Regional shear wave elastography of Achilles tendinopathy in symptomatic versus contralateral Achilles tendons

Crawford, Scott K.; Thelen, Darryl G.; Yakey, Janice M; Heiderscheit, Bryan C.; Wilson, J. B.; Lee, Kenneth S.

doi:10.1007/s00330-022-08957-3

Cited by 8 publications

(13 citation statements)

References 37 publications

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“…Although leg dominance can affect inter-limb tendon CSA asymmetry, laterality was not related to the side of injury in our study, making it unlikely that the larger CSA was caused by more intense loading. Furthermore, there is compelling evidence confirming our results of more pronounced tendon vascularity in tendinopathic Achilles tendon [18][19][20][21]. Indeed, vascular alterations in tendinopathy are well known [62] and are reported to correlate with severity [34], although a considerable proportion of tendinopathy patients (i.e., 37%) does not show any sign of neovascularization [63], questioning increased vascularization as a single valid clinical sign for all patients [64].…”

Section: Discussionsupporting

confidence: 76%

“…While a certain degree of limb asymmetry can be considered as non-pathological, pronounced inter-limb differences particularly in Achilles tendon CSA and vascularization appear to be a hallmark of Achilles tendinopathy. Enlarged tendinopathic Achilles tendons have been reported in many studies [18][19][20][21][59][60][61] and may be caused by inflammation related edema. Localized fusiform tendon swelling has been reported previously in midportion Achilles tendinopathy [61].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, higher tendon strain and reduced tendon stiffness for the tendinopathic Achilles tendon [17] have been reported. Increased tendon thickness and hypervascularization was reported in symptomatic Achilles tendons in runners [18,19] and in a general patient population [20,21]. These findings indicate that there are pronounced differences in mechanical, morphological, and functional (i.e., muscle strength or jump performance) properties between the symptomatic and the asymptomatic Achilles tendon, which may be linked to injury etiology or progression.…”

Section: Introductionmentioning

confidence: 87%

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In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial

Radovanović

Böhm

Arampatzis

et al. 2023

JCM

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Background: As inter-limb asymmetries can be associated with higher injury risk, we aimed to investigate their role in Achilles tendinopathy patients. Methods: In Achilles tendinopathy patients (n = 41), we assessed inter-limb asymmetries of mechanical, material, and morphological musculoskeletal properties and function and how those were affected by 12 weeks of exercise intervention (high-load protocol, n = 13; Alfredson protocol, n = 11). Moreover, we assessed whether asymmetry reductions correlated with improved Patient-Reported Outcomes (VISA-A score). Results: At baseline, tendinopathic tendons demonstrated lower tendon force (p = 0.017), lower tendon stress (p < 0.0001), larger tendon cross-sectional area (CSA) (p < 0.001), and increased intratendinous (p = 0.042) and tendon overall (p = 0.021) vascularization. For the high-load group, PRE-to-POST asymmetry comparisons revealed an asymmetry increase for the counter-movement jump (CMJ) (p = 0.034) and PRE-to-POST VISA-A score improvements correlated with CSA asymmetry reductions (p = 0.024). Within the Alfredson group, PRE-to-POST VISA-A score improvements correlated with CMJ asymmetry reductions (p = 0.044) and tendon stiffness asymmetry increases (p = 0.037). POST-to-POST in-between group comparisons revealed lower asymmetry in the high-load group for tendon elongation (p = 0.021) and tendon strain (p = 0.026). Conclusions: The tendinopathic limb differs from the asymptomatic limb while therapeutic exercise interventions have little effect on asymmetries. Asymmetry reductions are not necessarily associated with tendon health improvements.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

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In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial

Radovanović

Böhm

Arampatzis

et al. 2023

JCM

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“…Four studies were identified that evaluated the use of SWE in the diagnosis of Achilles tendinopathy. 6,[11][12][13] These studies identified that SWV and Young's modulus were lower in the symptomatic tendon compared to the contralateral tendon and were statistically significant. SWE was also useful in identifying subtypes of Achilles tendinopathy based on location (insertional and noninsertional).…”

Section: Achilles Tendinopathymentioning

confidence: 95%

“…However, there was no significant difference in SWV between relaxed and isometric contraction of the rectus femoris or vastus lateralis in patients with OSD and healthy controls. 9 Knee osteoarthritis Hamstring muscles • Shear modulus of the hamstrings in patients with knee OA have a higher shear modulus, that correlates with the Western Ontario and McMaster Universities Arthritis Index score 10 Foot/Ankle Achilles tendinopathy Achilles tendon • Regional SWV in the Achilles tendon is lower in the symptomatic limb compared to the contralateral asymptomatic limb with a minimum cutoff of 350 kPa (10 m/s) for healthy tendons 11,12 • SWE is also effective in diagnosing insertional versus midportion Achilles tendinopathy 13 • Individuals with Achilles tendinopathy had lower SWV at the distal insertion 11 • SWE may be able to identify and classify subtypes of Achilles tendinopathy, including activity-dominant, psychosocial-dominant, and structure-dominant, based on tissue viscosity (kPa) 32 Acute compartment syndrome Tibialis anterior (TA), peroneus longus (PL), gastrocnemius medialis (GA) • Acute compartment syndrome can be diagnosed using SWE, as there is an increase in Young's modulus on the affected side as compared to the unaffected side 14 Plantar fasciitis…”

Section: Quadriceps Musclementioning

confidence: 99%

Diagnostic utility of shear wave elastography in musculoskeletal injuries: A narrative review

Chowdhary,

Raum,

Visco

2024

PM&R

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Shear wave elastography (SWE) is an emerging and promising ultrasound modality, and is more recently employed in the diagnosis of musculoskeletal (MSK) pathologies. SWE evaluates tissue stiffness by measuring the speed of propagating acoustic waves through body tissue structures. Knowing the variations in stiffness of MSK soft tissue can provide helpful diagnostic insight for the evaluation of pathology in muscles, tendons, ligaments, nerves, and other soft tissues. The goal of this review is to synthesize recent literature on the utility of SWE for MSK pathology diagnosis. This review reveals that SWE adds important diagnostic data for the evaluation of several pathologies, such as median mononeuropathy at the wrist, Achilles tendinopathy, and plantar fasciitis. The review also reveals a lack of evidence pertaining to appropriate standardization of use and the connection to reliable and valid diagnostic benefit in the clinical setting.

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Achilles tendon and triceps surae muscle properties in athletes

Sukanen,

Khair,

Ihalainen

et al. 2023

Eur J Appl Physiol

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Purpose The aim of this study was to investigate internal Achilles tendon (AT) displacement, AT shear wave velocity (SWV), and triceps surae (TS) muscle shear modulus in athletes. Methods Internal AT displacement was assessed using ultrasound during isometric contraction. Shear wave elastography was used to assess AT SWV (m × s–1) at rest and TS muscle shear modulus (kPa) during passive ankle dorsiflexion. Results A total of 131 athletes participated in this study. Athletes who had not exercised within two days had greater AT non-uniformity and mean anterior tendon displacement, and lower SWV at the proximal AT measurement site (mean difference [95% CI]: 1.8 mm [0.6–2.9], p = 0.003; 1.6 mm [0.2–2.9], p = 0.021; – 0.9 m × s–1 [– 1.6 to – 0.2], p = 0.014, respectively). Male basketball players had a lower mean AT displacement compared to gymnasts (– 3.7 mm [– 6.9 to – 0.5], p = 0.042), with the difference localised in the anterior half of the tendon (– 5.1 mm [– 9.0 to – 1.1], p = 0.022). Male gymnasts had a smaller absolute difference in medial gastrocnemius-minus-soleus shear modulus than basketball players (59.6 kPa [29.0–90.2], p < 0.001) and track and field athletes (52.7 kPa [19.2–86.3], p = 0.004). Intraclass correlation coefficients of measurements ranged from 0.720 to 0.937 for internal AT displacement, from 0.696 to 0.936 for AT SWE, and from 0.570 to 0.890 for TS muscles. Conclusion This study provides a reliability assessment of muscle and tendon SWV. The relative differences in passive TS muscle shear modulus suggest sport-specific adaptation. Importantly, in healthy individuals, lower AT displacement after exercise may reflect the time required for tendon recovery.

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Regional shear wave elastography of Achilles tendinopathy in symptomatic versus contralateral Achilles tendons

Cited by 8 publications

References 37 publications

In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial

In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial

Diagnostic utility of shear wave elastography in musculoskeletal injuries: A narrative review

Achilles tendon and triceps surae muscle properties in athletes

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