Strain sonoelastography in asymptomatic individuals and individuals with knee osteoarthritis: an evaluation of quadriceps and patellar tendon

Abstract

An advanced ultrasound imaging technique, sonoelastography (SE) is used to evaluate tissue elasticity. To determine SE potential to detect pathological-related changes, and characteristics related to tendon pathology we aimed to (1) compare quadriceps and patellar tendon findings in individuals with knee osteoarthritis (KOA) and asymptomatic older adults (AC), and (2) explore associations between SE, participant characteristics (age, BMI, and leg circumference) and KOA status. 84 participants (47; KOA and 37; asymptomatic older adults) underwent SE examination of quadriceps (distal) and patellar (distal, proximal) tendon in a supine position with the knee bent at 30°. Colour score (CS) and Elasticity Ratio (ER) analysis were performed by a blinded experienced operator using Esaote Mylab 70 XVG Ultrasound equipment. Significantly reduced elasticity in the distal quadriceps (median (IQR) 2(2), 3(1), p = 0.033 for KOA and AC, respectively) and proximal patellar (3(1), 3(0), p = 0.001) tendons and more elastic distal patellar (1.50 (0.55), 1.87 (0.72), p = 0.034) tendons were observed in the KOA group. Significant associations) were identified between SE and participant BMI (Rs = − 0.249–0.750, p < 0.05) and leg circumference (Rs = − 0.260–0.903, p < 0.05). Age, BMI and KOA status, were independent explanatory variables of SE CS findings at the distal quadriceps tendon patellar tendon, proximal patellar tendon and distal patellar tendon, explaining 66%, 81% and 64% of variance, respectively. Age, BMI and KOA status were independent explanatory variables of SE ER findings at the distal patellar tendon explaining 19% of variance. Potentially clinically relevant altered tendon stiffness were observed between individuals with KOA and asymptomatic controls. Key KOA risk factors and participant characteristics explained variance in tendon stiffness. Findings provide context for future studies to investigate the potential for targeted SE detected early clinical management based on associated participant characteristics.

Sonoelastography: A powerful technique in musculoskeletal imaging

“…This report demonstrated sonoelastographic abnormalities in the common extensor tendon by both shear wave and strain elastography that were more pronounced than gray scale B‐mode US imaging. Similar greater sensitivity of sonoelastography versus grayscale US for early stages of tendinopathy have been reported in the Achilles, quadriceps, biceps, supraspinatus, and other tendons 9,14–17 . Sonoelastography has also been applied to osteoarthritic cartilage, the transverse ligament in carpal tunnel syndrome, myopathies, ligaments, rheumatoid synovitis, methotrexate hepatotoxicity (important in rheumatology), meniscal disease, trigger finger, and musculoskeletal tumors with similar changes in elasticity of the relevant tissue with variable sensitivity and specificity for pathology versus alternative imaging methods 14–25 …”

“…The low cost, convenience, noninvasive nature, lack of ionizing radiation, direct relevance to palpable anatomy, point‐of‐care applicability, and increasing number of applications indicate that US will only increase in use in musculoskeletal medicine 1–4 . Sonoelastography is another powerful method available to observe the musculoskeletal system, and appears particularly valuable in detecting early tendinopathies, areas of myopathy suitable for biopsy, pursuing complaints of localized musculoskeletal pain, analyzing soft tissue masses, and research applications in musculoskeletal medicine 14–25 . Shear wave elastography in particular permits rapid quantitative assessments of musculoskeletal structures and will be particularly valuable at the beside, in research studies and clinical trials, and in monitoring disease presence, progression, and response to therapy, especially in muscle and tendon disease.…”

“…Similar greater sensitivity of sonoelastography versus grayscale US for early stages of tendinopathy have been reported in the Achilles, quadriceps, biceps, supraspinatus, and other tendons. 9,[14][15][16][17] Sonoelastography has also been applied to osteoarthritic cartilage, the transverse ligament in carpal tunnel syndrome, myopathies, ligaments, rheumatoid synovitis, methotrexate hepatotoxicity (important in rheumatology), meniscal disease, trigger finger, and musculoskeletal tumors with similar changes in elasticity of the relevant tissue with variable sensitivity and specificity for pathology versus alternative imaging methods. [14][15][16][17][18][19][20][21][22][23][24][25] US is increasingly becoming an extension of the physical examination in musculoskeletal medicine.…”

“…9,[14][15][16][17] Sonoelastography has also been applied to osteoarthritic cartilage, the transverse ligament in carpal tunnel syndrome, myopathies, ligaments, rheumatoid synovitis, methotrexate hepatotoxicity (important in rheumatology), meniscal disease, trigger finger, and musculoskeletal tumors with similar changes in elasticity of the relevant tissue with variable sensitivity and specificity for pathology versus alternative imaging methods. [14][15][16][17][18][19][20][21][22][23][24][25] US is increasingly becoming an extension of the physical examination in musculoskeletal medicine. 1 The low cost, convenience, noninvasive nature, lack of ionizing radiation, direct relevance to palpable anatomy, point-of-care applicability, and increasing number of applications indicate that US will only increase in use in musculoskeletal medicine.…”

“…[1][2][3][4] Sonoelastography is another powerful method available to observe the musculoskeletal system, and appears particularly valuable in detecting early tendinopathies, areas of myopathy suitable for biopsy, pursuing complaints of localized musculoskeletal pain, analyzing soft tissue masses, and research applications in musculoskeletal medicine. [14][15][16][17][18][19][20][21][22][23][24][25] Shear wave elastography in particular permits rapid quantitative assessments of musculoskeletal structures and will be particularly valuable at the beside, in research studies and clinical trials, and in monitoring disease presence, progression, and response to therapy, especially in muscle and tendon disease. It is anticipated that sonoelastography will increase in specificity, sensitivity, depth of imaging, and applications as the technology of this US method becomes increasingly sophisticated.…”