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Wu CX, Xiong CY, Bai L, Chen SM, Yan YX, Wang L, Zhang XT. Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study. Chin J Traumatol 2023; 26:323-328. [PMID: 37940448 PMCID: PMC10755773 DOI: 10.1016/j.cjtee.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Previous studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function. METHODS In this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference. RESULTS AOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = -17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = -8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period. CONCLUSION Achilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.
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Affiliation(s)
- Chen-Xi Wu
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Chang-Yue Xiong
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Lu Bai
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China.
| | - Su-Meng Chen
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Yu-Xin Yan
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Lu Wang
- Department of Statistics and Mathematical Sciences, Southern University of Science and Technology, Shenzhen, 518055, Guangdong province, China
| | - Xin-Tao Zhang
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
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Yoshida K, Itoigawa Y, Morikawa D, Maruyama Y, Ishijima M. Chronologic Changes in the Elastic Modulus of a Healing Achilles Tendon Rupture Measured Using Shear Wave Elastography. Foot Ankle Int 2023; 44:243-250. [PMID: 36788728 DOI: 10.1177/10711007221151083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Shear wave elastography (SWE) has been used to examine the elasticity of a ruptured Achilles tendon; however, the healing process of a ruptured tendon has not been studied yet. This study aimed to detail the change in mechanical properties of a healing Achilles tendon rupture managed conservatively or surgically using SWE. METHODS Using a prospective cohort study design, we evaluated the patients treated conservatively (conservative group) and surgically (surgical group) with the "gift-box" technique for an isolated index acute Achilles tendon rupture during their healing process. SWE measurements were taken of both the injured and uninjured sides every 4 weeks up to 24, 36, and 48 weeks after treatment. Additionally, tendon thickness and power Doppler (PD) grade were measured at the same time points as SWE measurements. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot rating system score and Achilles tendon Total Rupture Score (ATRS) were compared at 24 and 48 weeks. RESULTS The ruptured Achilles tendon obtained an SWE value comparable with the unruptured side at 12 weeks in the conservative group and at 4 weeks with surgical group. The surgical group had significantly higher SWE values up to 24 weeks compared with the conservative group. Additionally, this group had a significantly larger increase in tendon thickness in nearly all periods. Both treatment groups were comparable regarding the PD grade, AOFAS score, and ATRS. CONCLUSION SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Our analysis using SWE has revealed the detailed chronologic changes in SWE values and related mechanical properties of a healing Achilles tendon rupture, which can be used for devising appropriate rehabilitation protocols. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Keiichi Yoshida
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan.,Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Daichi Morikawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan.,Department of Medicine for Orthopedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Evran S, Beker-Acay M, Saracli S, Acay A, Kacar E, Kaya F. Sonoelastographic Assessment of the Achilles Tendon in Familial Mediterranean Fever Patients: Comparison With Healthy Subjects. Cureus 2020; 12:e12143. [PMID: 33489555 PMCID: PMC7813538 DOI: 10.7759/cureus.12143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction and objective: This study aims at using sonoelastography as a novel technique to evaluate the stiffness and thickness of Achilles tendons in familial Mediterranean fever (FMF) patients. Methods: Achilles tendons of 26 FMF patients and 23 control subjects were assessed with ultrasound and real-time sonoelastography. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to their elasticity features: grade 1 blue (hardest tissue) to green (hard tissue); grade 2, yellow (soft tissue); and grade 3, red (softest tissue). Tendons of the groups were compared in terms of thickness and stiffness. Results: There were no significant differences in thickness and stiffness of the Achilles tendon between FMF patients and controls (p>0.05). Sonoelastography of Achilles tendons of FMF patients displayed no relationship between FMF and tendinopathy. Conclusion: This issue should be explored in prospective studies in larger groups.
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Affiliation(s)
- Seyfi Evran
- Radiology, Afyonkarahisar State Hospital, Afyonkarahisar, TUR
| | - Mehtap Beker-Acay
- Radiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
| | - Sinan Saracli
- Statistics, Afyon Kocatepe University, Afyonkarahisar, TUR
| | - Akif Acay
- Internal Medicine, Kutahya Park Hayat Hospital, Kutahya, TUR
| | - Emre Kacar
- Radiology, Doruk Setbasi Medical Center, Bursa, TUR
| | - Furkan Kaya
- Radiology, Afyonkarahisar Health Sciences University, Afyonkarahisar, TUR
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Laurent D, Walsh L, Muaremi A, Beckmann N, Weber E, Chaperon F, Haber H, Goldhahn J, Klauser AS, Blauth M, Schieker M. Relationship between tendon structure, stiffness, gait patterns and patient reported outcomes during the early stages of recovery after an Achilles tendon rupture. Sci Rep 2020; 10:20757. [PMID: 33247156 PMCID: PMC7695820 DOI: 10.1038/s41598-020-77691-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 11/05/2020] [Indexed: 11/09/2022] Open
Abstract
After an Achilles tendon (AT) injury, the decision to return to full weightbearing for the practice of sports or strenuous activities is based on clinical features only. In this study, tendon stiffness and foot plantar pressure, as objective quantitative measures that could potentially inform clinical decision making, were repeatedly measured in 15 patients until 3 months after the AT rupture by using shear wave elastography (SWE) and wearable insoles, respectively. Meanwhile, patient reported outcomes assessing the impact on physical activity were evaluated using the Achilles Tendon Total Rupture Score (ATRS). At week-2 post-injury, stiffness of the injured tendon varied from 6.00 ± 1.62 m/s (mean ± SD) close to the rupture to 8.91 ± 2.29 m/s when measured more distally. While near complete recovery was observed in distal and middle regions at week-8, the shear wave velocity in the proximal region recovered to only 65% of the contralateral value at week-12. In a parallel pre-clinical study, the tendon stiffness measured in vivo by SWE in a rat model was found to be strongly correlated with ex vivo values of the Young’s modulus, which attests to the adequacy of SWE for these measures. The insole derived assessment of the plantar pressure distribution during walking showed slight sub-optimal function of the affected foot at week-12, while the ATRS score recovered to a level of 59 ± 16. Significant correlations found between tendon stiffness, insole variables and distinct ATRS activities, suggest clinical relevance of tendon stiffness and foot plantar pressure measurements. These results illustrate how an alteration of the AT structure can impact daily activities of affected patients and show how digital biomarkers can track recovery in function over time.
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Affiliation(s)
- Didier Laurent
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland.
| | - Lorcan Walsh
- Novartis Ireland Ltd., Elm Park, Merrion Road, Dublin 4, Ireland
| | - Amir Muaremi
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland
| | - Nicolau Beckmann
- Musculoskeletal Diseases Area, Novartis Institutes for Biomedical Research, 4002, Basel, Switzerland
| | - Eckhard Weber
- Musculoskeletal Diseases Area, Novartis Institutes for Biomedical Research, 4002, Basel, Switzerland
| | - Frederique Chaperon
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland
| | - Harry Haber
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland
| | - Joerg Goldhahn
- Institute for Translational Medicine, ETH Zürich, HCP H 15.3, Leopold-Ruzicka-Weg 4, 8093, Zürich, Switzerland
| | - Andrea Sabine Klauser
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Michael Blauth
- Department of Trauma Surgery, Center Operative Medicine, University Hospital, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Matthias Schieker
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland
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