Shear‐Wave Elastography of Patellar Ligament and Achilles Tendon in Semiprofessional Athletes

Background: Sonoelastography is extensively used for clinical diagnosis. Different types of elastography can be used to assess the elastic properties (stiffness) of tissues. For quantitative analyses, shear wave elastography (SWE) has been applied as a non-invasive method in the past decade. Today, SWE is widely used for diagnosing diseases. However, a limited number of studies have investigated musculoskeletal injuries and neoplastic diseases. Objectives: This study aimed to evaluate the postoperative functional recovery of Achilles tendon ruptures by SWE to determine the Achilles tendon function and provide reliable evidence for clinicians. Methods: SWE was used to measure elasticity in 67 patients with Achilles tendon ruptures. In the postoperative stage, 17 patients were lost to follow-up. The remaining 50 patients with Achilles tendon ruptures were examined. Each patient was followed-up for one, three, and six months postoperatively. The 0° flexion of the ankle joint was considered as the standard position. The mean elasticity (Emean) of the Achilles tendon was measured and recorded at different time points before and after surgery. Besides, the thickness and width of the Achilles tendon were measured at the corresponding time points. Results: The mean elasticity (Emean) of normal and ruptured Achilles tendons was 447.4 ± 59.57 and 63.84 ± 45.18 kPa, respectively in 50 patients with ruptured Achilles tendons before surgery. On the other hand, the Emean values of ruptured Achilles tendons in one-, three-, and six-month follow-ups were 110.3 ± 35.60, 183.4 ± 46.08, and 279.1 ± 48.18 kPa in 50 patients, respectively. Regarding the Emean, the difference between the five time points was significant (F = 418.5, P < 0.01). With prolongation of postoperative recovery, the Emean of the Achilles tendon gradually increased; the Emean value significantly increased at six months after surgery. Conclusions: The quantitative analysis of the postoperative function of Achilles tendon, based on the Emean value obtained by SWE, can be helpful in guiding clinicians to objectively examine the prognosis of patients.

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Importance of shear-wave elastography in prediction of Achilles tendon rupture

International Orthopaedics ◽

10.1007/s00264-020-04670-2 ◽

2020 ◽

Author(s):

Gordana Ivanac ◽

Domagoj Lemac ◽

Vilma Kosovic ◽

Kristina Bojanic ◽

Tomislav Cengic ◽

...

Keyword(s):

Achilles Tendon ◽

Shear Wave ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Shear Wave Elastography

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Elastic Characteristics of the Normal Achilles Tendon Assessed by Virtual Touch Imaging Quantification Shear Wave Elastography

Journal of Ultrasound in Medicine ◽

10.7863/ultra.16.01052 ◽

2016 ◽

Vol 35 (9) ◽

pp. 1881-1887 ◽

Cited By ~ 17

Author(s):

Shuai Fu ◽

Ligang Cui ◽

Xiaoxi He ◽

Yang Sun

Keyword(s):

Achilles Tendon ◽

Shear Wave ◽

Shear Wave Elastography ◽

Elastic Characteristics

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Shear wave and strain sonoelastography for the evaluation of the Achilles tendon during isometric contractions

Insights into Imaging ◽

10.1186/s13244-021-00974-y ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Alessandro Schneebeli ◽

Ilaria Fiorina ◽

Chandra Bortolotto ◽

Marco Barbero ◽

Deborah Falla ◽

...

Keyword(s):

Mechanical Properties ◽

Reference Material ◽

Achilles Tendon ◽

Shear Wave ◽

Shear Wave Elastography ◽

Strain Ratio ◽

Achilles Tendinopathy ◽

Isometric Contractions ◽

Tendon Stiffness ◽

Healthy Participants

Abstract Objectives Changes in mechanical loading as well as pathology can modify the Achilles tendon mechanical properties and therefore detection of these changes is relevant for the diagnosis and management of Achilles tendinopathy. The aim of this study was to evaluate strain and shear wave sonoelastography for their ability to detect changes in the Achilles tendon mechanical properties during a series of isometric contractions. Methods Longitudinal sonoelastography images of the Achilles tendon were acquired from 20 healthy participants using four different ultrasound devices; two implementing strain sonoelastography technology (SE1, SE2) and two, shear wave elastography technology (SWE1, SWE2). Results SE1 measured a decreasing strain ratio (tendon become harder) during the different contraction levels from 1.51 (0.92) to 0.33 (0.16) whereas SE2 mesaured a decreasing strain ratio from 1.08 (0.76) to 0.50 (0.32). SWE1 measured decreasing tendon stiffness during contractions of increasing intensity from 33.40 (19.61) to 16.19 (2.68) whereas SWE2 revealed increasing tendon stiffness between the first two contraction levels from 428.65 (131.5) kPa to 487.9 (121.5) kPa followed by decreasing stiffness for the higher contraction levels from 459.35 (113.48) kPa to 293.5 (91.18) kPa. Conclusions Strain elastography used with a reference material was able to detect elasticity changes between the different contraction levels whereas shear wave elastography was less able to detect changes in Achilles tendon stiffness when under load. Inconsistent results between the two technologies should be further investigated.

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Differences in Achilles tendon stiffness in people with gout.

10.21203/rs.3.rs-16284/v1 ◽

2020 ◽

Author(s):

Simon Otter ◽

Payne Catherine ◽

Jones Anna-Marie ◽

Webborn Nick ◽

Watt Peter

Keyword(s):

Achilles Tendon ◽

Shear Wave ◽

Repeated Measures ◽

Demographic Data ◽

Shear Wave Elastography ◽

Tissue Elasticity ◽

Tendon Stiffness ◽

Chronic Gout ◽

Significant Difference ◽

Tendon Thickness

Abstract Background Chronic gout is associated with weaker foot/leg muscles, altered gait patterns and on-going foot pain. Inflammation associated with gout may change tissue elasticity and ultrasound imaging (US) utilising shear wave elastography (SWE) offers a non-invasive method of quantifying these changes in tendon stiffness and SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with chronic gout compared to controls (non-gout). Methods A cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along a longitudinal section of the mid-point of the Achilles tendon bilaterally. Prior to data collection, intra-observer error was good (0.75). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI). Results: A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04 (95% CI (0.38 to 1.7) p=0.003 and left Achilles mdiff = 0.7 (95% CI 0.09 to 1.32) p=0.025. Conclusion: Subjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.

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Shear Wave Elastography Measures of the Achilles Tendon: Influence of Time of Day, Leg Dominance and the Impact of an Acute 30-Minute Bout of Running

Applied Sciences ◽

10.3390/app8071170 ◽

2018 ◽

Vol 8 (7) ◽

pp. 1170

Author(s):

Catherine Payne ◽

Peter Watt ◽

Nick Webborn

Keyword(s):

Achilles Tendon ◽

Shear Wave ◽

Perceived Exertion ◽

Weight Bearing ◽

Shear Wave Elastography ◽

Time Of Day ◽

Rating Of Perceived Exertion ◽

Cont Group ◽

Leg Dominance ◽

The Impact

The mechanical properties of human tendons are likely to be influenced by factors known to affect elastic structures, including patterns of loading and unloading during the day. However, the exact scale and relevance of these variables to tendon stiffness remains unclear. The aim of this study was to (1) measure Achilles tendon (AT) stiffness over the course of the day, (2) examine AT stiffness between dominant and non-dominant standing leg tendons and (3) assess the impact of previous activity on AT stiffness. To assess the impact of time of day and leg dominance, 15 healthy participants (6 females, 9 males; mean age 28 ± 4 year, mean VISA-A score 99.0 ± 1.2) had shear wave elastography (SWE) measures taken at 08:00 h, 12:30 h and 17:00 h on both dominant and non-dominant legs. To assess the impact of exercise, 24 tendons were analysed (7 females, 5 males; mean age 27 ± 4 year, mean VISA-A Score 99.1 ± 1.1) with participants randomly assigned to either a control (CONT) group or a running (RUN) group. The RUN group performed a 30-min run at a subjective intensity of 13–15 on rating of perceived exertion (RPE) scale and had SWE measures taken before, immediately after, 6 h 24 h, 48 h and 72 h following the run. There were no significant differences in AT stiffness over the course of a day or between dominant and non-dominant leg. Significant increases in AT stiffness were noted pre-post run (0.27 m/s, 2.95%, p = 0.037). Leg dominance does not affect SWE values from asymptomatic ATs or change throughout a day, but a 30-min run significantly increases AT stiffness. Leg dominance and timing of clinical appointments are unlikely to affect SWE results, however a prior bout of physical activity may cause changes within the AT resulting in a significantly different SWE measure. Clinicians and researchers should be cautious of interpreting SWE results if weight bearing exercise has been performed beforehand.

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Reproducibility of shear wave elastography measuresof the Achilles tendon

Skeletal Radiology ◽

10.1007/s00256-017-2846-8 ◽

2017 ◽

Vol 47 (6) ◽

pp. 779-784 ◽

Cited By ~ 18

Author(s):

Catherine Payne ◽

Peter Watt ◽

Mara Cercignani ◽

Nick Webborn

Keyword(s):

Achilles Tendon ◽

Shear Wave ◽

Shear Wave Elastography

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Sonographic evaluation of the immediate effects of eccentric heel drop exercise on Achilles tendon and gastrocnemius muscle stiffness using shear wave elastography

PeerJ ◽

10.7717/peerj.3592 ◽

2017 ◽

Vol 5 ◽

pp. e3592 ◽

Cited By ~ 11

Author(s):

Wilson K.C. Leung ◽

KL Chu ◽

Christopher Lai

Keyword(s):

Achilles Tendon ◽

Shear Wave ◽

Gastrocnemius Muscle ◽

Shear Wave Elastography ◽

Achilles Tendinopathy ◽

Muscle Stiffness ◽

Eccentric Load ◽

Lateral Gastrocnemius ◽

Acute Bout ◽

Gastrocnemius Muscles

BackgroundMechanical loading is crucial for muscle and tendon tissue remodeling. Eccentric heel drop exercise has been proven to be effective in the management of Achilles tendinopathy, yet its induced change in the mechanical property (i.e., stiffness) of the Achilles tendon (AT), medial and lateral gastrocnemius muscles (MG and LG) was unknown. Given that shear wave elastography has emerged as a powerful tool in assessing soft tissue stiffness with promising intra- and inter-operator reliability, the objective of this study was hence to characterize the stiffness of the AT, MG and LG in response to an acute bout of eccentric heel drop exercise.MethodsForty-five healthy young adults (36 males and nine females) performed 10 sets of 15-repetition heel drop exercise on their dominant leg with fully-extended knee, during which the AT and gastrocnemius muscles, but not soleus, were highly stretched. Before and immediately after the heel drop exercise, elastic moduli of the AT, MG and LG were measured by shear wave elastography.ResultsAfter the heel drop exercise, the stiffness of AT increased significantly by 41.8 + 33.5% (P < 0.001), whereas the increases in the MG and LG stiffness were found to be more drastic by 75 + 47.7% (P < 0.001) and 71.7 + 51.8% (P < 0.001), respectively. Regarding the AT, MG and LG stiffness measurements, the inter-operator reliability was 0.940, 0.987 and 0.986, and the intra-operator reliability was 0.916 to 0.978, 0.801 to 0.961 and 0.889 to 0.985, respectively.DiscussionThe gastrocnemius muscles were shown to bear larger mechanical loads than the AT during an acute bout of eccentric heel drop exercise. The findings from this pilot study shed some light on how and to what extent the AT and gastrocnemius muscles mechanically responds to an isolated set of heel drop exercise. Taken together, appropriate eccentric load might potentially benefit mechanical adaptations of the AT and gastrocnemius muscles in the rehabilitation of patients with Achilles tendinopathy.

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Differences in Achilles tendon stiffness in people with gout: a pilot study

10.21203/rs.3.rs-16284/v4 ◽

2020 ◽

Author(s):

Simon Otter ◽

Catherine Payne ◽

Anna-Marie Jones ◽

Nick Webborn ◽

Peter Watt

Keyword(s):

Achilles Tendon ◽

Shear Wave ◽

Repeated Measures ◽

Demographic Data ◽

Shear Wave Elastography ◽

Tissue Elasticity ◽

Tendon Stiffness ◽

Increased Risk ◽

Significant Difference ◽

Tendon Thickness

Abstract Background: Gout has been associated with weaker foot/leg muscles and altered gait patterns. There is also evidence of on-going foot pain and an increased risk of tendinopathy, with the Achilles and patella tendons most frequently affected in gout. Additionally, the inflammation associated with gout may change tissue elasticity. Ultrasound imaging utilising shear wave elastography (SWE) offers a non-invasive method of quantifying changes in tendon stiffness. SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with gout compared to controls (non-gout).Methods: A cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated, and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along the centre of a longitudinal section of the mid-portion of each Achilles tendon. Prior to data collection, intra-observer error was good (0.75). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI).Results: A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04m/s (95% CI (0.38 to 1.7) p=0.003 and left Achilles mdiff = 0.7m/s (95% CI 0.09 to 1.32) p=0.025. No relationship between the presence of tophi and SWE values were detected. Conclusion: Subjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.

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