tendons and comparison to healthy volunteers. U Ultraschall Med 31(4):394–400CrossRef

De Zordo T, Fink C, Feuchtner GM, Smekal V, Reindl M, Klauser AS (2009) Real-time sonoelastography findings in healthy Achilles tendons. AJR Am J Roentgenol 193(2):W134–W138CrossRefPubMed

10.

Dewall RJ (2013) Ultrasound elastography: principles, techniques, and clinical applications. Crit Rev Biomed Eng 41(1):1–19CrossRefPubMed

11.

Doral MN, Alam M, Bozkurt M, Turhan E, Atay OA, Donmez G, Maffulli N (2010) Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc 18(5):638–643CrossRefPubMed

12.

Drakonaki EE, Allen GM, Wilson DJ (2009) Real-time ultrasound elastography of the normal Achilles tendon: reproducibility and pattern description. Clin Radiol 64(12):1196–1202CrossRefPubMed

13.

Filippucci E, Farina A, Bartolucci F, Spallacci C, Busilacchi P, Grassi W (2003) Levofloxacin-induced bilateral rupture of the Achilles tendon: clinical and sonographic findings. Reumatismo 55(4):267–269PubMed

14.

Gigante A, Moschini A, Verdenelli A, Del Torto M, Ulisse S, de Palma L (2008) Open versus percutaneous repair in the treatment of acute Achilles tendon rupture: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc 16(2):204–209CrossRefPubMed

15.

Gigante A, Specchia N, Rapali S, Ventura A, de Palma L (1996) Fibrillogenesis in tendon healing: an experimental study. Boll Soc Ital Biol Sper 72(7–8):203–210PubMed

16.

Hamamoto K (2006) Investigation on virtual palpation system using ultrasonic elasticity imaging. Conf Proc IEEE Eng Med Biol Soc 1:4873–4876PubMed

17.

Hippocrates: (400 B.C.) The books of prognostics. In: eBooks@Adelaide, The University of Adelaide Library, University of Adelaide, South Australia

18.

Kearney RS, Achten J, Lamb SE, Parsons N, Costa ML (2012) The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures. Health Qual Life Outcomes 29:10–24

19.

Klauser AS, Miyamoto H, Tamegger M, Faschingbauer R, Moriggl B, Klima G, Feuchtner GM, Kastlunger M, Jaschke WR (2013) Achilles tendon assessed with sonoelastography: histologic agreement. Radiology 267(3):837–842CrossRefPubMed

20.

Leadbetter WB (1992) Cell-matrix response in tendon injury. Clin Sports Med 11(3):533–578PubMed

21.

Magarelli N, Carducci C, Bucalo C, Filograna L, Rapisarda S, De Waure C, Dell’Atti C, Maccauro G, Leone A, Bonomo L (2014) Sonoelastography for qualitative and quantitative evaluation of superficial soft tissue lesions: a feasibility study. Eur Radiol 24(3):566–573CrossRefPubMed

22.

McNair P, Nordez A, Olds M, Young SW, Cornu C (2013) Biomechanical properties of the plantar flexor muscle-tendon complex 6 months post-rupture of the Achilles tendon. J Orthop Res 31(9):1469–1474CrossRefPubMed

23.

Nilsson-Helander K, Thomee R, Silbernagel KG, Thomee P, Faxen E, Eriksson BI, Karlsson J (2007) The Achilles tendon Total rupture score (ATRS): development and validation. Am J Sports Med 35(3):421–426CrossRefPubMed

24.

Ophir J, Alam SK, Garra B, Kallel F, Konofagou E, Krouskop T, Varghese T (1999) Elastography: ultrasonic estimation and imaging of the elastic properties of tissues. Proc Inst Mech Eng H 213(3):203–233CrossRefPubMed

25.

Palle L, Reddy MB, Reddy KJ, Kumari MV (2011) Technical note: real-time sonoelastography evaluation of Achilles tendon. Indian J Radiol Imaging 21(4):267–269CrossRefPubMedPubMedCentral

26.

Palmes D, Spiegel HU, Schneider TO, Langer M, Stratmann U, Budny T, Probst A (2002) Achilles tendon healing: long-term biomechanical effects of postoperative mobilization and immobilization in a new mouse model. J Orthop Res 20(5):939–946CrossRefPubMed

27.

Pesavento A, Perrey C, Krueger M, Ermert H (1999) A time-efficient and accurate strain estimation concept for ultrasonic elastography using iterative phase zero estimation. IEEE Trans Ultrason Ferroelectr Freq Control 46(5):1057–1067CrossRefPubMed

28.

Sconfienza LM, Silvestri E, Cimmino MA (2010) Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. Clin Exp Rheumatol 28(3):373–378PubMed

29.

Tan S, Kudas S, Ozcan AS, Ipek A, Karaoglanoglu M, Arslan H, Bozkurt M (2012) Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skeletal Radiol 41(9):1067–1072CrossRefPubMed

30.

Tudisco C, Bisicchia S, Stefanini M, Antonicoli M, Masala S, Simonetti G (2013) Tendon quality in small unilateral supraspinatus tendon tears. Real-time sonoelastography correlates with clinical findings. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2551-7

31.

Varghese T, Ophir J, Konofagou E, Kallel F, Righetti R (2001) Tradeoffs in elastographic imaging. Ultrason Imaging 23(4):216–248CrossRefPubMed

Title: Real-time sonoelastography as novel follow-up method in Achilles tendon surgery
Authors: A. Busilacchi
M. Olivieri
S. Ulisse
R. Gesuita
E. Skrami
T. Lording
F. Fusini
A. Gigante
Publication date: 01-07-2016
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-014-3484-5

ACC 2024 Congress

Springer Medicine

Real-time sonoelastography as novel follow-up method in Achilles tendon surgery

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 7/2016

Is the flexion strength really increased after tenodesis for tendinopathy of the long head of the biceps?

Medial malleolar osteotomy for the treatment of talar osteochondral lesions: anatomical and morbidity considerations

Increase in ACL and PCL injuries after implementation of a new professional football league

Muscle injuries of the lower extremity: a comparison between young and old male elite soccer players

Comparative analysis of visual field and image distortion in 30° and 70° arthroscopes

Comparison of open acromioplasty, arthroscopic acromioplasty and physiotherapy in patients with subacromial impingement syndrome: a prospective randomised study