Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures.
ABSTRACT The purpose of this study is to describe the elastographic appearance of the Achilles tendon in healthy subjects and patients with surgically repaired complete ruptures.
Nineteen Achilles tendons of 16 amateur footballers with surgically repaired complete ruptures and their contralateral asymptomatic Achilles tendons were assessed with ultrasound and real-time sonoelastography. Additionally, 40 asymptomatic Achilles tendons of 20 healthy amateur footballers were assessed. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to the elasticity features: type 1, blue (hardest tissue); type 2, blue/green (hard tissue); or type 3, green (intermediate tissue). In addition, three subtypes were determined: homogeneous, relatively homogeneous, and heterogeneous.
Most of the Achilles tendons of the patients with surgically repaired complete ruptures were detected to have type 2 elasticity (64.9%), and the remaining had type 1 (35.1%). In contrast, most of the healthy tendons had type 2 (64.2%), and the remaining had either a type 3 (20.8%) or a type 1 (15%) elastographic pattern. All of the ruptured tendons had a heterogeneous structure, whereas all of the healthy Achilles tendons had a homogeneous or relatively homogeneous structure.
In sonoelastography, the recognition of normal tendon structure will be useful in assessing pathologies of the Achilles tendon. Additionally, in patients with excellent American Orthopedic Foot and Ankle Society (AOFAS) scores and surgically repaired complete ruptures, a hard and heterogeneous pattern of tendon structure may be a natural consequence of tendon healing.
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ABSTRACT: To compare information gained by ultrasonography and magnetic resonance imaging (MRI) in chronic achilles tendinopathy with regard to the nature and severity of the lesion. Imaging of both achilles tendons with ultrasonography and MRI was performed prior to unilateral surgery. Operative findings and histological biopsies together served as a reference. Twenty-seven patients (22 men, 5 women; mean age 44 years; 21 athletes) suffering from chronic achilles tendinopathy participated in the study. Eighteen patients had unilateral and 9 had bilateral symptoms. Surgical findings included 4 partial ruptures, 21 degenerative lesions and 2 macroscopically normal cases. Microscopy revealed tendinosis (degeneration) in all tendon biopsies, including cases with a partial rupture, but only slight changes in the paratendinous tissues (paratenon). Ultrasonography was positive in 21 of 26 and MRI in 26 of 27 cases. Severe intratendinous abnormalities and a sagittal tendon diameter > 10 mm suggested a partial rupture. In tendons with a false negative result histopathological changes were mild and a tendency towards a better clinical outcome was noted in the sonographic cases. Assessment of the paratenon was unreliable with both methods. Ultrasonography and MRI give similar information and may have their greatest potential as prognostic instruments.Skeletal Radiology 11/1996; 25(7):615-20. · 1.74 Impact Factor
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ABSTRACT: To evaluate and compare MR and US findings in an unselected group of patients with 1-3-year-old surgically repaired complete ruptures of the Achilles tendon. Thirteen patients with complete Achilles tendon rupture underwent clinical, MR and US examinations. The average time interval from rupture to postoperative imaging was 18 months. The cross-sectional area of a postoperative tendon was 4.2 times that of the unaffected side. The shape of the operated tendon was more rounded than the unaffected side and it had irregular margins both in MR imaging and in US examination. In 4 of 13 cases an intratendinous area of intermediate to high signal intensity on proton density- and T2-weighted images was seen on MR. The size of this area varied from 4 to 18% of the cross-sectional tendon area. Two patients with the largest intratendinous area had poor clinical outcome. On US the tendon had mixed echogenicity in all cases and the tendon bands were thinner and shorter than normal. Comparison of dimension between MR and US revealed that in a.p. dimension the correlation was good (r = 0.87, p = 0.001), but in transversal width there was no significant correlation (r = 0.58, p = 0.06). The increased size and round irregular area of the operated Achilles tendon rupture was well detected by both MR and US, but intratendinous lesions were seen only by MR.Acta Radiologica 10/1996; 37(5):639-46. · 1.33 Impact Factor
- American Journal of Roentgenology 10/2002; 179(3):709-16. · 2.90 Impact Factor