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1.
Ann Rheum Dis ; 83(7): 847-857, 2024 Jun 12.
Article in English | MEDLINE | ID: mdl-38443140

ABSTRACT

OBJECTIVES: To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population. METHODS: In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas). RESULTS: In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses. CONCLUSIONS: This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.


Subject(s)
Enthesopathy , Spondylarthritis , Ultrasonography, Doppler , Humans , Female , Male , Enthesopathy/diagnostic imaging , Adult , Middle Aged , Ultrasonography, Doppler/methods , Spondylarthritis/diagnostic imaging , Spondylarthritis/complications , Arthritis, Psoriatic/diagnostic imaging , Arthritis, Psoriatic/complications , Severity of Illness Index , Achilles Tendon/diagnostic imaging , Achilles Tendon/pathology , Case-Control Studies
2.
NMR Biomed ; 37(1): e5040, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37740595

ABSTRACT

The purpose of this study is to investigate the use of ultrashort echo time (UTE) magnetic resonance imaging (MRI) techniques (T1 and magnetization transfer [MT] modeling) for imaging of the Achilles tendons and entheses in patients with psoriatic arthritis (PsA) compared with asymptomatic volunteers. The heels of twenty-six PsA patients (age 59 ± 15 years, 41% female) and twenty-seven asymptomatic volunteers (age 33 ± 11 years, 47% female) were scanned in the sagittal plane with UTE-T1 and UTE-MT modeling sequences on a 3-T clinical scanner. UTE-T1 and macromolecular proton fraction (MMF; the main outcome of MT modeling) were calculated in the tensile portions of the Achilles tendon and at the enthesis (close to the calcaneus bone). Mann-Whitney-U tests were used to examine statistically significant differences between the two cohorts. UTE-T1 in the entheses was significantly higher for the PsA group compared with the asymptomatic group (967 ± 145 vs. 872 ± 133 ms, p < 0.01). UTE-T1 in the tendons was also significantly higher for the PsA group (950 ± 145 vs. 850 ± 138 ms, p < 0.01). MMF in the entheses was significantly lower in the PsA group compared with the asymptomatic group (15% ± 3% vs. 18% ± 3%, p < 0.01). MMF in the tendons was also significantly lower in the PsA group compared with the asymptomatic group (17% ± 4% vs. 20% ± 5%, p < 0.01). Percentage differences in MMF between the asymptomatic and PsA groups (-16.6% and -15.0% for the enthesis and tendon, respectively) were higher than the T1 differences (10.8% and 11.7% for the enthesis and tendon, respectively). The results suggest higher T1 and lower MMF in the Achilles tendons and entheses in PsA patients compared with the asymptomatic group. This study highlights the potential of UTE-T1 and UTE-MT modeling for quantitative evaluation of entheses and tendons in PsA patients.


Subject(s)
Achilles Tendon , Arthritis, Psoriatic , Humans , Female , Adult , Middle Aged , Aged , Young Adult , Male , Achilles Tendon/diagnostic imaging , Arthritis, Psoriatic/diagnostic imaging , Arthritis, Psoriatic/pathology , Magnetic Resonance Imaging/methods , Protons
3.
Exp Physiol ; 109(5): 729-737, 2024 May.
Article in English | MEDLINE | ID: mdl-38488678

ABSTRACT

Due to Achilles tendon compliance, passive ankle stiffness is insufficient to stabilise the body when standing. This results in 'paradoxical' muscle movement, whereby calf muscles tend to shorten during forward body sway. Natural variation in stiffness may affect this movement. This may have consequences for postural control, with compliant ankles placing greater reliance upon active neural control rather than stretch reflexes. Previous research also suggests ageing reduces ankle stiffness, possibly contributing to reduced postural stability. Here we determine the relationship between ankle stiffness and calf muscle movement during standing, and whether this is associated with postural stability or age. Passive ankle stiffness was measured during quiet stance in 40 healthy volunteers ranging from 18 to 88 years of age. Medial gastrocnemius muscle length was also recorded using ultrasound. We found a significant inverse relationship between ankle stiffness and paradoxical muscle movement, that is, more compliant ankles were associated with greater muscle shortening during forward sway (r ≥ 0.33). This was seen during both quiet stance as well as voluntary sway. However, we found no significant effects of age upon stiffness, paradoxical motion or postural sway. Furthermore, neither paradoxical muscle motion nor ankle stiffness was associated with postural sway. These results show that natural variation in ankle stiffness alters the extent of paradoxical calf muscle movement during stance. However, the absence of a clear relationship to postural sway suggests that neural control mechanisms are more than capable of compensating for a lack of inherent joint stiffness.


Subject(s)
Ankle , Muscle, Skeletal , Postural Balance , Humans , Muscle, Skeletal/physiology , Adult , Aged , Middle Aged , Male , Female , Postural Balance/physiology , Young Adult , Aged, 80 and over , Ankle/physiology , Adolescent , Movement/physiology , Achilles Tendon/physiology , Achilles Tendon/diagnostic imaging , Ankle Joint/physiology , Aging/physiology , Leg/physiology , Posture/physiology
4.
Scand J Med Sci Sports ; 34(1): e14516, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37817483

ABSTRACT

PURPOSE: This study investigated the effects of a 12-week gait retraining program on the morphological and mechanical properties of the Achilles tendon (AT) during running on the basis of real-time dynamic ultrasound imaging. METHODS: A total of 30 male recreational runners who were used to wearing cushioned shoes with a rearfoot strike (RFS) pattern were recruited. They were randomized into a retraining group (RG, n = 15) and a control group (CG, n = 15). The RG group was asked to run in five-fingered minimalist shoes with a forefoot strike (FFS) pattern, and the CG group was asked to keep their strike pattern. Three training sessions were performed per week. All the participants in RG uploaded running tracks obtained through a mobile application (.jpg) after each session for training supervision. The ground reaction force, kinematics, and kinetics of the ankle joint at 10 km/h were collected using an instrumented split-belt treadmill and a motion capture system. The morphological (length and cross-sectional area) and mechanical characteristics (force, stress, strain, etc.) of AT in vivo were recorded and calculated with a synchronous ultrasonic imaging instrument before and after the intervention. Repeated two-way ANOVA was used to compare the aforementioned parameters. RESULTS: A total of 28 participants completed the training. The strike angle of RG after training was significantly smaller than that before training and significantly smaller than that of CG after training (F (1, 13) = 23.068, p < 0.001, partial η2 = 0.640). The length (F (1, 13) = 10.086, p = 0.007, partial η2 = 0.437) and CSA (F (1, 13) = 7.475, p = 0.017, partial η2 = 0.365) of AT in RG increased after training. A significant main effect for time was observed for the time-to-peak AT force (F (1, 13) = 5.225, p = 0.040, partial η2 = 0.287), average (F (1, 13) = 7.228, p = 0.019, partial η2 = 0.357), and peak AT loading rate (F (1, 13) = 11.687, p = 0.005, partial η2 = 0.473). CONCLUSION: Preliminary evidence indicated that a 12-week gait retraining program could exert a beneficial effect on AT. 57% (8/14) runners in RG shifted from RFS to FFS pattern. Although not all runners were categorized as FFS pattern after the intervention, their foot strike angle was reduced. Retraining primarily positively promoted AT morphological properties (i.e., CSA and length) to strengthen AT capability for mechanical loading.


Subject(s)
Achilles Tendon , Humans , Male , Achilles Tendon/diagnostic imaging , Ankle Joint , Biomechanical Phenomena , Foot , Gait , Lower Extremity , Shoes
5.
Scand J Med Sci Sports ; 34(6): e14679, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38898554

ABSTRACT

PURPOSE: The Achilles tendon consists of three subtendons with the ability to slide relative to each other. As optimal intratendinous sliding is thought to reduce the overall stress in the tendon, alterations in sliding behavior could potentially play a role in the development of Achilles tendinopathy. The aims of this study were to investigate the difference in intratendinous sliding within the Achilles tendon during isometric contractions between asymptomatic controls and patients with Achilles tendinopathy and the effect of changing the horizontal foot position on intratendinous sliding in both groups. METHODS: Twenty-nine participants (13 Achilles tendinopathy and 16 controls) performed isometric plantarflexion contractions at 60% of their maximal voluntary contraction (MVC), in toes-neutral, and at 30% MVC in toes-neutral, toes-in, and toes-out positions during which ultrasound images were recorded. Intratendinous sliding was estimated as the superficial-to-middle and middle-to-deep relative displacement. RESULTS: Patients with Achilles tendinopathy present lower intratendinous sliding than asymptomatic controls. Regarding the horizontal foot position in both groups, the toes-out foot position resulted in increased sliding compared with both toes-neutral and toes-out foot position. CONCLUSION: We provided evidence that patients with Achilles tendinopathy show lower intratendinous sliding than asymptomatic controls. Since intratendinous sliding is a physiological feature of the Achilles tendon, the external foot position holds promise to increase sliding in patients with Achilles tendinopathy and promote healthy tendon behavior. Future research should investigate if implementing this external foot position in rehabilitation programs stimulates sliding within the Achilles tendon and improves clinical outcome.


Subject(s)
Achilles Tendon , Foot , Isometric Contraction , Tendinopathy , Ultrasonography , Humans , Achilles Tendon/diagnostic imaging , Achilles Tendon/injuries , Achilles Tendon/physiopathology , Tendinopathy/physiopathology , Tendinopathy/rehabilitation , Male , Adult , Female , Case-Control Studies , Foot/physiopathology , Middle Aged , Posture/physiology , Young Adult
6.
Scand J Med Sci Sports ; 34(5): e14665, 2024 May.
Article in English | MEDLINE | ID: mdl-38773808

ABSTRACT

The objective of the study was to obtain adjusted ultrasonographic reference values of the Achilles tendon thickness (maximum anterior-posterior distance) in adults without (previous) Achilles tendinopathy (AT) and to compare these reference values with AT patients. Six hundred participants were consecutively included, comprising 500 asymptomatic individuals and 100 patients with clinically diagnosed chronic AT. The maximum tendon thickness was assessed using Ultrasound Tissue Characterization. A multiple quantile regression model was developed, incorporating covariates (personal characteristics) that were found to have a significant impact on the maximum anterior-posterior distance of the Achilles tendon. A 95% reference interval (RI) was derived (50th, 2.5th-97.5th percentile). In asymptomatic participants median (95% RI) tendon thickness was 4.9 (3.8-6.9) mm for the midportion region and 3.7 (2.8-4.8) mm for the insertional region. Age, height, body mass index, and sex had a significant correlation with maximum tendon thickness. Median tendon thickness for the midportion region was calculated with the normative equation -2.1 + AGE × 0.021 + HEIGHT × 0.032+ BMI × 0.028 + SEX × 0.05. For the insertional region, the normative equation was -0.34 + AGE × 0.010+ HEIGHT × 0.018 + BMI × 0.022 + SEX × -0.05. In the equations, SEX is defined as 0 for males and 1 for females. Mean (95% CI) difference in tendon thickness compared to AT patients was 2.7 mm (2.3-3.2, p < 0.001) for the midportion and 1.4 mm (1.1-1.7, p < 0.001) for the insertional region. Compared to the asymptomatic population 73/100 (73%) AT patients exhibited increased tendon thickening, with values exceeding the 95% RI. This study presents novel reference values for the thickness of midportion and insertional region of the Achilles tendon, which were adjusted for personal characteristics. Our novel web-based openly accessible calculator for determining normative Achilles tendon thickness (www.achillestendontool.com) will be a useful resource in the diagnostic process. Trial registration number: This trial is registered in the Netherlands Trial Register (NL9010).


Subject(s)
Achilles Tendon , Tendinopathy , Ultrasonography , Humans , Achilles Tendon/diagnostic imaging , Achilles Tendon/anatomy & histology , Achilles Tendon/pathology , Male , Female , Tendinopathy/diagnostic imaging , Tendinopathy/pathology , Cross-Sectional Studies , Adult , Middle Aged , Reference Values , Aged , Body Mass Index , Young Adult , Sex Factors
7.
Scand J Med Sci Sports ; 34(5): e14650, 2024 May.
Article in English | MEDLINE | ID: mdl-38712745

ABSTRACT

Quantitative MRI (qMRI) measures are useful in assessing musculoskeletal tissues, but application to tendon has been limited. The purposes of this study were to optimize, identify sources of variability, and establish reproducibility of qMRI to assess Achilles tendon. Additionally, preliminarily estimates of effect of tendon pathology on qMRI metrics and structure-function relationships between qMRI measures and ankle performance were examined. T1, T1ρ, T2, and T2* maps of the Achilles tendon were obtained using a 3T MRI scanner. In participants with asymptomatic tendons (n = 21), MRI procedures were repeated twice, and region of interest selection was performed by three raters. Variance decomposition and reproducibility statistics were completed. To estimate the effect of pathology, qMRI measures from individuals with asymptomatic tendons were compared to qMRI measures from a pilot group of individuals with Achilles tendinopathy (n = 7). Relationships between qMRI and ankle performance measures were assessed. Between-participant variation accounted for the majority of variability (46.7%-64.0%) in all qMRI measures except T2*. ICCs met or exceeded 0.7 for all qMRI measures when averaged across raters or scans. Relaxation times were significantly longer in tendinopathic tendons (mean (SD) T1: 977.8 (208.6) ms, T1ρ: 35.4 (7.1) ms, T2: 42.8 (7.9) ms, T2*: 14.1 (7.6) ms, n = 7) compared to asymptomatic control tendons (T1: 691.7 (32.4) ms, T1ρ: 24.0 (3.6) ms, T2: 24.4 (7.5) ms, T2*: 9.5 (3.4) ms, n = 21) (p < 0.011 for all comparisons). T1 related to functional performance measures in symptomatic and asymptomatic groups. Study findings suggest that qMRI is reliable to assess the Achilles tendon. qMRI quantitatively assesses the presence of tendon pathology and relates to functional performance outcomes, supporting the utility of incorporating qMRI in research and clinic.


Subject(s)
Achilles Tendon , Magnetic Resonance Imaging , Tendinopathy , Humans , Achilles Tendon/diagnostic imaging , Magnetic Resonance Imaging/methods , Tendinopathy/diagnostic imaging , Male , Female , Adult , Reproducibility of Results , Young Adult , Middle Aged , Ankle Joint/diagnostic imaging
8.
Rheumatol Int ; 44(8): 1469-1479, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38850322

ABSTRACT

The Achilles tendon (AT) insertion is the most common site of enthesitis in psoriatic arthritis (PsA). The structure and function of the AT in PsA, and the prevalence of mid-portion pathology, is unknown. To compare the structure and function of the AT in people with PsA with self-reported AT pain (PsA + AT), PsA without self-reported AT pain (PsA-AT) and healthy controls. A cross-sectional, observational study was conducted. The ATs were assessed by clinical and US examination (B-mode and Power Doppler), performance-based testing (bilateral heel raise test (HRT) and 10 m walk test), and patient-reported outcome measures (PROMs) (including the Victorian Institute of Sport Assessment-Achilles [VISA-A]). Between-group differences were described using descriptive statistics, Chi-squared testing, parametric (1-way ANOVA) and non-parametric (Mann-Whitney or Kruskal-Wallis) testing. 22 PsA (11 per group) and 11 healthy control participants who were comparable in terms of sex, age, and BMI (PsA-AT = longer PsA disease duration) were recruited. VISA-A scores were significantly worse in the PsA + AT group compared to the PsA-AT group and healthy controls (p < 0.001). Inflammatory US features were significantly more prevalent in the PsA + AT group (p < 0.001). Mid-portion AT pathology was observed in the PsA + AT group, irrespective of entheseal disease. Clinical examination alone missed 5/7 cases of 'active' US-confirmed AT enthesitis. AT functional deficits were significant in the PsA + AT group and both PsA groups had lower HRT repetition rates and walked slower compared to healthy controls. Less than 1/3 of the PsA + AT group had received podiatry or physiotherapy care. Significant differences in the structure and function of the AT in PsA were noted. Despite management in line with current guidance, AT pain appears to persist and can result in severe functional impairment.


Subject(s)
Achilles Tendon , Arthritis, Psoriatic , Humans , Achilles Tendon/diagnostic imaging , Achilles Tendon/physiopathology , Arthritis, Psoriatic/physiopathology , Cross-Sectional Studies , Male , Female , Middle Aged , Adult , Patient Reported Outcome Measures , Disability Evaluation , Case-Control Studies , Aged , Pain Measurement
9.
Eur J Appl Physiol ; 124(2): 633-647, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37950761

ABSTRACT

PURPOSE: The aim of this study was to investigate internal Achilles tendon (AT) displacement, AT shear wave velocity (SWV), and triceps surae (TS) muscle shear modulus in athletes. METHODS: Internal AT displacement was assessed using ultrasound during isometric contraction. Shear wave elastography was used to assess AT SWV (m × s-1) at rest and TS muscle shear modulus (kPa) during passive ankle dorsiflexion. RESULTS: A total of 131 athletes participated in this study. Athletes who had not exercised within two days had greater AT non-uniformity and mean anterior tendon displacement, and lower SWV at the proximal AT measurement site (mean difference [95% CI]: 1.8 mm [0.6-2.9], p = 0.003; 1.6 mm [0.2-2.9], p = 0.021; - 0.9 m × s-1 [- 1.6 to - 0.2], p = 0.014, respectively). Male basketball players had a lower mean AT displacement compared to gymnasts (- 3.7 mm [- 6.9 to - 0.5], p = 0.042), with the difference localised in the anterior half of the tendon (- 5.1 mm [- 9.0 to - 1.1], p = 0.022). Male gymnasts had a smaller absolute difference in medial gastrocnemius-minus-soleus shear modulus than basketball players (59.6 kPa [29.0-90.2], p < 0.001) and track and field athletes (52.7 kPa [19.2-86.3], p = 0.004). Intraclass correlation coefficients of measurements ranged from 0.720 to 0.937 for internal AT displacement, from 0.696 to 0.936 for AT SWE, and from 0.570 to 0.890 for TS muscles. CONCLUSION: This study provides a reliability assessment of muscle and tendon SWV. The relative differences in passive TS muscle shear modulus suggest sport-specific adaptation. Importantly, in healthy individuals, lower AT displacement after exercise may reflect the time required for tendon recovery.


Subject(s)
Achilles Tendon , Elasticity Imaging Techniques , Humans , Male , Achilles Tendon/diagnostic imaging , Achilles Tendon/physiology , Reproducibility of Results , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/physiology , Leg , Athletes
10.
J Ultrasound Med ; 43(4): 713-722, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38140763

ABSTRACT

INTRODUCTION: Ultrasound is the preferred imaging method in the diagnostic process of Achilles tendinopathy (AT). Ultrasound tissue characterization (UTC) is a frequently used, standardized and valid method to assess tendon geometry in AT patients. It is unknown whether UTC is reliable for measuring Achilles tendon thickness. The aim of the study was to assess intra- and inter-rater reliability of Achilles tendon thickness measurements using UTC in both asymptomatic individuals and patients with AT, and to evaluate if the reliability of thickness measurements differs between the midportion and insertional area. METHODS: Exactly 50 patients with AT and 50 asymptomatic individuals were included. Using the conventional US and standardized UTC procedure maximum thickness was measured in the midportion and insertion region. To determine inter- and intra-rater reliabilities, the intraclass correlation coefficient (ICC) was used. RESULTS: The ICC values for inter- and intra-rater reliability were classified as "excellent," for the AT group (0.93 [95% CI: 0.88-0.96] and 0.95 [0.92-0.97]) and asymptomatic participants (0.91 [0.87-0.94] and 0.94 [0.92-0.96]). The reliability of measuring tendon thickness in the midportion region was "excellent," with both inter-rater (0.97 [0.95-0.98]) and intra-rater (0.98 [0.96-0.99]) ICC values indicating high levels of agreement. In the insertional region, ICC values for inter-rater (0.79 [0.69-0.87]) and intra-rater (0.89 [0.84-0.93]) reliability were "moderate to good." CONCLUSION: We showed excellent reliability for measuring the US thickness of the midportion and good reliability of measuring the insertional region in patients with AT. Significantly lower ICCs were observed for the reliability of thickness measurements in the insertional region when compared with the midportion.


Subject(s)
Achilles Tendon , Tendinopathy , Humans , Achilles Tendon/diagnostic imaging , Reproducibility of Results , Tendinopathy/diagnostic imaging , Ultrasonography/methods
11.
J Ultrasound Med ; 43(7): 1303-1312, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38526138

ABSTRACT

OBJECTIVES: Calcaneal apophysitis (Sever's disease) is an overuse condition caused by repetitive traction stress to the calcaneal apophysis. Whether Achilles tendon morphology is altered in this young patient population remains unknown. Therefore, we aimed to identify differences in Achilles tendon morphology between youth athletes diagnosed with calcaneal apophysitis and healthy controls. METHODS: This retrospective chart review included 46 patients (n = 23 Sever's disease, 15F/8M, 12.4 ± 2.3 years old) and (n = 23 healthy controls, 13F/10M, 15.9 ± 1.5 years old) who sought care in a Children's Hospital Sports Medicine/Orthopedics Department between 2012 and 2022. We measured ultrasound-derived degree of tendon thickening, Achilles tendon thickness (cm), and cross-sectional area (CSA [cm2]). Separate multivariate analyses of covariance (MANCOVAs) were used to compare degree of thickening, mass-normalized Achilles tendon thickness, and CSA between participant groups, covarying for age. Cohen's d effect sizes were used to assess the magnitude of mean differences and standard error (MDSE) between groups. RESULTS: Young athletes with Sever's disease had a significantly greater degree of tendon thickening with a large effect compared with healthy controls (MDSE: 0.07 [0.01] mm P < .001, d = 1.39). Achilles tendon thickness and CSA did not statistically differ between groups; however, the magnitude of between-group differences for these measures (MDSE: 0.18 [0.05] cm, MDSE: 0.27 [0.07] cm2, respectively) were moderate. CONCLUSIONS: Our findings demonstrate previously unrecognized differences in Achilles tendon morphology between young athletes with clinically diagnosed Sever's disease and healthy controls. Our study supports incorporating diagnostic ultrasound as part of a comprehensive examination to ensure appropriate diagnosis and clinical management for adolescents with heel pain.


Subject(s)
Achilles Tendon , Ultrasonography , Humans , Achilles Tendon/diagnostic imaging , Retrospective Studies , Male , Female , Ultrasonography/methods , Adolescent , Case-Control Studies , Child , Cumulative Trauma Disorders/diagnostic imaging , Athletes/statistics & numerical data , Calcaneus/diagnostic imaging , Tendinopathy/diagnostic imaging , Tendinopathy/complications
12.
Skeletal Radiol ; 53(7): 1381-1388, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38277027

ABSTRACT

PURPOSE: To report normative stiffness parameters obtained using shear wave elastography in dorsiflexion from the Achilles tendons in asymptomatic professional ballet dancers and compare them with college-level athletes. METHODS: An Institutional Review Board (IRB)-approved study consists of 28 professional ballet dancers and 64 asymptomatic collegiate athletes. The athletes were further subdivided into runner and non-runner disciplines. Shear wave elastography (SWE) measurements were made in maximum ankle dorsiflexion position. RESULTS AND DISCUSSION: Forty-eight (52%) males and 44 (48%) females were examined with an overall mean age of 22.2 (± 3.8 years). There were no significant SWE differences between dominant and non-dominant legs in both groups and comparing spin vs. non-spin leg of ballet dancers (p > 0.05). Ballet dancers had significantly higher short-axis velocity values than runners and non-runners (2.34 m/s increase and 2.79 m/s increase, respectively, p < 0.001). Long-axis velocity was significantly higher in ballet dancers compared to non-runners (by 0.80 m/s, p < 0.001), but was not different between ballet dancers and runners (p > 0.05). Short-axis modulus was significantly higher in dancers compared to runners and non-runners (by 135.2 kPa and 159.2 kPa, respectively, p < 0.001). Long-axis modulus (LAM) was not significantly different in ballet dancers when compared to runners. CONCLUSION: Asymptomatic professional ballet dancers exhibit greater short-axis tendon stiffness compared to athletes and greater long-axis tendon stiffness compared to non-runners but similar to runners. The functional benefit from elevated short-axis stiffness in dancers is not clear but may be related to greater axial loading and adaptations of the tendon matrix.


Subject(s)
Achilles Tendon , Athletes , Dancing , Elasticity Imaging Techniques , Humans , Male , Female , Elasticity Imaging Techniques/methods , Dancing/physiology , Achilles Tendon/diagnostic imaging , Achilles Tendon/physiology , Young Adult , Adult
13.
J Clin Ultrasound ; 52(6): 731-736, 2024.
Article in English | MEDLINE | ID: mdl-38635342

ABSTRACT

OBJECTIVES: Ankylosing spondylitis (AS) can cause peripheral arthritis, tendinitis, enthesitis, and axial skeletal involvement. This study aims to determine early tendon damage by shear wave elastography (SWE) for the Achilles tendon in AS patients. METHODS: 48 AS patients and 48 asymptomatic individuals were included in the study. Participants were systematically examined with B-mode, power Doppler, and SWE using a high-resolution linear 6-15 MHz probe. Bilateral Achilles tendon stiffness, thickness, and vascularity were evaluated. Measurements were taken from the middle third of the Achilles tendon in the sagittal plane. Difference between the two groups was evaluated with statistical methods. Receiver operating characteristic analysis was performed to test the diagnostic performance of Achilles tendon stiffness. Additionally, the Spearman correlation test examined the relationship between Achilles tendon stiffness and disease duration. RESULTS: The difference between the two groups regarding Achilles tendon stiffness was statistically significant (p < 0.05). It was observed that Achilles tendon stiffness decreased in the patient group compared with the control group. The diagnostic value of Achilles tendon stiffness measured by SWE was found to be high. A negative correlation was detected between disease duration and tendon stiffness (p < 0.05). CONCLUSION: In patients diagnosed with AS, deterioration in the Achilles tendon structure was observed, and a significant decrease in tendon stiffness compared with the healthy population. It has been determined that these changes in the Achilles tendon are related to the duration of the disease.


Subject(s)
Achilles Tendon , Elasticity Imaging Techniques , Spondylitis, Ankylosing , Humans , Achilles Tendon/diagnostic imaging , Achilles Tendon/physiopathology , Elasticity Imaging Techniques/methods , Spondylitis, Ankylosing/diagnostic imaging , Spondylitis, Ankylosing/physiopathology , Spondylitis, Ankylosing/complications , Male , Female , Adult , Case-Control Studies , Middle Aged , Reproducibility of Results
14.
Int Orthop ; 48(6): 1533-1541, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38340143

ABSTRACT

PURPOSE: The aims of the study were to document the outcomes of percutaneous Achilles tenotomy (pAT) performed in older children with clubfoot, by assessing the clinical, functional and ultrasonographic evidence of Achilles tendon regeneration. METHODS: A retrospective case series of older children with clubfoot treated between August 2011 and July 2020 was studied. Clinical assessment of ankle range of motion and calf strength, functional assessment of triceps surae muscle endurance by single leg heel-rise test, and ultrasonographic assessment of Achilles tendon echotexture and dimensions to assess tendon regeneration were performed. RESULTS: Percutaneous Achilles tenotomy was performed on 31 children (48 clubfeet) at a mean age of 5.24 ± 2.14 years (1-10.2 years). At a mean follow-up of 4.86 ± 1.97 years, all children demonstrated normal calf strength with mean dorsiflexion range of 13.64° (0-25°) and mean plantarflexion range of 37.95° (10-40°). The heel-rise endurance test was completed by 27 children with mean 25.85 heel rises/minute (range 17-30) and mean height of heel rise of 6.29 cm (range 4-10 cm). Normal fibrillar tendinous echotexture with homogenous echogenicity was seen on ultrasonography in 41 feet (85.4%) with mean tendon width of 9.7 mm (3.3-16 mm) and thickness of 5.1 mm (1.8-15 mm), comparable with unaffected feet. CONCLUSIONS: Clinical, functional and ultrasonographic parameters unequivocally demonstrate complete regeneration of the Achilles tendon, when pAT is performed in older children with delayed-presenting idiopathic clubfoot treated using Ponseti principles.


Subject(s)
Achilles Tendon , Clubfoot , Tenotomy , Ultrasonography , Humans , Achilles Tendon/surgery , Achilles Tendon/diagnostic imaging , Achilles Tendon/physiopathology , Clubfoot/surgery , Clubfoot/physiopathology , Tenotomy/methods , Retrospective Studies , Male , Child , Female , Child, Preschool , Infant , Regeneration/physiology , Range of Motion, Articular/physiology , Treatment Outcome
15.
Surg Radiol Anat ; 46(9): 1379-1386, 2024 Sep.
Article in English | MEDLINE | ID: mdl-38916631

ABSTRACT

PURPOSE: The aim of this study is to determine if ultrasound (US) allows a precise assessment of the paratenon (PT) of the Achilles calcaneal tendon (AT), and to anatomically describe the US-guided paratendinous injection technique. METHODS: This study was initially conducted on eight cadaveric specimens using high-resolution ultrasound (HRUS) to examine the PT appearance, thickness, and its relationships with the AT, plantaris tendon (PLT), Kager's fat pad (KFP), sural nerve (SN), and fascia cruris (FC). US-guided paratendinous injection of China ink was performed in all specimens, followed by anatomical dissection to assess injectate distribution. Then, HRUS study of the PT was carried out bilaterally in twenty asymptomatic volunteers (40 legs). Two musculoskeletal radiologists recorded all data in consensus except PT thickness in volunteers which was recorded independently in order to calculate intra and inter-observer reliability. RESULTS: The PT was consistently identified with HRUS along its entire course in both cadaveric specimens (8/8) and volunteers (40/40). The mean PT thickness was 0.54 mm in cadavers and 0.39 mm in vivo, without any correlation with the AT thickness. Intra- and inter observer reliability were respectively excellent and good for PT thickness. All eight (100%) ex vivo China ink injections were accurate, demonstrating a circumferential distribution of the injectate between the PT and the AT, associated with an anterior spread to the KFP. CONCLUSION: HRUS allows visualization of the PT along its entire length, and assessment of its relationships to adjacent structures. US-guided paratendinous injections can accurately and safely deliver injectates in the paratendinous sheath.


Subject(s)
Achilles Tendon , Cadaver , Humans , Achilles Tendon/anatomy & histology , Achilles Tendon/diagnostic imaging , Male , Female , Adult , Middle Aged , Ultrasonography, Interventional/methods , Injections/methods , Reproducibility of Results , Aged , Ultrasonography/methods , Dissection , Healthy Volunteers , Carbon
16.
Mod Rheumatol ; 34(3): 607-613, 2024 Mar 28.
Article in English | MEDLINE | ID: mdl-37267199

ABSTRACT

OBJECTIVES: In our study, we investigated the presence of subclinical enthesitis by ultrasonography (US) in asymptomatic patients with enthesitis-related arthritis (ERA) and sacroiliitis associated with familial Mediterranean fever (FMF). METHODS: A total of 50 patients, including 35 patients with ERA and 15 with sacroiliitis associated with FMF, were included in the study. All patients were evaluated with US by a paediatric radiologist. Enthesis of seven tendons (common extensor and flexor tendons, quadriceps tendon, proximal and distal patellar tendon, Achilles tendon, and plantar fascia) was examined on both sides. RESULTS: Subclinical enthesitis was detected in 10 ERA (28.5%) and three FMF (20%) patients. Enthesitis was radiologically diagnosed in 16 (2.3%) out of 700 evaluated entheseal sites. The most frequent sites of enthesitis were Achilles (37.5%) and quadriceps (31.3%) tendons. All patients were in clinical remission and had no active complaints, and acute phase reactants were within normal limits. Therefore, the patients were followed up without treatment change. However, disease flare-up was observed in three of these patients (23.1%) during the follow-up, and their treatments were intensified. CONCLUSIONS: Our results showed that the US can be particularly helpful in detecting subclinical enthesitis and predicting disease flare-ups.


Subject(s)
Achilles Tendon , Arthritis, Juvenile , Enthesopathy , Familial Mediterranean Fever , Sacroiliitis , Child , Humans , Sacroiliitis/complications , Sacroiliitis/diagnostic imaging , Familial Mediterranean Fever/complications , Familial Mediterranean Fever/diagnostic imaging , Symptom Flare Up , Enthesopathy/complications , Enthesopathy/diagnostic imaging , Arthritis, Juvenile/complications , Achilles Tendon/diagnostic imaging
17.
Foot Ankle Surg ; 30(4): 313-318, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38296758

ABSTRACT

BACKGROUND: Injections around the Achilles tendon (AT) are commonly performed in clinical practice to manage non-insertional Achilles tendinopathy, but the presence/distribution of the injectate with relation to its sheath has not been assessed specifically. Accordingly, the aim of this cadaveric investigation was to demonstrate the feasibility of Achilles paratenon injection under ultrasound guidance - by confirming the exact needle positioning as well as the dye distribution inside the paratenon lumen. METHODS: A descriptive laboratory study with three human cadaveric specimens (one fresh cadaver and two cadavers embalmed using the Fix for Life (F4L) method) was performed in a tertiary-care academic institution. The interventional technique and the related anatomical findings were illustrated. During the injection, the needle was advanced inside the Achilles paratenon under ultrasound guidance i.e. in-plane medial-to-lateral approach. With the objective to confirm its correct placement, the needle was kept in situ on the right AT of the fresh cadaver. Likewise, to demonstrate the location of the dye inside the lumen of Achilles paratenon, the other five ATs - four on the embalmed cadavers and one on the fresh cadaver - were injected with 5 mL of green color dye. After removal of the needle, a layer-by-layer anatomical dissection was performed on all three cadavers. RESULTS: On the right AT of the fresh cadaver, the position of the needle's tip within the Achilles paratenon was confirmed. Accurate placement of the dye inside the paratenon lumen was confirmed in four (80%) ATs, one of the fresh and three of the embalmed cadavers. No spread inside the crural fascia compartment or between the AT and the Kager's fat pad was observed. Herewith, unintentional spilling of the dye within the superficial soft tissues of the posterior leg was reported in the left AT of one of the two embalmed cadavers (20%). CONCLUSIONS: Ultrasound-guided injection using the in-plane, medial-to-lateral approach can accurately target the lumen of Achilles paratenon.


Subject(s)
Achilles Tendon , Cadaver , Ultrasonography, Interventional , Humans , Achilles Tendon/diagnostic imaging , Achilles Tendon/anatomy & histology , Tendinopathy/diagnostic imaging , Injections , Male , Feasibility Studies , Aged
18.
Foot Ankle Surg ; 30(5): 432-439, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38494414

ABSTRACT

BACKGROUND: Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity. METHODS: A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n = 16) and Haglund non-resection (non-resection group, n = 13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively. RESULTS: Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38 ± 5.7 vs. 93.15 ± 12.17; P = 0.82), VAS (0.5 ± 0.52 vs. 0.61 ± 0.87; P = 0.66) and VISA-A questionnaire (82.56 ± 13.46 vs. 74.92 ± 16.4; P = 0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15 ± 2.51 weeks vs. 11.31 ± 4.06 weeks, P = 0.02). The Fowler-Philip angle of the resection group decreased from 55.55° ± 12.34° preoperatively to 44.52° ± 10.24° at the latest follow-up (P = 0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38° ± 8.41° preoperatively to 46.52° ± 8.02° at the latest follow-up (P = 0.016). The calcaneal pitch angle of the resection group increased from 22.76° ± 5.37° preoperatively to 25.98° ± 6. 4° at the latest follow-up (P = 0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm ± 5.37 mm preoperatively to 173.90 mm ± 8.07 mm at the latest follow-up (P = 0.018). CONCLUSION: Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformity.


Subject(s)
Achilles Tendon , Calcinosis , Tendinopathy , Humans , Achilles Tendon/surgery , Achilles Tendon/diagnostic imaging , Retrospective Studies , Tendinopathy/surgery , Tendinopathy/diagnostic imaging , Male , Female , Middle Aged , Adult , Calcinosis/surgery , Calcinosis/diagnostic imaging , Calcaneus/surgery , Calcaneus/diagnostic imaging , Treatment Outcome
19.
J Exp Biol ; 226(14)2023 07 01.
Article in English | MEDLINE | ID: mdl-37350252

ABSTRACT

Regulating ankle mechanics is essential for controlled interactions with the environment and rejecting unexpected disturbances. Ankle mechanics can be quantified by impedance, the dynamic relationship between an imposed displacement and the torque generated in response. Ankle impedance in the sagittal plane depends strongly on the triceps surae and Achilles tendon, but their relative contributions remain unknown. It is commonly assumed that ankle impedance is controlled by changing muscle activation and, thereby, muscle impedance, but this ignores that tendon impedance also changes with activation-induced loading. Thus, we sought to determine the relative contributions from the triceps surae and Achilles tendon during conditions relevant to postural control. We used a novel technique that combines B-mode ultrasound imaging with joint-level perturbations to quantify ankle, muscle and tendon impedance simultaneously across activation levels from 0% to 30% of maximum voluntary contraction. We found that muscle and tendon stiffness, the static component of impedance, increased with voluntary plantarflexion contractions, but that muscle stiffness exceeded tendon stiffness at very low loads (21±7 N). Above these loads, corresponding to 1.3% of maximal strength for an average participant in our study, ankle stiffness was determined predominately by Achilles tendon stiffness. At approximately 20% MVC for an average participant, ankle stiffness was 4 times more sensitive to changes in tendon stiffness than to changes in muscle stiffness. We provide the first empirical evidence demonstrating that the nervous system, through changes in muscle activations, leverages the non-linear properties of the Achilles tendon to increase ankle stiffness during postural conditions.


Subject(s)
Achilles Tendon , Ankle , Humans , Achilles Tendon/diagnostic imaging , Achilles Tendon/physiology , Electric Impedance , Ankle Joint/physiology , Muscle, Skeletal/physiology
20.
Eur Radiol ; 33(1): 720-729, 2023 Jan.
Article in English | MEDLINE | ID: mdl-35760909

ABSTRACT

OBJECTIVES: Ultrasound often corroborates clinical diagnosis of Achilles tendinopathy (AT). Traditional measures assess macromorphological features or use qualitative grading scales, primarily focused within the free tendon. Shear wave imaging can non-invasively quantify tendon elasticity, yet it is unknown if proximal structures are affected by tendon pathology. The purpose of the study was to determine the characteristics of both traditional sonographic measures and regional shear wave speed (SWS) between limbs in patients with AT. METHODS: Twenty patients with chronic AT were recruited. Traditional sonographic measures of tendon structure were measured. Regional SWS was collected in a resting ankle position along the entire length of the tendon bilaterally. SWS measures were extracted and interpolated across evenly distributed points corresponding to the free tendon (FT), soleus aponeurosis (SA), and gastrocnemius aponeurosis (GA). Comparisons were made between limbs in both traditional sonographic measures and regional SWS. RESULTS: Symptomatic tendons were thicker (10.2 (1.9) vs. 6.8 (1.8) mm; p < 0.001) and had more hyperemia (p = 0.001) and hypoechogenicity (p = 0.002) than the contralateral tendon. Regional SWS in the FT was lower in the symptomatic limb compared to the contralateral limb (11.53 [10.99, 12.07] vs. 10.97 [10.43, 11.51]; p = 0.03). No differences between limbs were found for the SA (p = 0.13) or GA (p = 0.99). CONCLUSIONS: Lower SWS was only observed in the FT in AT patients, indicating that alterations in tendon elasticity associated with AT were localized to the FT and did not involve the proximal passive tendon structures. KEY POINTS: • Baseline characteristics of a pilot sample of 20 subjects suffering from chronic Achilles tendinopathy showed differences in conventional sonographic measures of tendon thickness, qualitatively assessed hypoechogenicity, hyperemia, and quantitative measures of shear wave speed. • Regional shear wave speeds were lower in the free tendon but not in the proximal regions of the soleus or gastrocnemius aponeuroses in Achilles tendinopathy patients. • Using shear wave imaging to estimate tendon stiffness may prove beneficial for clinical validation studies to address important topics such as return to activity and the effectiveness of rehabilitation protocols.


Subject(s)
Achilles Tendon , Elasticity Imaging Techniques , Hyperemia , Tendinopathy , Humans , Achilles Tendon/diagnostic imaging , Elasticity Imaging Techniques/methods , Tendinopathy/diagnostic imaging , Elasticity , Ultrasonography/methods
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