Quantitative Magnetic Resonance Imaging Analysis of the Common Site of Acute Achilles Tendon Rupture: 5 to 8 cm Above the Distal End of the Calcaneal Insertion

2019 ◽  
Vol 47 (10) ◽  
pp. 2374-2379 ◽  
Author(s):  
Young Hwan Park ◽  
Jung Wook Lim ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Interobserver Reliability ◽  
Achilles Tendon Rupture ◽  
Patient Characteristics ◽  
Resonance Imaging ◽  
Significant Difference ◽  
Rupture Site

Background: Previous studies have not quantitatively analyzed the site of acute Achilles tendon rupture. Purpose: To investigate the site of acute Achilles tendon rupture via magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 4. Methods: The medical records and MRIs of 195 patients with acute Achilles tendon rupture were retrospectively reviewed. The rupture site was measured as the distance from the most distal fibers of the Achilles tendon at the calcaneal insertion to the proximal end of the distal stump. The relationship between the site of rupture and patient characteristics was analyzed, and the intra- and interobserver reliability of the measurements was assessed using intraclass correlation coefficients. Results: The rupture site had a mean distance of 6.4 cm (SD, 1.5) and the 10th to 90th percentile range was 5.0 to 8.4 cm. There was no significant difference in location of the rupture according to patient characteristics and the time of imaging. The intra- and interobserver reliability of measurements was excellent. Conclusion: Most acute Achilles tendon ruptures visible on MRI occurred 5 to 8 cm above the distal end of the calcaneal insertion, which is more proximal than the previously reported 2 to 6 cm location.

scholarly journals An MRI Analysis of the Site of Acute Achilles Tendon Rupture: Is the Most Common Site 2–6 Cm from the Calcaneal Insertion?

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Young Hwan Park ◽  
An Seong Chang ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Interobserver Reliability ◽  
Intraclass Correlation ◽  
Achilles Tendon Rupture ◽  
Correlation Coefficients ◽  
Distal Stump ◽  
Patient Demographics ◽  
Significant Difference ◽  
Rupture Site

Category: Sports, Ankle Introduction/Purpose: No previous study has performed a quantitative analysis of the site of acute Achilles tendon rupture. The purpose of this study was to investigate the site of acute Achilles tendon rupture via magnetic resonance imaging (MRI). Methods: The medical records and MRIs of 201 patients with acute Achilles tendon rupture were retrospectively reviewed. The rupture site was measured as the distance from the calcaneal insertion of the Achilles tendon to the proximal end of the distal stump. The relationship between the site of the rupture and patient demographics was analyzed, and the intra- and interobserver reliability scores of the measurements were assessed using intraclass correlation coefficients. Results: The rupture site had a mean size of 6.1 cm with a standard deviation of 1.6. The median was 6.3 cm, and the range of the 10th–90th percentile was 5.0–8.1 cm. There was no significant difference in rupture site according to patient demographics. All of the intra- and interobserver reliability scores of the measurements of the rupture site were excellent. Conclusion: Most acute Achilles tendon ruptures that were visible on MRI occurred 5–8 cm above the calcaneal insertion, which is greater than the previously reported 2–6 cm location.

Partial Achilles Tendon Ruptures Associated with Fluoroquinolone Antibiotics: A Case Report and Literature Review

1996 ◽  
Vol 17 (8) ◽  
pp. 496-498 ◽  
Author(s):  
William C. McGarvey ◽  
Dishan Singh ◽  
Saul G. Trevino
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Magnetic Resonance ◽  
Literature Review ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Resonance Imaging ◽  
Achilles Tendinitis ◽  
Fluoroquinolone Antibiotics ◽  
Tendon Ruptures

Fluoroquinolone antibiotics (such as ciprofloxacin, pefloxacin, ofloxacin, norfloxacin, temafloxacin, etc.) have recently been implicated in the etiology of Achilles tendinitis and subsequent tendon rupture. We report on a patient with bilateral partial Achilles tendon ruptures associated with ciprofloxacin therapy and present a review of the current literature on this increasingly recognized complication. Treatment with fluoroquinolones should be discontinued at the first sign of tendon inflammation so as to reduce the risk of subsequent rupture. Magnetic resonance imaging is useful in distinguishing between Achilles tendinitis and partial tendon rupture.

scholarly journals Interobserver agreement for detecting Hill-Sachs lesions on magnetic resonance imaging

2021 ◽  
Vol 24 (2) ◽  
pp. 98-105
Author(s):  
Hassanin Alkaduhimi ◽  
Aïmane Saarig ◽  
Ihsan Amajjar ◽  
Just A. van der Linde ◽  
Marieke F. van Wier ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Interobserver Agreement ◽  
Interobserver Reliability ◽  
Patient Characteristics ◽  
Accurate Diagnosis ◽  
Bonferroni Correction ◽  
Resonance Imaging ◽  
Similar Appearance ◽  
Magnetic Resonance Imaging Mri

Background: Our aim is to determine the interobserver reliability for surgeons to detect Hill-Sachs lesions on magnetic resonance imaging (MRI), the certainty of judgement, and the effects of surgeon characteristics on agreement. Methods: Twenty-nine patients with Hill-Sachs lesions or other lesions with a similar appearance on MRIs were presented to 20 surgeons without any patient characteristics. The surgeons answered questions on the presence of Hill-Sachs lesions and the certainty of diagnosis. Interobserver agreement was assessed using the Fleiss’ kappa (κ) and percentage of agreement. Agreement between surgeons was compared using a technique similar to the pairwise t-test for means, based on large-sample linear approximation of Fleiss' kappa, with Bonferroni correction. Results: The agreement between surgeons in detecting Hill-Sachs lesions on MRI was fair (69% agreement; κ, 0.304; p<0.001). In 84% of the cases, surgeons were certain or highly certain about the presence of a Hill-Sachs lesion. Conclusions: Although surgeons reported high levels of certainty for their ability to detect Hill-Sachs lesions, there was only a fair amount of agreement between surgeons in detecting Hill-Sachs lesions on MRI. This indicates that clear criteria for defining Hill-Sachs lesions are lacking, which hampers accurate diagnosis and can compromise treatment.

scholarly journals Comparing Absorbable and Nonabsorbable Suture Materials for Repair of Achilles Tendon Rupture: A Magnetic Resonance Imaging-Based Study

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1085
Author(s):  
Jaeho Cho ◽  
Hyun-Joo Kim ◽  
Jeong Seok Lee ◽  
Jahyung Kim ◽  
Sung Hun Won ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Sectional Area ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Cross Sectional ◽  
Significant Difference ◽  
Group A ◽  
Group B

We aimed to compare magnetic resonance imaging (MRI) findings and corresponding clinical outcomes of repaired Achilles tendons using absorbable and nonabsorbable sutures. Patients who underwent Achilles tendon repair were divided into 2 groups, with 11 in the absorbable group (group A) and 11 in the nonabsorbable group (group B). For all patients, MRI findings taken 6 months postoperatively were evaluated for morphological changes in the tendon. Concurrently, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score and incidence of postoperative complications were evaluated. Regarding MRI findings, the extent to which the cross-sectional area of the repaired tendon was thicker than that of the preoperative tendon was significantly greater in group B than in group A (p = 0.0012). Notably, more stitches remained within the tendon in group B than in group A (p = 0.0063). No other MRI findings showed a significant difference between the two groups. No significant difference was observed in the AOFAS score, and there was one re-rupture each in both groups. Because nonabsorbable suture material in the treatment of Achilles tendon rupture yielded a thicker postoperative MRI cross-sectional area, enhanced rehabilitation is recommended in order to prevent scar formation.

Evaluation of Decellularized Bovine Tendon Sheets for Achilles Tendon Defect Reconstruction in a Rabbit Model

2018 ◽  
Vol 46 (11) ◽  
pp. 2687-2699 ◽  
Author(s):  
Cheng-Hao Zhang ◽  
Yan-Lin Jiang ◽  
Liang-Ju Ning ◽  
Qi Li ◽  
Wei-Li Fu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Achilles Tendon ◽  
Histological Examination ◽  
Rabbit Model ◽  
Control Group ◽  
Resonance Imaging ◽  
Tissue Integration ◽  
Defect Reconstruction ◽  
Significant Difference

Background: Achilles tendon (AT) defects frequently occur in trauma and chronic injuries. Currently, no method can satisfactorily reconstruct the AT with completely restored function. Purpose: To evaluate the postoperative outcomes of AT defect reconstruction with decellularized bovine tendon sheets (DBTSs) in a rabbit model. Study Design: Controlled laboratory study. Methods: DBTSs were prepared from bovine tendons after compression, decellularization, antigen extraction, freeze drying, and sterilization. Platelet-rich plasma (PRP) was obtained by differential centrifugation. Sixty-three rabbits were used in this study, and the AT defect model was created bilaterally. All rabbits were divided into 3 groups (n = 21). In the DBTS group and the DBTS + PRP group, 2-cm-long AT was excised and reconstructed by DBTSs or PRP-treated DBTSs. In the control group, the rabbits underwent AT transection, and stumps were sutured. After surgery, all rabbits were assessed by ultrasonography and magnetic resonance imaging and then sacrificed for histological examination and biomechanical testing at 4, 8, or 12 weeks. Results: Gross observations demonstrated the absence of immunologic incompatibility and rejection. Histological examination showed that DBTSs promoted host cell infiltration and new fibrous tissue integration as compared with the control group. In each group, there was an AT-like structure formation and aligned collagen fiber deposition at 12 weeks. Mechanical properties of the reconstructed AT were not significantly different among the 3 groups at 4, 8, and 12 weeks after surgery ( P > .05). Ultrasonography and magnetic resonance imaging results illustrated that the reconstructed AT from each group maintained remodeling, and there was no significant difference in the echogenicity scoring ( P > .05) and percentages of good and excellent ( P > .05) among the 3 groups. Conclusion: DBTSs, which retain the native tendon structure and bioactive factors, had the ability to remodel and integrate into the rabbit AT and improve the healing process. Clinical Relevance: DBTSs could serve as an effective bioscaffold to reconstruct AT defects.

The Kaplan Fibers of the Iliotibial Band Can Be Identified on Routine Knee Magnetic Resonance Imaging

2019 ◽  
Vol 47 (12) ◽  
pp. 2895-2903 ◽  
Author(s):  
Lachlan Batty ◽  
Jerome Murgier ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
Julian A. Feller ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sagittal Plane ◽  
Interobserver Reliability ◽  
Joint Line ◽  
Coronal Plane ◽  
Iliotibial Band ◽  
Resonance Imaging ◽  
Lateral Gastrocnemius ◽  
The Mean

Background: The Kaplan fibers (KFs) of the iliotibial band have been suggested to play a role in anterolateral rotational instability of the knee, particularly in the setting of an anterior cruciate ligament (ACL) rupture. Description of the normal magnetic resonance imaging (MRI) anatomy of the KFs may facilitate subsequent investigation into the MRI signs of injury. Purpose: To assess if the KF complex can be identified on 3-T MRI using standard knee protocols. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: 3-T MRI scans of 50 ACL-intact knees were reviewed independently by a musculoskeletal radiologist and 2 orthopaedic surgeons. Identification of the KFs was based on radiological diagnostic criteria developed a priori. Identification of the KFs in the sagittal, coronal, and axial planes was recorded. Interobserver reliability was assessed using the Kappa statistic. Detailed anatomy including distance to the joint line and relationship to adjacent structures was recorded. Results: The mean patient age was 43 years (range, 15-81 years), 58% were male, and 50% were right knees. The KFs were identified by at least 2 reviewers on the sagittal images in 96% of cases, on the axial images in 76% of cases, and on the coronal images in 4% of cases. The mean distance from the KF distal femoral insertion to the lateral joint line was 50.1 mm (SD, 6.6 mm) and the mean distance to the lateral gastrocnemius tendon origin was 10.8 mm (SD, 8.6 mm). The KFs were consistently identified immediately anterior to the superior lateral geniculate artery on sagittal imaging. Interobserver reliability for identification was best in the sagittal plane (Kappa 0.5) and worst in the coronal plane (Kappa 0.1). Conclusion: The KF complex can be identified on routine MRI sequences in the ACL-intact knee; however, there is low to moderate interobserver reliability. Imaging in the sagittal plane had the highest rate of identification and the coronal plane the lowest. There is a consistent relationship between the most distal KF femoral attachment and the lateral joint line, lateral gastrocnemius tendon, and superior lateral geniculate artery.

The Percutaneous Surgical Approach for Repairing Acute Achilles Tendon Rupture

2010 ◽  
Vol 100 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Shay Tenenbaum ◽  
Niv Dreiangel ◽  
Ayal Segal ◽  
Amir Herman ◽  
Amnon Israeli ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Demographic Data ◽  
Achilles Tendon Rupture ◽  
Treatment Modalities ◽  
Main Concern ◽  
Complication Rates ◽  
Percutaneous Surgery ◽  
Significant Difference ◽  
The Mean

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. Methods: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24–58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results: All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90°/sec for plantarflexion power between the injured and healthy legs but no difference at 30° and 240°/sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. Conclusions: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments. (J Am Podiatr Med Assoc 100(4): 270–275, 2010)

scholarly journals Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

2020 ◽  
Author(s):  
Yongliang Yang ◽  
Honglei Jia ◽  
Wupeng Zhang ◽  
Shihong Xu ◽  
Fu Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Saphenous Vein ◽  
Sural Nerve ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Intraoperative Ultrasonography ◽  
Medial Side ◽  
Significant Difference

Abstract Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the SSV.Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean AOFAS scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute AT rupture.

scholarly journals The ultrasonographic dynamic heel-rise test of the Achilles tendon

2021 ◽  
Vol 21 (86) ◽  
pp. e260-e266
Author(s):  
Beata Ciszkowska-Łysoń ◽  
◽  
Urszula Zdanowicz ◽  
Robert Śmigielski ◽  
◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Dynamic Assessment ◽  
Healing Process ◽  
Achilles Tendon Rupture ◽  
Recovery Process ◽  
Biomechanical Properties ◽  
Resonance Imaging ◽  
Ultrasound Monitoring ◽  
And Function

The treatment of Achilles tendon rupture attempts to restore the primary anatomical structure and principal biomechanical properties of the damaged tendon. Postoperative clinical assessment of the healing progression and function monitoring may be difficult and require experience. Diagnostic imaging (ultrasonography and magnetic resonance imaging) helps monitor the healing process. In the following paper, we propose a heel-rise test – a dynamic assessment of the Achilles tendon performed under direct observation and ultrasound monitoring to establish the tension of the Achilles tendon. The test allows for a simple assessment of tendon function and may be safely repeated at any postoperative stage. It may be performed by a physician, radiologist and physiotherapist to monitor the recovery process following Achilles tendon damage.

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