Sonoanatomy of the Achilles tendon insertion in children

Grechenig, W.; Mayr, Johannes; Peicha, G.; Hammerl, Randolf; Schatz, B.; Grechenig, Stephan

doi:10.1002/jcu.20042

Cited by 35 publications

(20 citation statements)

References 19 publications

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“…We neither addressed the enthesis nor the findings on Doppler US in healthy children. The enthesis by itself is a relatively complex anatomic structure (2) and the interpretation of Doppler findings in children is very complex (1,24,25). Additional studies are needed to address this.…”

Section: Discussionmentioning

confidence: 99%

Definitions for the Sonographic Features of Joints in Healthy Children

Roth

Jousse‐Joulin

Magni‐Manzoni

et al. 2014

Arthritis Care & Research

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Objective. Musculoskeletal ultrasonography (US) has potential in the assessment of disease activity and structural damage in childhood arthritides. In order to assess pathology, the US characteristics of joints in healthy children need to be defined first. The aim of this study was to develop definitions for the various components of the normal pediatric joint. Methods. The definitions were developed by an expert group and applicability was assessed on a collection of standardized scans of the knee and ankle joints by scoring the scans on a Likert scale. The definitions were then modified and applicability was reassessed before sending the definitions for approval to a larger panel of experts. A final scoring on stored images of all relevant joints at different ages followed. Results. Five definitions were developed addressing the articular bone, cartilage, joint capsule, epiphyseal ossification center, and synovial membrane. In total, 224 US images of knees and ankles were acquired, of which 172 were selected for scoring. An agreement of >80% was not met for any of the definitions, but after modifications, 81-97% agreement was reached. This version of the definitions was approved by 15 US experts. In the final validation exercise, all definitions reached an agreement of >80% for the shoulder, elbow, wrist, metacarpophalangeal hip, knee, ankle and metatarsophalangeal joint. Conclusion. US definitions for the normal pediatric joint were successfully developed through a Delphi process and validated in a practical exercise. These results provide the basis to develop definitions for pathology and to support the standardized use of US in pediatric rheumatology.

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Section: Discussionmentioning

confidence: 99%

Definitions for the Sonographic Features of Joints in Healthy Children

Roth

Jousse‐Joulin

Magni‐Manzoni

et al. 2014

Arthritis Care & Research

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“…The stages of maturation of the tibial tuberosity were based on the three-point scale initially based on the work by Grechenig et al 19 and then further developed by Ducher et al 1418 In order to improve the accuracy of the developmental aspect of the apophysis, the choice was made to split the first stage into two.…”

Section: Methodsmentioning

confidence: 99%

Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation

2012

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BackgroundThe pathogenesis of the Osgood-Schlatter's disease (OSD) is still debated. The fragmentation of the ossification centre has been questioned as a definitive sign of OSD and has been seen as a normal development of the anterior tibial tubercle (ATT).ObjectivesIt is unknown if such changes are present in the presumed pathological tendon insertion seen in OSD, nor the relation of Doppler-positive changes to pain on clinical examination.MethodsA prospective analysis was carried out on 20 consecutive symptomatic male athletes (13.9 years±1.3) and a comparison group of asymptomatic subjects. All underwent a comparative clinical assessment and ultrasound with colour Doppler scan on both knees. Subjective pain was recorded with a visual analogue scale (VAS) during provocative manoeuvres: palpation, resisted contraction and single leg squat.ResultsPositive Doppler US (within the distal end of the patellar tendon) was associated with higher pain on palpation (47±24.5 vs 18±11.4, p<0.01) and resisted static contraction (59±20.2 vs 27±12.5, p<0.001) compared with Doppler-negative subjects. No Doppler activity was found in the comparison group. VAS for palpation and resisted contraction of the athletes graded as stage 2 (51.1±22.0 and 60.0±21.2) were significantly higher than stage 3 (17.8±12.0 and 18.9±16.9) and stage 4 (15.0±7.1 and 25.0±7.1; p<0.01).ConclusionsMore painful OSD is associated with the presence of neo-vessels. This may be linked with a particular stage of ATT maturation and applied compressive forces. A Doppler ultrasound scan adds practical information to develop the care plan of the patient.

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“…The varying types of imaging are useful for different types of structures. For example, an X-ray may find a fracture or neoplasm, whereas ultrasound imaging can give reliable information about the Achilles tendon insertion and the bone–cartilage interface at the calcaneal tuberosity 5,39. CT and MRI may, for example, be needed to rule out conditions such as stress fracture, tarsal coalition, or osteomyelitis 5…”

Section: Diagnosismentioning

confidence: 99%

Aspects of treatment for posterior heel pain in young athletes

Elengard¹,

Karlsson²,

Silbernagel³

2010

OAJSM

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Posterior heel pain occurs in young athletes involved in running and jumping. Due to the pain, the child often limits his/her physical activity level, with a possible negative effect on health and well-being. Although numerous research studies have examined the cause and treatment of heel and Achilles tendon pain in adults, there are no randomized clinical trials on treatment in children and adolescents. Therefore, there is limited evidence for how to treat young athletes with this type of complaint. The purpose of this review was to analyze critically and summarize the literature in regards to the cause and treatment of posterior heel pain in young athletes. The various diagnoses and clinical presentations relating to posterior heel and Achilles tendon pain are discussed. The theory and mechanism behind various recommended treatment strategies are also reviewed in the context of use in the young athlete. In summary, it is important to perform a thorough evaluation of each young athlete with heel pain to determine the appropriate diagnosis and to treat the deficits found and allow for a gradual progression to training. However, the recommendations at this time are based on clinical experience and a few retrospective studies, so further well designed prospective studies with validated outcome measures are urgently needed for the young athlete.

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Sonoanatomy of the Achilles tendon insertion in children

Cited by 35 publications

References 19 publications

Definitions for the Sonographic Features of Joints in Healthy Children

Definitions for the Sonographic Features of Joints in Healthy Children

Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation

Aspects of treatment for posterior heel pain in young athletes

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