Elastography in the assessment of the Achilles tendon: a systematic review of measurement properties

Mifsud, Tiziana; Gatt, Alfred; Micallef-Stafrace, Kirill; Chockalingam, Nachiappan; Padhiar, Nat

doi:10.1186/s13047-023-00623-1

Cited by 5 publications

(2 citation statements)

References 83 publications

(110 reference statements)

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“…Ultrasound M-mode and ultrasound elastography assessments could be essential tools for researching the Achilles tendon [ 30 , 31 , 32 ], KFP, retrocalcaneal bursa, and deep soleal fibres, providing additional imaging analyses. Previous research has revealed structural modifications in the Achilles complex and identified changes in patients with AT.…”

Section: Discussionmentioning

confidence: 99%

A New Test for Achilles Tendinopathy Based on Kager’s Fat Pad Clinical Assessment Predictive Values

Rodríguez‐Sanz

Iglesias

Becerro-de-Bengoa-Vallejo

et al. 2023

JCM

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Background This study aimed to check the diagnostic accuracy of a new test to identify Achilles tendinopathy. Study Design: Observational study. Methods: Seventy patients recruited from a private medical centre met the diagnostic criteria for unilateral Achilles tendinopathy (age, 45.1 ± 12.7 years; weight, 75.00 ± 10 kg; height, 1.75 ± 0.1 m) and were tested based on both Achilles tendons. Seventy patients with a unilateral Achilles tendinopathy ultrasound diagnosis were tested using David’s test. Results: Most (86%) subjects demonstrated Kager’s fat pad asymmetry in relation to the Achilles tendon in the complete passive dorsiflexion in the prone position (David’s sign). No healthy tendons had David’s sign. Conclusions: The presence of asymmetry in Kager’s fat pad in relation to the Achilles tendon during complete passive dorsiflexion is strongly indicative of ultrasound-diagnosed tendinopathy. David’s test demonstrated a sensitivity of 85.71% (95% CI, 77.51% to 93.91%) and a specificity of 100% (95% CI, 100% to 100%), while noting the lack of blinding of the assessors and the uncertainty of the diagnostic measures (95% CI). Asymmetry of the fat pad could potentially serve as a characteristic marker for patients with Achilles tendinopathy.

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Section: Discussionmentioning

confidence: 99%

A New Test for Achilles Tendinopathy Based on Kager’s Fat Pad Clinical Assessment Predictive Values

Rodríguez‐Sanz

Iglesias

Becerro-de-Bengoa-Vallejo

et al. 2023

JCM

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“…In recent years, the evaluation of AT stiffness using ultrasound elastography has become a valuable method [ 14 ]. However, the disadvantages of ultrasound elastography include differences in device performance and high cost, which make it difficult to use in clinical settings [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Achilles Tendon Stiffness Using Myoton PRO and Translation Using a Tensile Testing Machine: A Biomechanical Study of a Porcine Model

Kurashina,

Takahashi,

Sasanuma

et al. 2023

Cureus

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Background Achilles tendinopathy is a common ankle disorder in both the general population and athletes. This condition can alter the mechanical characteristics of the Achilles tendon (AT) by decreasing tendon stiffness. Achilles tendinopathy is primarily treated conservatively; however, few monitoring tools exist for evaluating the condition of the AT. The Myoton PRO (Myoton AS, Tallinn, Estonia) device is a handheld tool used to evaluate tissue stiffness. However, no basic studies have examined the validity of Myoton PRO for assessing the AT. This study aimed to assess the validity of Myoton PRO using animal ATs and to examine its clinical applicability. Methods We used 28 fresh porcine ankles and evaluated AT stiffness at the calcaneus insertion site (AT0) and 2.0 cm above the calcaneus (AT2) using Myoton PRO. We also measured changes in the AT length using a tensile testing machine during the cyclic loading test. We investigated the correlation between dynamic stiffness and length change. Furthermore, we assessed the difference in stiffness between AT0 and AT2. Results The dynamic stiffness was 717.6 ± 183.1 N/m at AT0 and 467.4 ± 152.3 N/m at AT2. The change in length during the cyclic loading test was 1.8 ± 0.7 mm. The correlation between dynamic stiffness and length change was as follows: AT0, r=-0.61; AT2, r=-0.64 (P<0.001). The dynamic stiffness at AT0 was significantly greater than that at AT2 (P<0.001). Conclusions AT assessment using Myoton PRO has potential clinical utility as an indicator of tissue stiffness.

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Minimal effect of scanning parameters on ultrasound shear wave elastography variability in tendons

Zellers,

Li,

Vaidya

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeUltrasound shear wave elastography has potential use in assessing tendon tissue; however, reducing measurement variability remains challenging. The primary purpose of this study was to identify the amount of variability accounted for by ultrasound parameter (frequency, harmonics and CrossXBeam) settings on shear wave speed at two testing sites.MethodsShear wave elastography images of the Achilles tendon were obtained from individuals with healthy tendons (n = 28) at two testing sites with standardised image acquisition/postprocessing protocols. Images were acquired at a range of frequencies (7–15 MHz) with CrossXBeam (a filtering technique) and harmonics settings toggled on and off. Variance decomposition analysis was performed to identify the amount of variability in shear wave speed accounted for by scan acquisition settings and testing sites.ResultsShear wave speed variance was primarily attributed to participants (56.87% of variance; residual error: 35%). All scanning parameters, testing site and interaction terms each accounted for less than 2.5% of the variance. A statistically significant, negative relationship was observed between shear wave speed and image quality (p = 0.001) suggesting poor image quality yields higher shear wave speed estimates.ConclusionThe findings of this study suggest that natural variation in Achilles tendon mechanics between individuals without tendon pathology accounts for most of the shear wave speed variability. Optimising image quality, which may be observed in higher frequencies, should be considered to improve shear wave speed estimation. Clinically, this study highlights the need to take multiple images, maintain consistent ultrasound settings when tracking patient progress over time and use caution when comparing raw values from tendon scans performed in different clinics with shear wave elastography.Level of EvidenceLevel III.

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Elastography in the assessment of the Achilles tendon: a systematic review of measurement properties

Cited by 5 publications

References 83 publications

A New Test for Achilles Tendinopathy Based on Kager’s Fat Pad Clinical Assessment Predictive Values

A New Test for Achilles Tendinopathy Based on Kager’s Fat Pad Clinical Assessment Predictive Values

Relationship Between Achilles Tendon Stiffness Using Myoton PRO and Translation Using a Tensile Testing Machine: A Biomechanical Study of a Porcine Model

Minimal effect of scanning parameters on ultrasound shear wave elastography variability in tendons

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