Ultrasonography for the assessment of the structural properties of the Achilles tendon in asymptomatic individuals: An intra-rater reproducibility study

Intziegianni, Konstantina; Cassel, Michael; König, Niklas; Müller, Steffen; Fröhlich, Katja; Mayer, Frank

doi:10.3233/ies-150586

Cited by 11 publications

(17 citation statements)

References 32 publications

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“…First, we have to note that we used two different digitization methods for US and MRI image analysis. In the past, several US studies used manual tracing (Brushoj et al 2006; Dudley-Javoroski et al 2010; Intziegianni et al 2015), equation-based digitization (Milgrom et al 2014), or assumptions of the tendon shape (Kallinen and Suominen 1994) to assess the AT CSA. Moreover, MRI images were traced manually (Brushoj et al 2006) or automatically (Hansen et al 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous studies (Brushoj et al 2006; Dudley-Javoroski et al 2010; Foure et al 2011; Intziegianni et al 2015; Kallinen and Suominen 1994; Kongsgaard et al 2005; Magnusson et al 2001; Milgrom et al 2014; Rosager et al 2002; Waugh et al 2012; Ying et al 2003), we conducted the CSA measurements at the level between the malleoli and additionally at a second more proximal position (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

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Ultrasound and magnetic resonance imaging are not interchangeable to assess the Achilles tendon cross-sectional-area

2016

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PurposeThe major aim of this study was to compare ultrasound (US) and magnetic resonance imaging (MRI) measurements of the Achilles tendon cross-sectional area (CSA). Further aims were to conduct reliability analyses and to assess the influence of transducer pressure on the tendon properties in US measurements.MethodsThe Achilles tendon CSA of 15 participants was assessed at two positions with US and MRI by use of a standardized protocol. Method comparison was performed by two-way analysis of variance (ANOVA) and paired t test. Reliability was assessed by coefficients of variation (CV), intraclass correlation (ICC2,2), standard error of measurement (SEM), and minimal detectable change (MDC95). A paired t test was performed to investigate the effect of probe pressure on tendon CSA and thickness.ResultsMean US measurements provided a ~5.5% smaller CSA compared to MRI measurements. Intra-rater reliability analyses of US demonstrated CV values of 1.5–4.9%, ICC of 0.89–0.97, SEM and MDC95 values of 0.22–0.77 mm2 and 0.61–2.16 mm2 for both raters, whereby CV values for intra-rater reliability of MRI ranged from 1.0 to 3.7%. Inter-rater reliability was lower for both modalities. Pressure applied on the transducer altered Achilles tendon CSA and thickness significantly (p < 0.05).ConclusionsOur findings show that US and MRI cannot be used interchangeably for Achilles tendon CSA assessments, however, each imaging modality separately is reliable to assess this property. Pressure applied on the transducer during US measurements causes alterations of the tendon’s morphology and should be avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Ultrasound and magnetic resonance imaging are not interchangeable to assess the Achilles tendon cross-sectional-area

2016

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“…AT length was measured as the distance from the most distal part of AT insertion to the calcaneus and the medial gastrocnemius myotendinous junction (MTJ) using a measuring tape. Structures were identified by use of US and metal fine wires and marked accurately on the skin as described in previous studies [14,15]. AT CSA was measured at 4 cm from most distal attachment on the calcaneus defined by use of a measuring tape [15].…”

Section: Tendon Structural Properties During Restmentioning

confidence: 99%

“…Structures were identified by use of US and metal fine wires and marked accurately on the skin as described in previous studies [14,15]. AT CSA was measured at 4 cm from most distal attachment on the calcaneus defined by use of a measuring tape [15]. The area of 4 cm falls well within the level of malleolus, and has been previously reported to be one of the most reliable site to measure [15].…”

Section: Tendon Structural Properties During Restmentioning

confidence: 99%

“…AT CSA was measured at 4 cm from most distal attachment on the calcaneus defined by use of a measuring tape [15]. The area of 4 cm falls well within the level of malleolus, and has been previously reported to be one of the most reliable site to measure [15]. Tendon thickness was measured at its maximal (antero to posterior) thickness in the sagittal plane identified by visual inspection [29].…”

Section: Tendon Structural Properties During Restmentioning

confidence: 99%

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Influence of Age and Pathology on Achilles Tendon Properties During a Single-leg Jump

et al. 2016

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Prevalence of Achilles tendinopathy increases with age leading to a weaker tendon with predisposition to rupture. Conclusive evidence of the influence of age and pathology on Achilles tendon (AT) properties remains limited, as previous studies are based on standardized isometric conditions. The study investigates the influence of age and pathology on AT properties during single-leg vertical jump (SLVJ). 10 children (C), 10 asymptomatic adults (A), and 10 tendinopathic patients (T) were included. AT elongation [mm] from rest to maximal displacement during a SLVJ on a force-plate was sonographically assessed. AT compliance [mm/N]) and strain [%] was calculated by dividing elongation by peak ground reaction force [N] and length, respectively. One-way ANOVA followed by Bonferroni post-hoc correction (α=0.05) were used to compare C with A and A with T. AT elongation (p=0.004), compliance (p=0.001), and strain were found to be statistically significant higher in C (27±3 mm, 0.026±0.006 [mm/N], 13±2%) compared to A (21±4 mm, 0.017±0.005 [mm/N], 10±2%). No statistically significant differences (p≥0.05) was found between A and T (25±5 mm, 0.019±0.004 [mm/N], 12±3%). During SLVJ, tendon responded differently in regards to age and pathology with children having the most compliant AT. Higher compliance found in healthy tendons might be considered as a protective factor against load-related injuries.

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Validity and reliability of a novel 3D ultrasound approach to assess static lengths and the lengthening behavior of the gastrocnemius medialis muscle and the Achilles tendon in vivo

Habersack

Zussner

Thaller

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Human muscle–tendon units (MTUs) are highly plastic and undergo changes in response to specific diseases and disorders. To investigate the pathological changes and the effects of therapeutic treatments, the use of valid and reliable examination methods is of crucial importance. Therefore, in this study, a simple 3D ultrasound approach was developed and evaluated with regard to: (1) its validity in comparison to magnetic resonance imaging (MRI) for the assessment of the gastrocnemius medialis (GM) MTU, muscle belly, and Achilles tendon lengths; and (2) its reliability for static and dynamic length measurements. Methods Sixteen participants were included in the study. To evaluate the validity and reliability of the novel 3D ultrasound approach, two ultrasound measurement sessions and one MRI assessment were performed. By combining 2D ultrasound and 3D motion capture, the tissue lengths were assessed at a fixed ankle joint position and compared to the MRI measurements using Bland–Altman plots. The intra-rater and inter-rater reliability for the static and dynamic length assessments was determined using the coefficient of variation, standard error of measurement (SEM), minimal detectable change (MDC95), and intraclass correlation coefficient (ICC). Results The 3D ultrasound approach slightly underestimated the length when compared with MRI by 0.7%, 1.5%, and 1.1% for the GM muscle belly, Achilles tendon, and MTU, respectively. The approach showed excellent intra-rater as well as inter-rater reliability, with high ICC (≥ 0.94), small SEM (≤ 1.3 mm), and good MDC95 (≤ 3.6 mm) values, with even better reliability found for the static length measurements. Conclusion The proposed 3D ultrasound approach was found to be valid and reliable for the assessment of the GM MTU, muscle belly, and Achilles tendon lengths, as well as the tissue lengthening behavior, confirming its potential as a useful tool for investigating the effects of training interventions or therapeutic treatments (e.g., surgery or conservative treatments such as stretching and orthotics). Level of evidence Level II.

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Ultrasonography for the assessment of the structural properties of the Achilles tendon in asymptomatic individuals: An intra-rater reproducibility study

Cited by 11 publications

References 32 publications

Ultrasound and magnetic resonance imaging are not interchangeable to assess the Achilles tendon cross-sectional-area

Ultrasound and magnetic resonance imaging are not interchangeable to assess the Achilles tendon cross-sectional-area

Influence of Age and Pathology on Achilles Tendon Properties During a Single-leg Jump

Validity and reliability of a novel 3D ultrasound approach to assess static lengths and the lengthening behavior of the gastrocnemius medialis muscle and the Achilles tendon in vivo

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