No abstract

Supersonic shear imaging (SSI) is an ultrasound imaging modality that can provide insight into tissue mechanics by measuring shear wave propagation speed, a property that depends on tissue elasticity. SSI has previously been used to characterize the increase in Achilles tendon shear wave speed that occurs with loading, an effect attributable to the strain-stiffening behavior of the tissue. However, little is known about how shear wave speed varies spatially, which is important, given the anatomical variation that occurs between the calcaneus insertion and the gastrocnemius musculotendon junction. The purpose of this study was to investigate spatial variations in shear wave speed along medial and lateral paths of the Achilles tendon for three different ankle postures: resting ankle angle (R, i.e. neutral), plantarflexed (P; R − 15 deg), and dorsiflexed (D; R + 15 deg). We observed significant spatial and posture variations in tendon shear wave speed in ten healthy young adults. Shear wave speeds in the Achilles free tendon averaged 12 ± 1.2 m/s in a resting position, but decreased to 7.2 ± 1.8 m/s with passive plantarflexion. Distal tendon shear wave speeds often reached the maximum tracking limit (16.3 m/s) of the system when the ankle was in the passively dorsiflexed posture (+15 deg from R). At a fixed posture, shear wave speeds decreased significantly from the free tendon to the gastrocnemius musculotendon junction, with slightly higher speeds measured on the medial side than on the lateral side. Shear wave speeds were only weakly correlated with the thickness and depth of the tendon, suggesting that the distal-to-proximal variations may reflect greater compliance in the aponeurosis relative to the free tendon. The results highlight the importance of considering both limb posture and transducer positioning when using SSI for biomechanical and clinical assessments of the Achilles tendon.

Ultrasound elastography is an emerging set of imaging modalities used to image tissue elasticity and are often referred to as virtual palpation. These techniques have proven effective in detecting and assessing many different pathologies, because tissue mechanical changes often correlate with tissue pathological changes. This article reviews the principles of ultrasound elastography, many of the ultrasound-based techniques, and popular clinical applications. Originally, elastography was a technique that imaged tissue strain by comparing pre- and postcompression ultrasound images. However, new techniques have been developed that use different excitation methods such as external vibration or acoustic radiation force. Some techniques track transient phenomena such as shear waves to quantitatively measure tissue elasticity. Clinical use of elastography is increasing, with applications including lesion detection and classification, fibrosis staging, treatment monitoring, vascular imaging, and musculoskeletal applications.

Muscle stiffness is known to vary as a result of a variety of disease states, yet current clinical methods for quantifying muscle stiffness have limitations including cost and availability. We investigated the capability of shear wave elastography (SWE) to measure variations in gastrocnemius shear wave speed induced via active contraction and passive stretch. Ten healthy young adults were tested. Shear wave speeds were measured using a SWE transducer positioned over the medial gastrocnemius at ankle angles ranging from maximum dorsiflexion to maximum plantarflexion. Shear wave speeds were also measured during voluntary plantarflexor contractions at a fixed ankle angle. Average shear wave speed increased significantly from 2.6 m/s to 5.6 m/s with passive dorsiflexion and the knee in an extended posture, but did not vary with dorsiflexion when the gastrocnemius was shortened in a flexed knee posture. During active contractions, shear wave speed monotonically varied with the net ankle moment generated, reaching 8.3 m/s in the maximally contracted condition. There was a linear correlation between shear wave speed and net ankle moment in both the active and passive conditions; however, the slope of this linear relationship was significantly steeper for the data collected during passive loading conditions. The results show that SWE is a promising approach for quantitatively assessing changes in mechanical muscle loading. However, the differential effect of active and passive loading on shear wave speed makes it important to carefully consider the relevant loading conditions in which to use SWE to characterize in vivo muscle properties.

Objective Evaluate the effects of aging on healthy Achilles tendon and aponeurosis shear wave speed (SWS), a quantitative metric which reflects tissue elasticity. Methods Shear wave elastography was used to measure spatial variations in Achilles tendon SWS in healthy young (n=15, 25±4 years), middle-aged (n=10, 49±4 years) and older (n=10, 68±5 years) adults. SWS was separately measured in the free Achilles tendon, soleus aponeurosis and gastrocnemius aponeurosis in resting (R), stretched (dorsiflexed 15 deg from R) and slack (plantarflexed 15 deg from R) postures. Results SWS significantly increased with stretch and varied with age in all tendon regions. Slack free tendon SWS was significantly higher in older adults than young adults (p=0.025). However, stretched soleus aponeurosis SWS was significantly lower in older adults than young adults (p=0.01). Stretched gastrocnemius aponeurosis SWS was significantly lower in both middle-aged (p=0.003) and older (p=0.001) adults, relative to younger adults. Conclusions These results suggest that aging alters spatial variations in Achilles tendon elasticity, which could alter deformations within the triceps surae muscle-tendon units, thus affecting injury potential. The observed location- and posture-dependent variations highlight the importance of controlling ankle posture and imaging location when using shear wave approaches clinically to evaluate tendon disorders.