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Albarova-Corral I, Segovia-Burillo J, Malo-Urriés M, Ríos-Asín I, Asín J, Castillo-Mateo J, Gracia-Tabuenca Z, Morales-Hernández M. A New Quantitative Tool for the Ultrasonographic Assessment of Tendons: A Reliability and Validity Study on the Patellar Tendon. Diagnostics (Basel) 2024; 14:1067. [PMID: 38893594 PMCID: PMC11171978 DOI: 10.3390/diagnostics14111067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Ultrasound is widely used for tendon assessment due to its safety, affordability, and portability, but its subjective nature poses challenges. This study aimed to develop a new quantitative analysis tool based on artificial intelligence to identify statistical patterns of healthy and pathological tendons. Furthermore, we aimed to validate this new tool by comparing it to experts' subjective assessments. A pilot database including healthy controls and patients with patellar tendinopathy was constructed, involving 14 participants with asymptomatic (n = 7) and symptomatic (n = 7) patellar tendons. Ultrasonographic images were assessed twice, utilizing both the new quantitative tool and the subjective scoring method applied by an expert across five regions of interest. The database contained 61 variables per image. The robustness of the clinical and quantitative assessments was tested via reliability analyses. Lastly, the prediction accuracy of the quantitative features was tested via cross-validated generalized linear mixed-effects logistic regressions. These analyses showed high reliability for quantitative variables related to "Bone" and "Quality", with ICCs above 0.75. The ICCs for "Edges" and "Thickness" varied but mostly exceeded 0.75. The results of this study show that certain quantitative variables are capable of predicting an expert's subjective assessment with generally high cross-validated AUC scores. A new quantitative tool for the ultrasonographic assessment of the tendon was designed. This system is shown to be a reliable and valid method for evaluating the patellar tendon structure.
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Affiliation(s)
- Isabel Albarova-Corral
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - José Segovia-Burillo
- Fluid Mechanics, Instituto de Investigación en Ingeniería de Aragón (I3A), University of Zaragoza, 50018 Zaragoza, Spain
| | - Miguel Malo-Urriés
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Izarbe Ríos-Asín
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jesús Asín
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jorge Castillo-Mateo
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Zeus Gracia-Tabuenca
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Mario Morales-Hernández
- Fluid Mechanics, Instituto de Investigación en Ingeniería de Aragón (I3A), University of Zaragoza, 50018 Zaragoza, Spain
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Ivankovic I, Lin HA, Özbek A, Orive A, Deán‐Ben XL, Razansky D. Multispectral Optoacoustic Tomography Enables In Vivo Anatomical and Functional Assessment of Human Tendons. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308336. [PMID: 38445972 PMCID: PMC11095142 DOI: 10.1002/advs.202308336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/11/2023] [Indexed: 03/07/2024]
Abstract
Tendon injuries resulting from accidents and aging are increasing globally. However, key tendon functional parameters such as microvascularity and oxygen perfusion remain inaccessible via the currently available clinical diagnostic tools, resulting in disagreements on optimal treatment options. Here, a new noninvasive method for anatomical and functional characterization of human tendons based on multispectral optoacoustic tomography (MSOT) is reported. Healthy subjects are investigated using a hand-held scanner delivering real-time volumetric images. Tendons in the wrist, ankle, and lower leg are imaged in the near-infrared optical spectrum to utilize endogenous contrast from Type I collagen. Morphology of the flexor carpi ulnaris, carpi radialis, palmaris longus, and Achilles tendons are reconstructed in full. The functional roles of the flexor digitorium longus, hallicus longus, and the tibialis posterior tendons have been visualized by dynamic tracking during toe extension-flexion motion. Furthermore, major vessels and microvasculature near the Achilles tendon are localized, and the global increase in oxygen saturation in response to targeted exercise is confirmed by perfusion studies. MSOT is shown to be a versatile tool capable of anatomical and functional tendon assessments. Future studies including abnormal subjects can validate the method as a viable noninvasive clinical tool for tendinopathy management and healing monitoring.
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Affiliation(s)
- Ivana Ivankovic
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| | - Hsiao‐Chun Amy Lin
- Department of Biomedical Engineering and Environmental SciencesNational Tsing Hua UniversityNo.101, Sec.2, Kuang‐Fu RdHsinchu300044Taiwan
| | - Ali Özbek
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| | - Ana Orive
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| | - Xosé Luís Deán‐Ben
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
| | - Daniel Razansky
- Faculty of MedicineInstitute for Biomedical Engineering and Institute of Pharmacology and ToxicologyUniversity of ZurichWinterthurerstrasse 190ZurichCH‐8057Switzerland
- Department of Information Technology and Electrical EngineeringInstitute for Biomedical EngineeringETH Zurich, Wolfgang‐Pauli‐Str. 27ZurichCH‐8093Switzerland
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Klich S, Michalik K, Rajca J, Ficek K, Fernández-de-Las-Peñas C, Kawczynski A, Madeleine P. Fatigue-induced Alterations of the Patellar Tendon in Elite Sprint Track Cyclists. Int J Sports Med 2023; 44:995-1002. [PMID: 36690028 DOI: 10.1055/a-2018-2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study aims to investigate morphological and mechanical properties and echogenicity of the patellar tendon (PT) after acute fatigue-induced alterations in sprint track cyclists. Fourteen elite track cyclists participated in this study. The exercise protocol consisted of three maximal start accelerations (over a distance of 62.5 m), one maximal start acceleration (at both 125 m and 250 m), and sprints from the standing start. Immediately after testing all measurements, PT stiffness and thickness were set at 5-10-15-20 mm distal from the apex of the patella and 5-10 mm proximal to the tibial tuberosity. CSA was set at proximal, middle, and distal, while echogenicity was at proximal and distal points. The results showed significant increases in PT stiffness at all reference points after start acceleration (p<0.001). PT thickness showed similar results for stiffness, except for location placed at TT-5 (p<0.001). CSA increased significantly in proximal, middle, and distal regions (p<0.001), while echogenicity of the tendon increased in proximal and distal regions (p<0.001) after start acceleration. Regional-dependent alterations of PT thickness and stiffness may be related to anatomical and physiological mechanisms due to acute isometric contraction in the initial phase of standing start. Tendon echogenicity might be also useful in monitoring tendon mechanical properties and defining acute fatigue-induced changes.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
| | - Kamil Michalik
- Department of Human Motor Skills, Wroclaw University of Health and Sport Sciences, Wrocław, Poland
| | - Jolanta Rajca
- Department of Science, Innovation and Development, Galen-Orthopaedics, Bieruń, Poland
| | - Krzysztof Ficek
- Department of Physiotherapy, Jerzy Kukuczka Academy of Physical Education In Katowice, Katowice, Poland
- Department of Science, Innovation and Development, Galen-Orthopaedics, Bieruń, Poland
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
- Cátedra Institucional En Docencia, Clínica E Investigación En Fisioterapia: Terapia Manual, Punción Seca Y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Adam Kawczynski
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Pascal Madeleine
- Health Science and Technology, Aalborg University, Aalborg, Denmark
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Lunardi M, Furtado FE, Sakugawa RL, Sonda FC, Sampaio LT, Diefenthaeler F. Reliability of a special device for measuring the cross-sectional area of the patellar tendon by ultrasonography. J Ultrasound 2023; 26:897-903. [PMID: 37743436 PMCID: PMC10632332 DOI: 10.1007/s40477-023-00829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
The objective of this study was to evaluate the intra- and inter-rater reliability and agreement between conditions with and without a special device (SD) in the evaluation of the patellar tendon (PT) cross-sectional area (CSA). Forty trained adult volunteers participated in the study. With the knee positioned at 90°, the ultrasound probe was placed in the transverse plane at 25, 50, and 75% of the PT length. Two raters and one analyzer obtained the images. We use a two-way ANOVA with a significance level of α = 0.05. No significant differences were found between raters or conditions. Intra-rater reliability ranged from moderate to good. Inter-rater reliability without the SD ranged from low to good, improving from moderate to good when the SD was used. Evaluation of the PT ends showed a lower coefficient of variation with the SD. We observed a moderate correlation at the ends and a strong correlation in the middle between conditions. The mean difference in the three positions is small (~ 0.013 cm2/ ~ 1.7%) with an upper limit of 43.2% and a lower limit of 32.5%. Therefore, we conclude that the use of the SD can be employed for evaluating the PT ends, while for the central region, it becomes optional.
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Affiliation(s)
- Morgana Lunardi
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Franklin Everaldo Furtado
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Raphael Luiz Sakugawa
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Francesca Chaida Sonda
- Laboratório de Pesquisa do Exercício, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lucas Tavares Sampaio
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Fernando Diefenthaeler
- Laboratório de Biomecânica, Centro de Desportos, Universidade Federal de Santa Catarina, Campus Universitário, Trindade, Florianópolis, SC, 88040-900, Brazil.
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Rodríguez-Sanz D, Losa-Iglesias ME, de Bengoa-Vallejo RB, Sánchez-Milá Z, Dorgham HAA, Elerian AE, Yu T, Calvo-Lobo C, Velázquez-Saornil J, Martínez Jimene EM. A New Test for Achilles Tendinopathy Based on Kager's Fat Pad Clinical Assessment Predictive Values. J Clin Med 2023; 12:5183. [PMID: 37629225 PMCID: PMC10455944 DOI: 10.3390/jcm12165183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Background This study aimed to check the diagnostic accuracy of a new test to identify Achilles tendinopathy. STUDY DESIGN Observational study. METHODS Seventy patients recruited from a private medical centre met the diagnostic criteria for unilateral Achilles tendinopathy (age, 45.1 ± 12.7 years; weight, 75.00 ± 10 kg; height, 1.75 ± 0.1 m) and were tested based on both Achilles tendons. Seventy patients with a unilateral Achilles tendinopathy ultrasound diagnosis were tested using David's test. RESULTS Most (86%) subjects demonstrated Kager's fat pad asymmetry in relation to the Achilles tendon in the complete passive dorsiflexion in the prone position (David's sign). No healthy tendons had David's sign. CONCLUSIONS The presence of asymmetry in Kager's fat pad in relation to the Achilles tendon during complete passive dorsiflexion is strongly indicative of ultrasound-diagnosed tendinopathy. David's test demonstrated a sensitivity of 85.71% (95% CI, 77.51% to 93.91%) and a specificity of 100% (95% CI, 100% to 100%), while noting the lack of blinding of the assessors and the uncertainty of the diagnostic measures (95% CI). Asymmetry of the fat pad could potentially serve as a characteristic marker for patients with Achilles tendinopathy.
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Affiliation(s)
- David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Marta Elena Losa-Iglesias
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (M.E.L.-I.); (J.V.-S.)
| | - Ricardo Becerro de Bengoa-Vallejo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Zacarías Sánchez-Milá
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain;
| | | | - Ahmed Ebrahim Elerian
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Al Salam University, Tanta 31511, Egypt;
| | - Tian Yu
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Jorge Velázquez-Saornil
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (M.E.L.-I.); (J.V.-S.)
| | - Eva María Martínez Jimene
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
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Chai JW, Lee JH, Kim DH, Park J, Oh SH, Shin SM. Effect of Patient's Positioning on the Grade of Tendinosis and Visible Range of Infraspinatus Tendon on Ultrasound. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:627-637. [PMID: 37325003 PMCID: PMC10265234 DOI: 10.3348/jksr.2022.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/16/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Purpose To investigate the effect of patient positioning on tendinosis grade, visible range, and infraspinatus tendon (IST) thickness, and to determine the feasibility of internal rotation (IR) position to assess IST on ultrasound (US). Materials and Methods This study included 52 shoulders of 48 subjects who were evaluated for IST in three different positions: neutral position (N), IR, and position with the ipsilateral hand on the contralateral shoulder (HC). Two radiologists retrospectively graded IST tendinosis from grade 0 to grade 3 and the visible range from grade 1 to grade 4. The thickness of the IST was measured by another radiologist with a short-axis view. A generalized estimating equation was used for statistical analysis. Results The tendinosis grades were higher in the HC position than in the IR position, with a cumulative odds ratio of 2.087 (0.004, 95% confidence interval [CI]: 1.268-3.433). The tendinosis grades in the HC position (p = 0.370) and IR position (p = 0.146) were not significantly different from those in the N position. The overall difference in IST thickness was significant (p < 0.001), but the visible range (p = 0.530) was not significantly different according to position. Conclusion Patient positioning significantly affected the grade of tendinosis and thickness but not the visible range of the IST. The IR position is a feasible position for assessing the IST on US.
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Klich S, Kosendiak A, Krymski I, Kawczyński A, Madeleine P, Fernández-de-las-Peñas C. Ultrasound imaging of patellar tendon thickness in elite sprint track cyclists and elite soccer players: An intra-rater and inter-rater reliability study. PLoS One 2022; 17:e0270871. [PMID: 35789336 PMCID: PMC9255822 DOI: 10.1371/journal.pone.0270871] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/19/2022] [Indexed: 12/02/2022] Open
Abstract
The goal of our study was to investigate the relative and absolute intra-rater and inter-rater reliability of ultrasound assessment of patellar tendon (PT) thickness assessed over four locations, in track cyclists and soccer players. Fifteen male elite track cyclists and 15 male elite soccer players participated. Tendon thickness was measured over 4 locations placed at 5-10-15-20 mm inferior to the apex of the patella by two experienced examiners. Each examiner took two US images for the test measurements with a 10-min rest period. After a 30-min period, the subjects underwent a retest measurements that were also repeated 1-week after. A two-way analysis of variance revealed a significant group x location interaction on PT thickness for Examiner 1 (p = .001, η2 = .81) and Examiner 2 (p = 0.001, η2 = 0.78). Intra-rater reliability ranged from good to excellent (ICC2,k ≥ 0.75), whereas inter-rater reliability was good (ICC2,k ≥ 0.75) in both groups. Ultrasonographic assessment of PT was found to be a reliable method to assess tendon thickness. The middle location of the PT (corresponding to 15 and 20 mm) can be considered the most reliable spot to measure PT thickness. The PT thickness was larger among track cyclists than soccer players, with larger differences over the distal location (15 mm). Ultrasonographic assessment of PT was found to be a reliable method to assess tendon thickness. The middle location of the PT corresponding to 15 mm and 20 mm can be considered the most reliable area to measure PT thickness.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wrocław University of Health and Sport Science, Wrocław, Poland
- * E-mail:
| | - Aureliusz Kosendiak
- Study of Physical Education and Sport, Wrocław Medical University, Wrocław, Poland
| | | | - Adam Kawczyński
- Department of Paralympic Sport, Wrocław University of Health and Sport Science, Wrocław, Poland
| | - Pascal Madeleine
- Department of Health Science and Technology, Sport Sciences–Performance and Technology, Aalborg University, Aalborg, Denmark
| | - Cesar Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Madrid, Spain
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Krogh TP, Jensen TT, Madsen MN, Fredberg U. An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:6268590. [PMID: 38655172 PMCID: PMC11022783 DOI: 10.1155/2022/6268590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 04/26/2024]
Abstract
Background Achilles tendinopathy (AT) is a common musculoskeletal disorder, and its management remains challenging. Hypothesis/Purpose. By conducting a pilot study, we aimed to assess the feasibility, safety, and clinical improvement of a new home-based 4-stage rehabilitation program with progressive loading including isometric exercises on a small scale prior to setting up a randomized controlled trial. Methods Ten recreational athletes with chronic midportion AT were included. The primary outcome was change in VISA-A score after 1, 2, 3, 6, and 12 months. Secondary outcomes included tenderness on palpation of the tendon and ultrasonographic changes after 6 months. Results Average VISA-A improvements of 26.9 points (P=0.004) and 35.4 points (P=0.006) were observed at 6- and 12-month follow-up, respectively. Tenderness on palpation of the tendon (0-10) was reduced from 5.5 to 2.5 (P < 0.001). Color Doppler ultrasound activity (0-4) was reduced by 50%, from an average of grade 2 to grade 1 (P=0.023). The hypoechoic cross-sectional area of the Achilles tendon was reduced from an average of 29.1% to 8.5% (P=0.001). Tendon thickness showed no statistically significant change (P=0.415). Conclusion Following the 4-stage rehabilitation program for AT based on isometric training and progressive loading, we observed improvement in both VISA-A score and ultrasonography in a group of athletes who had previously failed to benefit from standard AT rehabilitation. The study was feasible in terms of high adherence to the program and with no observed safety issues. The results of this pilot study support a further assessment of this specific approach for rehabilitation in a future randomized controlled trial.
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Affiliation(s)
- Thøger Persson Krogh
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Sports Medicine, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Center for Sports Medicine, Regional Hospital of Northern Denmark, Hjørring, Denmark
| | - Thomas Theis Jensen
- Department of Sports Medicine, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Merete Nørgaard Madsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Center for Sports Medicine, Regional Hospital of Northern Denmark, Hjørring, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
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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. Knee Surg Sports Traumatol Arthrosc 2022; 30:4203-4213. [PMID: 35906410 PMCID: PMC9668947 DOI: 10.1007/s00167-022-07076-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
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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Shear wave elastography assessment and comparison study of the Achilles tendons in optimally conditioned asymptomatic young collegiate athletes. Skeletal Radiol 2021; 50:2381-2392. [PMID: 33963895 DOI: 10.1007/s00256-021-03798-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/19/2021] [Accepted: 04/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the functional parameters of the Achilles tendons among asymptomatic college level athletes using shear wave elastography (SWE) and to describe the relationship to athlete demographics and anthropometric lower extremity measurements. MATERIAL AND METHODS Sixty-five athletes were included in this IRB-approved study. SWE measurements were made on two tendon positions (neutral state and active maximum dorsiflexion) with two different probe orientations (longitudinal and transverse). Associations were assessed with BMI, tibial/foot length, type of sports, and resting/maximal dorsiflexion-plantar flexion angles. RESULTS Thirty-five (53.8%) males and 30 (46.2%) females with an overall mean age of 20.9 years (± 2.8), mean height of 176 cm (± 0.11), and mean weight of 74.1 kg (± 12) were studied. In the neutral state, the mean wave velocity of 7.5 m sec-1 and the mean elastic modulus of 176.8 kPa were recorded. In active maximum dorsiflexion, the mean velocity was 8.3 m sec-1 and mean elastic modulus was 199 kPa. On the transverse view, the mean velocity and elastic measurements were significantly lower (p = 0.0001). No significant differences in SWE parameters were seen between male and female athletes regardless of probe orientation (p < 0.05) with SWE values being higher in the running group vs non-running group (p < 0.05). In neutral state, longitudinal SWE measurements correlated with the tibia-foot length whereas transverse measurements correlated with the tendon diameter and ankle resting angle (ARA) (p < 0.005). CONCLUSION SWE can distinguish functional differences in Achilles tendon stiffness between athletes engaged in running-intensive sports compared with other athletes.
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Morrison T, Jones S, Causby RS, Thoirs K. Reliability of ultrasound in evaluating the plantar skin and fat pad of the foot in the setting of diabetes. PLoS One 2021; 16:e0257790. [PMID: 34555088 PMCID: PMC8459958 DOI: 10.1371/journal.pone.0257790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
Ultrasound can be used to assess injury and structural changes to the soft-tissue structure of the foot. It may be useful to assess the feet of people with diabetes who are at increased risk of plantar soft-tissue pathological changes. The aim of this study was to determine if ultrasound measurements of plantar soft-tissue thickness and assessments of tissue acoustic characteristics are reliable in people with and without diabetes mellitus. A repeated measures design was used to determine intra-observer reliability for ultrasound measurements of plantar skin and fat pad thickness and intra- and inter-observer reliability of plantar skin and fat pad tissue characterisation assessments made at foot sites which are at risk of tissue injury in people with diabetes. Thickness measurements and tissue characterisation assessments were obtained at the heel and forefoot in both the unloaded and compressed states and included discrete layers of the plantar tissues: skin, microchamber, horizontal fibrous band, macrochamber and total soft-tissue depth. At each site, relative intra-observer reliability was achieved for the measurement of at least one plantar tissue layer. The total soft-tissue thickness measured in the unloaded state (ICC 0.925-0.976) demonstrated intra-observer reliability and is the most sensitive for detecting small change on repeated measures. Intra-observer agreement was demonstrated for tissue characteristic assessments of the skin at the heel (k = 0.70), fat pad at the lateral sesamoid region (k = 0.70) and both skin and fat pad at the second (k = 0.80, k = 0.70 respectively) and third metatarsal heads (k = 0.90, k = 0.79 respectively). However, acceptable inter-observer agreement was not demonstrated for any tissue characteristic assessment, therefore the use of multiple observers should be avoided when making these assessments.
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Affiliation(s)
- Troy Morrison
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- * E-mail:
| | - Sara Jones
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Department of Rural Health, University of South Australia, Whyalla Norrie, South Australia, Australia
| | - Ryan Scott Causby
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kerry Thoirs
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Mascarenhas S. A Narrative Review of the Classification and Use of Diagnostic Ultrasound for Conditions of the Achilles Tendon. Diagnostics (Basel) 2020; 10:E944. [PMID: 33202763 PMCID: PMC7696236 DOI: 10.3390/diagnostics10110944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/23/2022] Open
Abstract
Enthesitis is a cardinal feature of spondyloarthropathies. The Achilles insertion on the calcaneus is a commonly evaluated enthesis located at the hindfoot, generally resulting in hindfoot pain and possible tendon enlargement. For decades, diagnosis of enthesitis was based upon patient history of hindfoot or posterior ankle pain and clinical examination revealing tenderness and/or enlargement at the site of the tendon insertion. However, not all hindfoot or posterior ankle symptoms are related to enthesitis. Advanced imaging, including magnetic resonance imaging (MRI) and ultrasound (US), has allowed for more precise evaluation of hindfoot and posterior ankle conditions. Use of US in diagnosis has helped confirm some of these cases but also identified other conditions that may have otherwise been misclassified without use of advanced imaging diagnostics. Conditions that may result in hindfoot and posterior ankle symptoms related to the Achilles tendon include enthesitis (which can include retrocalcaneal bursitis and insertional tendonopathy), midportion tendonopathy, paratenonopathy, superficial calcaneal bursitis, calcaneal ossification (Haglund deformity), and calcific tendonopathy. With regard to classification of these conditions, much of the existing literature uses confusing nomenclature to describe conditions in this region of the body. Some terminology may imply inflammation when in fact there may be none. A more uniform approach to classifying these conditions based off anatomic location, symptoms, clinical findings, and histopathology is needed. There has been much debate regarding appropriate use of tendonitis when there is no true inflammation, calling instead for use of the terms tendinosis or tendonopathy. To date, there has not been clear examination of a similar overuse of the term enthesitis in conditions where there is no underlying inflammation, thus raising the need for more comprehensive taxonomy.
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Affiliation(s)
- Sheryl Mascarenhas
- Department of Internal Medicine, Division of Rheumatology, The Ohio State University Wexner Medical Center, 543 Taylor Ave, Columbus, OH 43203, USA
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Castro J, Livino de Carvalho K, Silva PE, Fachin-Martins E, Babault N, Marqueti RDC, Durigan JLQ. Intra- and inter-rater reproducibility of ultrasound imaging of patellar and quadriceps tendons in critically ill patients. PLoS One 2019; 14:e0219057. [PMID: 31247020 PMCID: PMC6597100 DOI: 10.1371/journal.pone.0219057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/15/2019] [Indexed: 02/06/2023] Open
Abstract
Since the outset of body image reconstruction for diagnosis purposes, ultrasound has been used to investigate structural changes located in tendons. Ultrasound has clinical applications in the intensive care unit, but its utility for tendon imaging remains unknown. Thus, we aimed to determine intra- and inter-rater reproducibility of measures obtained by images generated through morphological tendon sonographic analysis recorded from critically ill patients. We designed a cross-sectional study to assess thickness, cross-sectional area, and echogenicity of patellar and quadriceps tendons in a convenience sample formed with 20 critically ill patients. Two independent raters (experienced and novice) recorded repeated measures, checking for agreement (Kappa statistics) and reliability (Intraclass coefficient Correlation-ICC and Bland-Altman). The quality of images acquired by the two independent raters substantially agreed (k = 0.571–1.000), regardless of the region on the patellar tendon or the studied tendon (patellar or quadriceps). Regardless of how much experience the rater had, their repeated records (intra-rater reliability) always demonstrated almost complete correlation, ICC ranging from 0.89 to 0.98 for both tendons in all outcomes. At the same way, the statistically significant inter-rater ICC ranging from 0.87 to 0.97. Both repeated measures by the raters (intra-rater) and the repeated single and double measures between the raters (inter-rater) presented a minimum measurement error constituting a predominant pattern of random variability. We conclude that ultrasound imaging acquisition performed by independent raters for tendon thickness, CSA, and echogenicity monitoring of critically ill patients are acceptable and are not influenced by rater experience.
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Affiliation(s)
- Joana Castro
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Institute of Strategic Health Management of the Federal District (IGESDF), Brasília, Brazil
- * E-mail:
| | - Karina Livino de Carvalho
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Paulo Eugênio Silva
- Institute of Strategic Health Management of the Federal District (IGESDF), Brasília, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Emerson Fachin-Martins
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - Nicolas Babault
- INSERM UMR1093-CAPS, Université Bourgogne Franche-Comté, UFR des Sciences du Sport, Dijon, France
| | - Rita de Cássia Marqueti
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
| | - João Luiz Quagliotti Durigan
- Graduate Program in Rehabilitation Sciences, University of Brasília (UnB), Ceilândia, Federal District, Brazil
- Graduate Program in Science and Technology in Health, University of Brasília (UnB), Ceilândia, Federal District, Brazil
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Ultrasonographic assessment of patellar tendon thickness at 16 clinically relevant measurement sites - A study of intra- and interrater reliability. J Bodyw Mov Ther 2019; 23:344-351. [PMID: 31103118 DOI: 10.1016/j.jbmt.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine intra- and interrater reliability of ultrasonographic imaging (USI) measurements of patellar tendon (PT) thickness using 16 measurement sites covering the entire tendon. DESIGN Reliability study. SETTING Physiotherapy outpatient clinic. PARTICIPANTS Twenty healthy and physically active volunteers (9 women). Mean age: 24 years (SD ± 2.73). Mean body mass: 75.8 kg (SD ± 11.8). MAIN OUTCOME MEASURES Intraclass correlation coefficient (ICC) and 95% limits of agreement (LOA) in cm and in percentage relative to the mean PT thickness. RESULTS Intrarater reliability ranged from 0.59 to 0.87 and 0.59 to 0.93 for examiners I and II, respectively. Interrater reliability ranged from 0.37 to 0.89. Measurement precision for examiner I ranged from 0.05 to 0.09 cm (17.5%-26.7%) while ranging from 0.04 to 0.13 cm (13.3%-38.7%) for examiner II. Interrater measurement precision ranged from 0.07 to 0.15 cm (19.1%-42.5%). CONCLUSION In an attempt to replicate daily clinical USI practice, this was the first study extensively assessing reliability throughout the full range of the patellar tendon - revealing a considerable variation in intra- and interrater reliability as well as measurement precision throughout the 16 individual PT sites. In a clinical context, the low interrater reliability and precision found at the proximal tendon insertion site may have implications for USI of the symptomatic PT, as this is the site mainly associated with underlying pathologic changes. Further reliability studies are needed to clarify the region-specific reliability of the full length PT.
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Romero-Morales C, Martín-Llantino PJ, Calvo-Lobo C, Palomo-López P, López-López D, Pareja-Galeano H, Rodríguez-Sanz D. Comparison of the sonographic features of the Achilles Tendon complex in patients with and without achilles tendinopathy: A case-control study. Phys Ther Sport 2018; 35:122-126. [PMID: 30543997 DOI: 10.1016/j.ptsp.2018.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023]
Abstract
AIM The aim of the present study was to evaluate and quantify with ultrasound imaging (USI) the Achilles tendon thickness, cross-sectional area (CSA), Kager's fat pad length and gastrocnemius-soleus pennation angle (PA) between chronic mid-portion Achilles tendinopathy (AT) and healthy subjects. METHODS A total sample of 143 individuals (age: 41.3 ± 12.0 y; height: 1.74 ± 0.0 m; weight: 75.0 ± 11.4 kg; body mass index, BMI: 24.4 ± 2.6 kg/m2) was recruited and divided in two groups: chronic mid-portion AT group (n = 71) and a healthy group (n = 72). RESULTS The thickness and CSA at 4 cm and 6 cm from the calcaneus was increased showing statistically significant differences (P < .01) in favor the tendinopathy group. For the gastrocnemius-soleus PA and Kager's fat pad length, significant differences (P < .01) were observed for a decrease in favor of the tendinopathy group. CONCLUSIONS This study reported an increase of Achilles tendon thickness and CSA at 4 cm and 6 cm from the calcaneus as well as a decrease in gastrocnemius-soleus PA and Kager's fat pad length in patients with chronic mid-portion AT.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sports Sciences, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | | | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Faculty of Health Sciences, Universidad de León, Ponferrada, Spain
| | | | - Daniel López-López
- Department of Health Sciences, Research, Health and Podiatry Unit, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain.
| | - Helios Pareja-Galeano
- Faculty of Sports Sciences, European University of Madrid, Villaviciosa de Odón, Madrid, Spain
| | - David Rodríguez-Sanz
- Faculty of Sports Sciences, European University of Madrid, Villaviciosa de Odón, Madrid, Spain; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
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Thoirs KA, Childs J. Are Ultrasound Measurements of Achilles Tendon Size Reliable? A Systematic Review of Rater Reliability. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2476-2491. [PMID: 30154035 DOI: 10.1016/j.ultrasmedbio.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/04/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound measurements of Achilles tendon size are used to assess the tendon's response to exercise, aging, rehabilitation, tendon loading and healing. It is important to understand and minimise the measurement error that occurs with these measurements. This review identified and synthesised studies reporting on intra- and inter-rater reliability of ultrasound measurements of Achilles tendon size. Analysis of 21 studies revealed that good to excellent intra- and inter-rater reliability can be achieved for ultrasound measurements of Achilles tendon size. Reliability can be optimised by using one experienced operator, standardising transducer pressure and orientation and averaging two or three measurements. There was a high risk of methodological bias across the included studies. Reporting of reliability studies needs to be improved by the use of existing reporting guidelines and expansion of these guidelines to include important elements of ultrasound imaging.
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Affiliation(s)
- Kerry A Thoirs
- International Centre of Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia 5001, Australia.
| | - Jessie Childs
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001, Australia
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Khan AA, Çarlı AB, Akhlaque U, Kara M, Waheed A, Özçakar L. Ultrasonographic evaluation of the ankle after unilateral traumatic lower limb amputations. Foot Ankle Surg 2018; 24:506-508. [PMID: 29409276 DOI: 10.1016/j.fas.2017.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 03/10/2017] [Accepted: 05/31/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Unilateral lower limb amputation can alter the tissue morphology leading to increase future risk of degenerative secondary disorders. METHODS Thirty-four consecutive male patients with unilateral lower limb amputations of different levels and 34 well matched male controls were included. To explore whether the ankles of traumatic lower limb amputees were undergoing morphological changes, three different tissue types i.e. talar cartilage, plantar fascia and Achilles tendon thicknesses in the intact limb of the lower limb amputee and healthy controls were measured by using ultrasound. RESULTS Plantar fascia was found to be thicker (p=0.013) and talar cartilage was thinner (p<0.001) on the intact sides of the patients than those of the controls. Achilles tendon thickness was found to be similar. In patients group, plantar fascia thickness was positively correlated with age (r=0.601, p<0.001), BMI (r=0.454, p=0.007) and durations of amputation (r=0.443, p=0.009) and prosthetic use (r=0.429, p=0.011). Achilles tendon thickness was positively correlated with durations of amputation (r=0.338, p=0.05) and prosthetic use (r=0.468, p=0.005). In controls group, talar cartilage thickness was negatively correlated with age (r=-0.640, p<0.001) and BMI (r=-0.401, p=0.019). CONCLUSIONS The talar cartilage seemed to be thinner and the plantar fascia to be thicker on the intact sides of the unilateral limb amputees.
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Affiliation(s)
- Atif A Khan
- Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
| | - Alparslan B Çarlı
- Saglik Bilimleri University, Sultan Abdulhamit Han Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey.
| | - Uzma Akhlaque
- Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
| | - Murat Kara
- Hacettepe University Medical School, Department of Physical Medicine and Rehabilitation, Ankara, Turkey
| | - Akhtar Waheed
- Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical Medicine and Rehabilitation, Ankara, Turkey
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Patel NN, Labib SA. The Achilles Tendon in Healthy Subjects: An Anthropometric and Ultrasound Mapping Study. J Foot Ankle Surg 2018; 57:285-288. [PMID: 29275904 DOI: 10.1053/j.jfas.2017.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 02/03/2023]
Abstract
Ultrasonography is an inexpensive, fast, and reliable imaging technique widely used to assess the Achilles tendon. Although significant data exists regarding pathologic tendon changes, ultrasound data from healthy individuals are more limited. We aimed to better characterize ultrasound Achilles tendon measurements in healthy individuals and identify important correlating factors. The information collected included patient demographics, body habitus, activity level, foot dominance, and resting ankle angle. Ultrasound analysis was performed bilaterally on the Achilles tendons of 50 subjects using a high-frequency transducer to measure tendon width, thickness, cross-sectional area, and length. Males had a significantly larger mean tendon length, width, thickness, and cross-sectional area. No statistically significant difference was found in any tendon dimension between the white and black participants. Similarly, no difference was found in any tendon parameter when comparing right versus left leg dominance. Healthy subjects had a mean ankle resting angle of 45.1° ± 24° with no statistically significant difference between right and left ankles. Considering all individuals, each tendon parameter (tendon length, width, thickness, and cross-sectional area) correlated positively with subject height, weight, tibia length, and foot size. Only the Achilles cross-sectional area correlated significantly with the activity level. The resting angle of the ankle correlated positively with both tendon length and thickness. In conclusion, we found significant variations in Achilles tendon anatomy in the healthy adult population. We have thoroughly characterized significant correlations between healthy tendon dimensions and various body habitus, activity levels, and ankle parameters. Greater knowledge of the normal Achilles tendon anatomy and characterization of its variations in the healthy population will potentially allow for better pathologic diagnosis and surgical repair.
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Affiliation(s)
- Nick N Patel
- Resident Physician, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Sameh A Labib
- Associate Professor, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA
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Jacobsen JS, Bolvig L, Hölmich P, Thorborg K, Jakobsen SS, Søballe K, Mechlenburg I. Muscle-tendon-related abnormalities detected by ultrasonography are common in symptomatic hip dysplasia. Arch Orthop Trauma Surg 2018; 138:1059-1067. [PMID: 29728835 DOI: 10.1007/s00402-018-2947-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Hip dysplasia is characterized by reduced acetabular coverage of the femoral head leading to an increased mechanical load on the hip joint and the acting hip muscles. Potentially, the muscles and tendons functioning close to the hip joint may present with overuse-related ultrasonography findings. The primary aim was to report the prevalence of muscle-tendon-related abnormalities detected by ultrasonography in 100 patients with symptomatic hip dysplasia. The secondary aim was to investigate correlations between muscle-tendon-related abnormalities detected by ultrasonography and clinically identified pain related to muscles and tendons. MATERIALS AND METHODS One hundred patients (17 men) with a mean age of 29 ± 9 years were included. Muscle-tendon-related abnormalities were detected with a standardized ultrasound examination. Correlations between muscle-tendon-related abnormalities detected by ultrasonography and clinically identified pain related to muscles and tendons were tested with Spearman's rank correlation coefficient. RESULTS The most prevalent ultrasonography findings were identified in the iliopsoas tendon [50% (95% CI 40; 60)], the adductor longus tendon [31% (95% 22; 40)] and the gluteus medius/minimus tendons [27% (18; 36)]. Significant correlations between ultrasonography findings and pain related to muscles and tendons were only found for the iliopsoas tendon (ρ = 0.24 and p = 0.02) and the gluteus medius/minimus tendons (ρ = 0.35 and p < 0.001). CONCLUSIONS Muscle-tendon-related abnormalities detected by ultrasonography in the hip and groin region are common in patients with symptomatic hip dysplasia, and the ultrasonography findings of the iliopsoas and gluteus medius/minimus tendons are weakly to moderately correlated to pain related to muscles and tendons in these structures. Both the iliopsoas and the gluteus medius/minimus have a pronounced stabilizing role in the dysplastic hip joint, and the common muscle-tendon-related abnormalities in these patients may be caused by injuries related to excessive use or degenerative changes in the muscle-tendon tissue.
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Affiliation(s)
- Julie Sandell Jacobsen
- Department of Physiotherapy, Faculty of Health Sciences, VIA University College, Hedeager 2, 8200, Aarhus N, Denmark.
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark.
| | - Lars Bolvig
- Department of Radiology, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Per Hölmich
- Department of Orthopaedic Surgery, Sports Orthopaedic Research Center-Copenhagen (SORC-C), Copenhagen University Hospital, Amager and Hvidovre, Italiensvej 1, 2300, Copenhagen S, Denmark
| | - Kristian Thorborg
- Department of Orthopaedic Surgery, Sports Orthopaedic Research Center-Copenhagen (SORC-C), Copenhagen University Hospital, Amager and Hvidovre, Italiensvej 1, 2300, Copenhagen S, Denmark
| | - Stig Storgaard Jakobsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8000, Aarhus C, Denmark
- Centre of Research in Rehabilitation (CORIR), Institute of Clinical Medicine, Aarhus University, Palle Juul-Jensens, Boulevard 82, Building 2, 8200, Aarhus N, Denmark
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Del Baño-Aledo ME, Martínez-Payá JJ, Ríos-Díaz J, Mejías-Suárez S, Serrano-Carmona S, de Groot-Ferrando A. Ultrasound measures of tendon thickness: Intra-rater, Inter-rater and Inter-machine reliability. Muscles Ligaments Tendons J 2017; 7:192-199. [PMID: 28717629 DOI: 10.11138/mltj/2017.7.1.192] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ultrasound imaging is often used by physiotherapists and other healthcare professionals but the reliability of image acquisition with different ultrasound machines is unknown. The objective was to compare the intra-rater, inter-rater and intermachine reliability of thickness measurements of the plantar fascia (PF), Achilles tendon (AT), patellar tendon (PT) and elbow common extensor tendon (ECET) with musculoskeletal ultrasound imaging (MSUS). METHODS Tendon thickness was measured in four anatomical structures (14 participants, 28 images per tendon) by two sonographers and with two different ultrasound machines. Intraclass Correlation Coefficients (ICCs) and Bland-Altman plots were calculated. The standard error of measurement (SEM) and minimum detectable difference (MDD) were calculated. RESULTS Inter-rater reliability was excellent for AT (ICC=0.98; 95% CI= 0.96-0.99) and very good for PT (ICC=0.85; 95% CI = 0.67-0.93) and ECET (ICC=0.81; 95% CI= 0.72-0.94). Reliability for PF was moderate, with an ICC of 0.63 (CI 95%= 0.20-0.83). Bland-Altman plot for inter-machine reliability showed a mean difference of 1 m for PF measurements and a mean difference of 4 m and 20 m for AT and PT. The relative SEMs were below 7% and the MDCs were below 0.7 mm. CONCLUSION The MSUS reliability in measuring thickness of the four tendons is confirmed by the homogeneous readings intra sonographers, between operators and between different machines. Level of evidence: Tendon thickness can be measured reliably on different ultrasound devices, which is an important step forward in the use of this technique in daily clinical practice and research. LEVEL OF EVIDENCE III.
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Affiliation(s)
- María Elena Del Baño-Aledo
- ECOFISTEM Research Group, Health Sciences Deparment, Facultad de Ciencias de la Salud, UCAM, Guadalupe (Murcia), Spain
| | - Jacinto Javier Martínez-Payá
- ECOFISTEM Research Group, Health Sciences Deparment, Facultad de Ciencias de la Salud, UCAM, Guadalupe (Murcia), Spain
| | - José Ríos-Díaz
- ECOFISTEM Research Group, Health Sciences Deparment, Facultad de Ciencias de la Salud, UCAM, Guadalupe (Murcia), Spain.,Centro Universitario de Ciencias de la Salud San Rafael-Nebrija, Madrid, Spain
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Mc Auliffe S, Mc Creesh K, Purtill H, O'Sullivan K. A systematic review of the reliability of diagnostic ultrasound imaging in measuring tendon size: Is the error clinically acceptable? Phys Ther Sport 2016; 26:52-63. [PMID: 28162938 DOI: 10.1016/j.ptsp.2016.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 11/21/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnostic ultrasound (US) is a commonly used imaging modality for visualising tendon pathology and morphology. In comparison to magnetic resonance imaging (MRI), diagnostic US is perceived to have a higher risk of error when evaluating tendon size. AIM To systematically assess the evidence regarding the Intra rater and Inter rater reliability of diagnostic US measurements of tendon size. DATA SOURCES Eight electronic databases were searched using an agreed set of keywords. Studies which investigated the reliability of tendon size (thickness or cross sectional area) using diagnostic US were eligible. RESULTS Combined Inter rater and Intra rater ICC values for tendon thickness ranged from 0.45 to 0.99. Combined Inter rater and Intra rater ICC values for tendon cross-sectional area (CSA) ranged from 0.58 to 0.92. Overall, Intra rater ICC values (0.59-0.99) were marginally higher than Inter rater values (0.45-0.99) across all tendon sites. Percentage co-efficient of variation (CV%) for tendon thickness and CSA ranged from 0 to 35% across all tendons. Percentage standard error of the mean SEM% values for tendon thickness ranged from 3.33% to 7.39%. CONCLUSIONS The findings of this review suggest diagnostic US measures of tendon size are reliable, both in terms of relative and absolute reliability. However, the findings must be considered in light of the presence of tendon abnormalities in a large percentage of asymptomatic populations.
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Affiliation(s)
- Sean Mc Auliffe
- Department of Clinical Therapies, University of Limerick, Ireland.
| | - Karen Mc Creesh
- Department of Clinical Therapies, University of Limerick, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Ireland
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Kruse A, Stafilidis S, Tilp M. Ultrasound and magnetic resonance imaging are not interchangeable to assess the Achilles tendon cross-sectional-area. Eur J Appl Physiol 2016; 117:73-82. [PMID: 27838848 PMCID: PMC5306331 DOI: 10.1007/s00421-016-3500-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 11/03/2016] [Indexed: 11/21/2022]
Abstract
Purpose The 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. Methods The 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. Results Mean 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). Conclusions Our 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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Affiliation(s)
- Annika Kruse
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
| | - Savvas Stafilidis
- Centre of Sport Science, University of Vienna, Auf der Schmelz 6a, 1150, Vienna, Austria.
| | - Markus Tilp
- Institute of Sports Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria
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Johannsen F, Jensen S, Stallknecht SE, Olsen LO, Magnusson SP. Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable: A test-retest intra- and intertester study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:480-486. [PMID: 27155081 DOI: 10.1002/jcu.22365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 03/31/2016] [Indexed: 06/05/2023]
Abstract
PURPOSE To determine intra- and interobserver reliability and precision of sonographic (US) scanning in measuring thickness of the Achilles tendon, plantar fascia, and heel fat pad in patients with heel pain. METHODS Seventeen consecutive patients referred with heel pain were included. Two evaluators blinded to the diagnosis performed independently US scanning of both feet without any dialogue with the patient. The examiner left the room, and the next examiner entered. All patients had two US scans performed by each examiner. Two months later, the US images were randomly presented to the evaluators for measurements. Reliability and agreement were assessed by calculation of intraclass correlation coefficient (ICC), 95% limits of agreement (LOA), and typical error (TE). LOA was calculated as a percentage of the mean thickness of each structure to obtain a unitless parameter. RESULTS We found excellent intratester reliability (ICC 0.78-0.98) and good intertester reliability using one measurement (ICC 0.72-0.91) and excellent (ICC 0.85-0.95) when using average of two measurements. The intratester agreements were good with LOA: 9.5-23.4% and TE: 3.4-8.4%. The intertester agreements were acceptable using one measurement with LOA: 16.1-36.4%, and better using two measurements with LOA: 14.4-33.2%. CONCLUSIONS US is a reliable technique of measurement in the daily clinic, and one single measurement is sufficient. In research, we recommend that the same observer performs the US measurements, if one single scanning is preferred; if more researchers are involved, the average measurement of two US scans is recommended. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:480-486, 2016.
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Affiliation(s)
- Finn Johannsen
- Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark.
- Furesø-Reumatologerne, Gammelgårdsvej 10, DK-3520, Farum, Denmark.
| | - Signe Jensen
- Furesø-Reumatologerne, Gammelgårdsvej 10, DK-3520, Farum, Denmark
| | | | - Lars Otto Olsen
- Furesø-Reumatologerne, Gammelgårdsvej 10, DK-3520, Farum, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
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Bohm S, Mersmann F, Schroll A, Mäkitalo N, Arampatzis A. Insufficient accuracy of the ultrasound-based determination of Achilles tendon cross-sectional area. J Biomech 2016; 49:2932-2937. [DOI: 10.1016/j.jbiomech.2016.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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Nadeau MJ, Desrochers A, Lamontagne M, Larivière C, Gagnon DH. Quantitative ultrasound imaging of Achilles tendon integrity in symptomatic and asymptomatic individuals: reliability and minimal detectable change. J Foot Ankle Res 2016; 9:30. [PMID: 27540416 PMCID: PMC4989299 DOI: 10.1186/s13047-016-0164-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background Quantifying the integrity of the Achilles tendon (AT) is a rehabilitation challenge. Adopting quantitative ultrasound measurements (QUS measurements) of the AT could fill this gap by 1) evaluating the test-retest reliability and accuracy of QUS measurements of the AT; 2) determining the best protocol for collecting QUS measurements in clinical practice. Methods A total of 23 ATs with symptoms of Achilles tendinopathy and 63 asymptomatic ATs were evaluated. Eight images were recorded for each AT (2 visits × 2 evaluators × 2 images). Multiple sets of QUS measurements were taken: geometric (thickness, width, area), first-order statistics (computed from a grayscale histogram distribution: echogenicity, variance, skewness, kurtosis, entropy) and texture features (computed from co-occurrence matrices: contrast, energy, homogeneity). A generalizability study quantified the reliability and standard error of measurement (accuracy) of each QUS measurement, and a decision study identified the best measurement taking protocols. Results Geometric QUS measurements demonstrated excellent accuracy and reliability. QUS measurements computed from the grayscale histogram distribution revealed poor accuracy and reliability. QUS measurements derived from co-occurrence matrices showed variable accuracy and moderate to excellent reliability. In clinical practice, using an average of the results of three images collected by a single evaluator during a single visit is recommended. Conclusions The use of geometric QUS measurements enables quantification of AT integrity in clinical practice and research settings. More studies on QUS measurements derived from co-occurrence matrices are warranted.
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Affiliation(s)
- Marie-Josée Nadeau
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada
| | - Amélie Desrochers
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Christian Larivière
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; Occupational Health and Safety Research Institute Robert-Sauvé (IRSST), Montreal, Canada
| | - Dany H Gagnon
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada
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Yeo A, Kendall N, Jayaraman S. Ultrasound-guided dry needling with percutaneous paratenon decompression for chronic Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 2016; 24:2112-8. [PMID: 25448138 DOI: 10.1007/s00167-014-3458-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 11/20/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Chronic Achilles tendinopathy is a common overuse injury. There are several modalities of treatment, reflecting difficulties in management. In particular, due to the well-recognised surgical morbidity, treatment has steered towards less invasive routes. Previous studies have targeted pathology either inside or outside the tendon in isolation with varying results. This study aimed to target both pathological sites by combining dry needling with percutaneous hydrostatic decompression as a novel treatment. METHODS Twenty-one patients with 26 chronic, non-insertional Achilles tendinopathy were prospectively enrolled. Ultrasound-guided dry needling of neovascular areas and small-volume hydrostatic paratenon decompression was performed 6-weekly. Sonographic assessment of tendon thickness and neovascularity was undertaken. Following treatment, a standardised physiotherapy regime was adopted. Visual analogue scores (VAS) were used as the primary outcome measure. Telephonic interviews were carried out 12 and 24 months post-treatment. RESULTS Twenty-four tendons (in 19 patients) were successfully treated. The mean treatment session was 2. There was no significant change in neovascularity or tendon thickness. Therapeutic intervention led to a significant improvement in VAS at rest (42.4 ± 24.4 vs. 18.4 ± 26.0, p = 0.0005) and during activity (72.8 ± 16.0 vs. 33.7 ± 23.2, p < 0.0001). At 12 and 24 months, >75 % of patients were highly satisfied with their outcome with nearly half reporting complete resolution of their symptoms. >85 % were also able to return to their sporting interests. CONCLUSION Combined therapy of dry needling with percutaneous hydrostatic paratenon decompression under ultrasound guidance is a well-tolerated procedure with good short- and long-term pain and functional outcomes. LEVEL OF EVIDENCE Prospective case series, Level IV.
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Affiliation(s)
- Andrea Yeo
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - Namita Kendall
- St Richard's Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE, UK
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Ingwersen KG, Hjarbaek J, Eshoej H, Larsen CM, Vobbe J, Juul-Kristensen B. Ultrasound assessment for grading structural tendon changes in supraspinatus tendinopathy: an inter-rater reliability study. BMJ Open 2016; 6:e011746. [PMID: 27221128 PMCID: PMC4885468 DOI: 10.1136/bmjopen-2016-011746] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the inter-rater reliability of measuring structural changes in the tendon of patients, clinically diagnosed with supraspinatus tendinopathy (cases) and healthy participants (controls), on ultrasound (US) images captured by standardised procedures. METHODS A total of 40 participants (24 patients) were included for assessing inter-rater reliability of measurements of fibrillar disruption, neovascularity, as well as the number and total length of calcifications and tendon thickness. Linear weighted κ, intraclass correlation (ICC), SEM, limits of agreement (LOA) and minimal detectable change (MDC) were used to evaluate reliability. RESULTS 'Moderate-almost perfect' κ was found for grading fibrillar disruption, neovascularity and number of calcifications (k 0.60-0.96). For total length of calcifications and tendon thickness, ICC was 'excellent' (0.85-0.90), with SEM(Agreement) ranging from 0.63 to 2.94 mm and MDC(group) ranging from 0.28 to 1.29 mm. In general, SEM, LOA and MDC showed larger variation for calcifications than for tendon thickness. CONCLUSIONS Inter-rater reliability was moderate to almost perfect when a standardised procedure was applied for measuring structural changes on captured US images and movie sequences of relevance for patients with supraspinatus tendinopathy. Future studies should test intra-rater and inter-rater reliability of the method in vivo for use in clinical practice, in addition to validation against a gold standard, such as MRI. TRIAL REGISTRATION NUMBER NCT01984203; Pre-results.
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Affiliation(s)
- Kim Gordon Ingwersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Rehabilitation, Hospital Lillebaelt—Vejle Hospital, Vejle, Denmark
| | - John Hjarbaek
- Department of Radiology, Musculoskeletal section, Odense University Hospital, Odense, Denmark
| | - Henrik Eshoej
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Camilla Marie Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Health Sciences Research Centre, University College Lillebaelt, Odense, Denmark
| | - Jette Vobbe
- Shoulder Unit, Orthopaedic Department, Hospital Lillebaelt, Vejle Hospital, Vejle, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Health Sciences, Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
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28
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McCreesh KM, Anjum S, Crotty JM, Lewis JS. Ultrasound measures of supraspinatus tendon thickness and acromiohumeral distance in rotator cuff tendinopathy are reliable. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:159-166. [PMID: 26666736 DOI: 10.1002/jcu.22318] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Rotator cuff (RC) tendinopathy has been widely ascribed to impingement of the supraspinatus tendon (SsT) in the subacromial space, measured as the acromiohumeral distance (AHD). Ultrasound (US) is suitable for measuring AHD and SsT thickness, but few reliability studies have been carried out in symptomatic populations, and interrater reliability is unconfirmed. This study aimed to examine the intrarater and interrater reliability of US measurements of AHD and SsT thickness in asymptomatic control subjects and patients with RC tendinopathy. METHODS Seventy participants were recruited and grouped as healthy controls (n = 25) and RC tendinopathy (n = 45). Repeated US measurements of AHD and SsT thickness were obtained by one rater in both groups and by two raters in the RC tendinopathy group. RESULTS Intrarater and interrater reliability coefficients were excellent for both measurements (intraclass correlation > 0.92), but the intrarater reliability was superior. The minimal detectable change values in the symptomatic group were 0.7 mm for AHD and 0.6 mm for SsT thickness for a single experienced examiner; the values rose to 1.2 mm and 1.3 mm, respectively, for the pair of examiners. CONCLUSIONS The results support the reliability of US for the measurement of AHD and SsT thickness in patients with symptomatic RC tendinopathy and provide minimal detectable change values for use in future research studies.
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Affiliation(s)
- Karen M McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | - Shakeel Anjum
- Department of Rheumatology, University Hospital Limerick, Limerick, Ireland
| | - James M Crotty
- Department of Radiology, University Hospital Limerick, Limerick, Ireland
| | - Jeremy S Lewis
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
- Central London Community Healthcare NHS Trust, London, UK
- University of Hertfordshire, Hatfield, Hertfordshire, UK
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Gärdin A, Rasinski P, Berglund J, Shalabi A, Schulte H, Brismar TB. T2* relaxation time in Achilles tendinosis and controls and its correlation with clinical score. J Magn Reson Imaging 2015; 43:1417-22. [DOI: 10.1002/jmri.25104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Anna Gärdin
- Department of Clinical Science; Intervention and Technology at Karolinska Institutet, Division of Radiology Karolinska University Hospital; Stockholm Sweden
| | - Pawel Rasinski
- Department of Clinical Science; Intervention and Technology at Karolinska Institutet, Division of Radiology Karolinska University Hospital; Stockholm Sweden
| | - Johan Berglund
- Department of Clinical Science; Intervention and Technology at Karolinska Institutet, Division of Diagnostic Medical Physics, Karolinska University Hospital; Stockholm Sweden
| | - Adel Shalabi
- Department of Clinical Science; Intervention and Technology at Karolinska Institutet, Division of Radiology Karolinska University Hospital; Stockholm Sweden
- Department of Radiology; Oncology and Radiation Sciences at Uppsala University, Division of Radiology, Akademiska Hospital; Uppsala Sweden
| | - Helene Schulte
- Scandinavian College of Naprapathic Manual Medicine; Stockholm Sweden
| | - Torkel B. Brismar
- Department of Clinical Science; Intervention and Technology at Karolinska Institutet, Division of Radiology Karolinska University Hospital; Stockholm Sweden
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Bűhler M, Johnson G, Meikle G. Longitudinal In Vivo Ultrasound Observations of the Surgically Repaired Zone II Flexor Digitorum Profundus Tendon. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:3018-3022. [PMID: 26304499 DOI: 10.1016/j.ultrasmedbio.2015.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/06/2015] [Accepted: 07/07/2015] [Indexed: 06/04/2023]
Abstract
The link between the healing process and functional outcomes in the surgically repaired digital flexor tendon is poorly understood. This clinical note describes those gray-scale and power Doppler (PD) ultrasound parameters that can be used to document longitudinal change in the morphologic and dynamic properties of the surgically repaired zone II flexor digitorum profundus (FDP) tendon. The method is supported by ultrasound data obtained from three participants at five points in time post-surgically (two, four, six, 12 and 18 weeks). Longitudinal documentation of the ultrasound properties of echogenicity, defect size, tendon excursion and power Doppler signal is feasible and has the potential to explore the possible link between changes in the structural status of surgically repaired flexor tendons and associated clinical outcomes.
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Affiliation(s)
- Miranda Bűhler
- Centre for Health, Activity and Rehabilitation Research, University of Otago, Dunedin, New Zealand; Physiotherapy Outpatient Department, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand.
| | - Gillian Johnson
- Centre for Health, Activity and Rehabilitation Research, University of Otago, Dunedin, New Zealand
| | - Grant Meikle
- Radiology Department, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand; Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Tendinopathy of the achilles tendon: volume assessed by automated contour detection in submillimeter isotropic 3-dimensional magnetic resonance imaging data sets recorded at a field strength of 3 T. J Comput Assist Tomogr 2015; 39:250-6. [PMID: 25594384 DOI: 10.1097/rct.0000000000000203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This prospective study assesses volume changes of the Achilles tendon in case of chronic tendinopathy (TEN), using an automated contour detection algorithm in submillimeter isotropic 3-dimensional magnetic resonance imaging data sets, recorded at 3 T. METHODS Forty-one subjects (median age, 40 years; range, 19-68 years) were included in this prospective study and underwent nonenhanced magnetic resonance imaging of both Achilles tendons at 3 T, deploying a T2-weighted 3-dimensional Fast-Spin-Echo sequence with submillimeter resolution of 0.8 mm. Of the 41 subjects, 13 were classified as patients with TEN and 28 were healthy volunteers and served as control group. Of the 13 patients, 10 had unilateral TEN and 3 had bilateral TEN. Achilles tendons were automatically segmented in the T2-weighted magnetic resonance data sets for the evaluation of the tendon volume (0-3 cm proximal to the cranial border of the calcaneal bone). The total volume (length, 3 cm) was divided in 3 subvolumes of 1 cm length, named volume (0-1 cm), volume (1-2 cm), and volume (2-3 cm). Minimum and maximum tendon cross-sectional area within the total volume was processed. A standardized pain questionnaire was obtained from all patients. RESULTS The automated contour detection algorithm worked reliably in all cases. The TEN group showed a significantly increased tendon volume compared to the control group (mean volume, 2.94 vs 2.43 mm; P < 0.05). The difference was most obvious concerning volume (2-3 cm) (P < 0.0001). Evaluation of clinical severity revealed a moderate correlation between VISA-score and tendon volume (2-3 cm) as well as the maximum/minimum tendon area (ρ = -0.44, ρ = -0.48, and ρ = -0.41). In case of unilateral TEN, the symptomatic side showed an increased tendon volume (2-3 cm) and increased minimum area (P < 0.05). CONCLUSIONS Tendon volume and size are adequate surrogate parameters to differentiate patients with chronic TEN from healthy subjects, and may discriminate symptomatic TEN from asymptomatic "silent" TEN in patients with unilateral symptoms.
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Fischer CA, Weber MA, Neubecker C, Bruckner T, Tanner M, Zeifang F. Ultrasound vs. MRI in the assessment of rotator cuff structure prior to shoulder arthroplasty. J Orthop 2015; 12:23-30. [PMID: 25829757 DOI: 10.1016/j.jor.2015.01.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/04/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS We compared the accuracy of US to 3 T Tesla MRI for the detection of rotator cuff and long biceps tendon pathologies before joint replacement. METHODS 45 patients were prospectively included. RESULTS For the supraspinatus tendon, the accuracy of US when using MRI as reference was 91.1%. For the infraspinatus tendon, the accuracy with MRI as reference was 84.4%. The subscapularis tendon was consistently assessed by US and MRI in 35/45 patients (accuracy 77.8%). For the long biceps tendon the accuracy was 86.7%. CONCLUSION US detection of rotator cuff and biceps tendon integrity is comparable to MRI and should be preferred in revision cases.
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Affiliation(s)
- Christian Alexander Fischer
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, BW, 69120, Germany
| | - Clément Neubecker
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, BW, 69120, Germany
| | - Michael Tanner
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
| | - Felix Zeifang
- Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, BW, 69118, Germany
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Ultrasound dimensions of the rotator cuff in young healthy adults. J Shoulder Elbow Surg 2014; 23:1107-12. [PMID: 24439247 DOI: 10.1016/j.jse.2013.11.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/29/2013] [Accepted: 11/06/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND No studies have looked at the rotator cuff dimensions in the young healthy population using ultrasonography. Our aim is to define the ultrasound dimensions of the rotator cuff in the healthy young adult population and explore correlations with other patient characteristics. METHODS Thirty male and 30 female healthy volunteers (aged 18-40 years), with no shoulder problems, underwent ultrasound assessment of both shoulders by a musculoskeletal radiologist. The dimensions of the rotator cuff, deltoid, and biceps were measured in a standardized manner. RESULTS A total of 120 shoulders were scanned. The mean maximum width of the supraspinatus footprint was 14.9 mm in men and 13.5 mm in women (P < .001). The mean thickness of the supraspinatus tendon was 4.9 mm in women and 5.6 mm in men. The mean thickness of the subscapularis was 4.4 in men and 3.8 mm in women and for the infraspinatus was 4.9 mm in men and 4.4 mm in women. There was no correlation between height, weight, biceps, or deltoid thickness with any tendon measurements. Apart from supraspinatus tendon thickness, the difference between dominant and nondominant shoulders in the same sex was not significant for any other tendon dimensions. CONCLUSION This study has defined the dimensions of the rotator cuff in the young healthy adult, which has not been previously published. This is important for the documentation of normal ultrasound anatomy of the rotator cuff and also demonstrates that the asymptomatic contralateral shoulder can and should be used to estimate the expected dimensions.
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Abstract
Background: Calcific deposits (CaDs) may be related to chronic postoperative pain and may affect function after patellar tendon surgery. Study Design: Cross-sectional. Hypothesis: We hypothesized that patients with CaDs (+CaDs) would rate lower than those without (−CaDs) on measures of knee function and quality of life. Methods: Patients completed the Tegner Lysholm Knee Scoring Scale (Lysholm), Knee Injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Form (IKDC), and the Tegner Activity Level Scale. Sixteen postsurgical and 16 age-matched controls were tested. Patients +CaDs were 5.6 years older than those patients −CaDs and had 4.2 years of longer elapse since surgery. Bilateral patellar tendons were examined for CaDs with musculoskeletal ultrasound imaging. One-way analysis of variance was used to determine if differences existed among patients +CaDs and −CaDs and healthy controls. Hierarchical logistic regressions were used to determine which variables best predicted the presence of CaDs. Results: CaDs were found in 44% (7 of 16) of postsurgical patients, who scored lower than controls on all dimensions of the Lysholm, KOOS, and IKDC. Patients +CaD had lower KOOS scores than controls (symptoms, activities of daily living, and quality of life). Age and time since surgery were both moderately related to the presence of CaDs, and both correctly predicted 71% of patients +CaDs. Conclusion: Calcific deposits were found in the patellar tendon of 44% of postsurgical patients, who rated themselves lower on all subjective measures of knee function and quality of life following surgery. Age is an important factor for developing CaDs postsurgery. Clinical Relevance: Calcific deposits may be present in patellar tendons following surgery, but their direct role in functional or clinical limitations remains unknown.
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Gärdin A, Brismar TB, Movin T, Shalabi A. Dynamic contrast enhanced magnetic resonance imaging in chronic Achilles tendinosis. BMC Med Imaging 2013; 13:39. [PMID: 24261480 PMCID: PMC4222571 DOI: 10.1186/1471-2342-13-39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 11/14/2013] [Indexed: 11/29/2022] Open
Abstract
Background Chronic Achilles tendinosis is a common problem. When evaluating and comparing different therapies there is a need for reliable imaging methods. Our aim was to evaluate if chronic Achilles tendinosis affects the dynamic contrast-enhancement in the tendon and its surroundings and if short-term eccentric calf-muscle training normalizes the dynamic contrast-enhancement. Methods 20 patients with chronic Achilles tendinopathy were included. Median duration of symptoms was 31 months (range 6 to 120 months). Both Achilles tendons were examined with dynamic contrast enhanced MRI before and after a 12- week exercise programme of eccentric calf-muscle training. The dynamic MRI was evaluated in tendon, vessel and in fat ventrally of tendon. Area under the curve (AUC), time to peak of signal, signal increase per second (SI/s) and increase in signal between start and peak as a percentage (SI%) was calculated. Pain and performance were evaluated using a questionnaire. Results In the fat ventrally of the tendon, dynamic contrast enhancement was significantly higher in the symptomatic leg compared to the contralateral non-symptomatic leg before but not after treatment. Despite decreased pain and improved performance there was no significant change of dynamic contrast enhancement in symptomatic tendons after treatment. Conclusion In Achilles tendinosis there is an increased contrast enhancement in the fat ventrally of the tendon. The lack of correlation with symptoms and the lack of significant changes in tendon contrast enhancement parameters do however indicate that dynamic enhanced MRI is currently not a useful method to evaluate chronic Achilles tendinosis.
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Affiliation(s)
- Anna Gärdin
- Department of Clinical Science, Division of Medical Imaging and Technology, Intervention and Technology at Karolinska Institutet, Stockholm SE-141-86, Sweden.
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Scholten-Peeters GGM, Franken N, Beumer A, Verhagen AP. The opinion and experiences of Dutch orthopedic surgeons and radiologists about diagnostic musculoskeletal ultrasound imaging in primary care: a survey. ACTA ACUST UNITED AC 2013; 19:109-13. [PMID: 24075710 DOI: 10.1016/j.math.2013.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 08/08/2013] [Accepted: 08/22/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIM The use of diagnostic musculoskeletal ultrasound (DMUS) in primary health care has increased in the recent years. Nevertheless, there are hardly any data concerning the reliability, accuracy and treatment consequences of DMUS used by physical therapists or general practitioners. Moreover, there are no papers published about how orthopedic surgeons or radiologists deal with the results of DMUS performed in primary care. Therefore, our aim is to evaluate the opinion, possible advantages or disadvantages and experiences of Dutch orthopedic surgeons and radiologists about DMUS in primary care. METHODS A cross-sectional survey in which respondents completed a self-developed questionnaire to determine their opinion, experiences, advantages, disadvantages of performing DMUS in primary care. RESULTS Questionnaires were sent to 838 Dutch orthopedic surgeons and radiologists of which 213 were returned (response rate 25.4%). Our respondents saw no additional value for health care for diagnostic DMUS in primary care. DMUSs were generally repeated in secondary care. They perceived more disadvantages than advantages of performing DMUS in primary care. Mentioned disadvantages were: 'false positive results' (71.4%), 'lack of experience' (70%), 'insufficient education' (69.5%), not able to relate the outcomes of DMUS with other forms of diagnostic imaging' (65.7%), and 'false negative results' (65.3%). CONCLUSION Radiologists and orthopedic surgeons sampled in the Netherlands show low trust in DMUS knowledge of physical therapists and general practitioners. The results should be interpreted with caution because of the small response rate and the lack of representativeness to other countries.
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Affiliation(s)
- Gwendolijne G M Scholten-Peeters
- Department Physical Therapy, Research Group Diagnostics, University of Applied Sciences, Breda, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Nicole Franken
- Department Physical Therapy, Research Group Diagnostics, University of Applied Sciences, Breda, The Netherlands
| | - Annechien Beumer
- Orthopedic Surgeon and Handsurgeon, Upper Limb Unit Department of Orthopedic surgery, Amphia Hospital, Breda, The Netherlands
| | - Arianne P Verhagen
- Department Physical Therapy, Research Group Diagnostics, University of Applied Sciences, Breda, The Netherlands; Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Skou ST, Aalkjaer JM. Ultrasonographic measurement of patellar tendon thickness—a study of intra- and interobserver reliability. Clin Imaging 2013; 37:934-7. [DOI: 10.1016/j.clinimag.2013.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/30/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022]
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Helfenstein M, Ferreira MS, Assad Maia AB, Fávaro Siena CA, Techy A. Ultrassonografia no diagnóstico da tendinite e eletroneuromiografia no diagnóstico da neuropatia periférica e da radiculopatia do membro superior – visão do reumatologista. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000300006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gellhorn AC, Carlson MJ. Inter-rater, intra-rater, and inter-machine reliability of quantitative ultrasound measurements of the patellar tendon. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:791-796. [PMID: 23465140 DOI: 10.1016/j.ultrasmedbio.2012.12.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 11/28/2012] [Accepted: 12/03/2012] [Indexed: 06/01/2023]
Abstract
The use of ultrasound (US) to perform quantitative measurements of musculoskeletal tissues requires accurate and reliable measurements between investigators and ultrasound machines. The objective of this study was to evaluate inter-rater and intra-rater reliability of patellar tendon measurements between providers with different levels of US experience and inter-machine reliability of US machines. Sixteen subjects without a history of knee pain were evaluated with US examinations of the patellar tendon. Each tendon was scanned independently by two investigators using two different ultrasound machines. Tendon length and cross-sectional area (CSA) were obtained, and examiners were blinded to each other's results. Tendon length was measured using a validated system involving surface markers and calipers, and CSA was measured using each machine's measuring software. Intra-class correlation coefficients (ICCs) were used to determine reliability of measurements between observers, where ICC > 0.75 was considered good and ICC > 0.9 was considered excellent. Inter-rater reliability between sonographers was excellent and revealed an ICC of 0.90 to 0.92 for patellar tendon CSA and an ICC of 0.96 for tendon length. ICC for intra-rater reliability of tendon CSA was also generally excellent, with ICC between 0.87 and 0.96. Inter-machine reliability was excellent, with ICC of 0.91-0.98 for tendon CSA and 0.96-0.98 for tendon length. Bland-Altman plots were constructed to measure validity and demonstrated a mean difference between sonographers of 0.03 mm(2) for CSA measurements and 0.2 mm for tendon length. Using well-defined scanning protocols, a novice and an experienced musculoskeletal sonographer attained high levels of inter-rater agreement, with similarly excellent results for intra-rater and inter-machine reliability. To our knowledge, this study is the first to report inter-machine reliability in the setting of quantitative musculoskeletal ultrasound.
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Affiliation(s)
- Alfred C Gellhorn
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, Washington, USA.
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Kox LS, Wiegerinck EMA, Maas M. I-test: a gymnast with anterior knee pain: not a typical case of jumper's knee. Quadriceps femoris tendinopathy. Br J Sports Med 2013; 48:476, 479-80. [PMID: 23372066 DOI: 10.1136/bjsports-2012-091773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Laura Susan Kox
- Academic Medical Center, University of Amsterdam, , Amsterdam, The Netherlands.
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Abstract
We present a literature review about implant removal after operative extremity and spine fracture treatment. The indication for implant removal procedures has become less frequent in recent years, but is still more common in Europe than for example in North America. The time required to perform a implant removal can easily exceed the planned amount. Implant removal can result in significant complications like soft tissue damage, fractures, infections, and other problems. Not only because of these problems, the decision on whether or not to remove the implant should be made with great care. Therefore good communication with the patient and thorough information about risks and benefits are essential.
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Syha R, Würslin C, Ketelsen D, Martirosian P, Grosse U, Schick F, Claussen C, Springer F. Automated volumetric assessment of the Achilles tendon (AVAT) using a 3D T2 weighted SPACE sequence at 3T in healthy and pathologic cases. Eur J Radiol 2012; 81:1612-7. [DOI: 10.1016/j.ejrad.2011.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
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Shen ZL, Li ZM. Ultrasound assessment of transverse carpal ligament thickness: a validity and reliability study. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:982-8. [PMID: 22502882 PMCID: PMC3348456 DOI: 10.1016/j.ultrasmedbio.2012.02.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 02/17/2012] [Accepted: 02/21/2012] [Indexed: 05/31/2023]
Abstract
The transverse carpal ligament (TCL) forms the palmar boundary of the carpal tunnel and plays an important role in carpal tunnel mechanics. TCL hypertrophy has been observed for individuals with carpal tunnel syndrome (CTS) and postulated as a potential etiologic factor. Ultrasound is particularly advantageous for TCL imaging because of its capability of detecting the interfaces between the TCL and other tissues. The purposes of this study were to develop an ultrasound based method to measure the TCL thickness and to test the validity and reliability of this method. Three operators conducted two sessions of ultrasound examination on eight cadaveric specimens and eight healthy volunteers. A custom script was used to calculate TCL thickness along the TCL length from the ultrasound images. The ultrasound based TCL thickness of the cadaveric specimens was compared with the dissection based TCL thickness for validation. The results showed Pearson's correlation coefficients of 0.867-0.928, intraclass correlation coefficient (ICC) values of 0.726-0.865, a standard error of measurement of 0.02-0.07 mm and a minimal detectable difference of 0.05-0.15 mm. The high correlation coefficients and small errors indicate that the ultrasound based method is valid for measuring TCL thickness. Furthermore, ultrasound measurements showed excellent intraoperator and interoperator reliability with ICC values as 0.826-0.933 and 0.840-0.882, respectively. The ultrasound based TCL thickness was in the range of 0.93-2.34 (1.54 ± 0.33) mm and agreed well with previous studies. The ultrasound method developed in this study is a valuable tool to examine morphologic properties of healthy and pathologic TCLs.
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Affiliation(s)
- Zhilei Liu Shen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
| | - Zong-Ming Li
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
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Gellhorn AC, Morgenroth DC, Goldstein B. A novel sonographic method of measuring patellar tendon length. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:719-726. [PMID: 22425379 DOI: 10.1016/j.ultrasmedbio.2012.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/03/2012] [Accepted: 01/22/2012] [Indexed: 05/31/2023]
Abstract
Obtaining accurate and readily repeatable measurements is a prerequisite for using measures of soft tissue structures both clinically and in the research setting. Few studies have evaluated the interrater reliability of ultrasound measurements of tendons. The objective of this study was to determine the accuracy and reliability of a new method of sonographic measurement of patellar tendon length using direct dissection as the gold standard. Four cadaveric knees were sonographically evaluated by two independent investigators. Two custom designed straps with nylon strapping and stainless steel wire were used to firmly mark position on the leg and create an acoustic shadow on the ultrasound image. Anatomic landmarks were the distal patellar pole and the bony ridge on the anterior proximal tibia. After sonographic evaluation, the knee was dissected to expose the patellar tendon, which was measured using digital calipers. Intraclass correlation coefficients (ICC) were used to determine reliability of measurements between observers, where ICC >0.75 was considered good and >0.9 was considered excellent. Validity was measured using a Bland-Altman plot, which measures bias between measurement methods as well as variability of scatter. Three sonographic measurements were made by each investigator on each tendon. The length of each of the four tendons based on the mean values of sonographic measurements was 53.8 mm, 53.4 mm, 49.4 mm and 46.8 mm. The length based on visual inspection of the dissected tissue was 54.6 mm, 52.8 mm, 49.8 mm and 46.9 mm. The calculated ICC between raters was 0.96. On the Bland-Altman plot, the bias, or mean difference between sonographic and visual measures, was 0.17 mm, with a standard deviation of 0.71. The 95% limit of agreement was -1.55 to 1.22 mm. Measurement of patellar tendon length with ultrasound using adjustable surface markers and calipers is highly accurate and has good interrater reliability.
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Affiliation(s)
- Alfred C Gellhorn
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105, USA.
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45
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Reliability of sonographic assessment of tendinopathy in tennis elbow. Skeletal Radiol 2012; 41:83-9. [PMID: 21384199 DOI: 10.1007/s00256-011-1132-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 01/25/2011] [Accepted: 02/13/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the reliability and compute the minimum detectable change using sonographic scales to quantify the extent of pathology and hyperaemia in the common extensor tendon in people with tennis elbow. MATERIALS AND METHODS The lateral elbows of 19 people with tennis elbow were assessed sonographically twice, 1-2 weeks apart. Greyscale and power Doppler images were recorded for subsequent rating of abnormalities. Tendon thickening, hypoechogenicity, fibrillar disruption and calcification were each rated on four-point scales, and scores were summed to provide an overall rating of structural abnormality; hyperaemia was scored on a five point scale. Inter-rater reliability was established using the intraclass correlation coefficient (ICC) to compare scores assigned independently to the same set of images by a radiologist and a physiotherapist with training in musculoskeletal imaging. Test-retest reliability was assessed by comparing scores assigned by the physiotherapist to images recorded at the two sessions. The minimum detectable change (MDC) was calculated from the test-retest reliability data. RESULTS ICC values for inter-rater reliability ranged from 0.35 (95% CI: 0.05, 0.60) for fibrillar disruption to 0.77 (0.55, 0.88) for overall greyscale score, and 0.89 (0.79, 0.95) for hyperaemia. Test-retest reliability ranged from 0.70 (0.48, 0.84) for tendon thickening to 0.82 (0.66, 0.90) for overall greyscale score and 0.86 (0.73, 0.93) for calcification. The MDC for the greyscale total score was 2.0/12 and for the hyperaemia score was 1.1/5. CONCLUSION The sonographic scoring system used in this study may be used reliably to quantify tendon abnormalities and change over time. A relatively inexperienced imager can conduct the assessment and use the rating scales reliably.
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de Oliveira RR, Lemos A, de Castro Silveira PV, da Silva RJ, de Moraes SRA. Alterations of tendons in patients with diabetes mellitus: a systematic review. Diabet Med 2011; 28:886-95. [PMID: 21749441 DOI: 10.1111/j.1464-5491.2010.03197.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS To perform a systematic review of observational studies which analyse tendon alterations in patients with diabetes mellitus compared with healthy individuals. METHODS Data collection was performed, with no language restriction, using the databases of PubMed/Medline, BIREME, CINAHL, LILACS and Cochrane, as well as the references found in these studies. Three reviewers performed independent extractions of articles. Subsequently, these reviewers analysed the articles, focusing on their methodological quality, using the appropriate scale to evaluate observational studies from the Agency for Healthcare Research and Quality. RESULTS Six articles were included in the analysis. Of these, four had used ultrasonographic diagnostics, one computed tomography and one magnetic resonance imaging. The patient pool comprised 396 individuals. All the articles evaluated tendon thickness and presented heterogeneous results. Two articles stated thickening or increased volume of the tendons in diabetic people, one article did not report any alteration, the fourth failed to determine any alterations and the fifth showed thinning of the tendons. The arrangement of collagen fibrils and the presence of calcification were analysed in only one article (n = 80), showing that 88.10% (n = 68) of individuals with diabetes presented disorientation of collagen fibril arrangement, while only 10% (n = 1) of healthy individuals presented this condition. Regarding tendon calcification, the article showed diabetic individuals with higher values than healthy individuals. CONCLUSIONS All the articles indicated some relation between diabetes mellitus and tendon alterations in human beings, but due to methodological drawbacks, this association could not be sustained.
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Affiliation(s)
- R R de Oliveira
- Master Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Brazil.
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Rathleff MS, Moelgaard C, Lykkegaard Olesen J. Intra- and interobserver reliability of quantitative ultrasound measurement of the plantar fascia. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:128-134. [PMID: 21387326 DOI: 10.1002/jcu.20787] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 10/25/2010] [Indexed: 05/30/2023]
Abstract
PURPOSE To determine intra- and interobserver reliability and measurement precision of sonographic assessment of plantar fascia thickness when using one, the mean of two, or the mean of three measurements. METHODS Two experienced observers scanned 20 healthy subjects twice with 60 minutes between test and retest. A GE LOGIQe ultrasound scanner was used in the study. The built-in software in the scanner was used to measure the thickness of the plantar fascia (PF). Reliability was calculated using intraclass correlation coefficient (ICC) and limits of agreement (LOA). RESULTS Intraobserver reliability (ICC) using one measurement was 0.50 for one observer and 0.52 for the other, and using the mean of three measurements intraobserver reliability increased up to 0.77 and 0.67, respectively. Interobserver reliability (ICC) when using one measurement was 0.62 and increased to 0.82 when using the average of three measurements. LOA showed that when using the average of three measurements, LOA decreased to 0.6 mm, corresponding to 17.5% of the mean thickness of the PF. CONCLUSIONS The results showed that reliability increases when using the mean of three measurements compared with one. Limits of agreement based on intratester reliability shows that changes in thickness that are larger than 0.6 mm can be considered actual changes in thickness and not a result of measurement error.
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Affiliation(s)
- Michael Skovdal Rathleff
- Orthopaedic Division, North Denmark Region, Aalborg Hospital-Aarhus University Hospital, Aalborg, Denmark.
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Dudley-Javoroski S, McMullen T, Borgwardt MR, Peranich LM, Shields RK. Reliability and responsiveness of musculoskeletal ultrasound in subjects with and without spinal cord injury. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1594-1607. [PMID: 20800961 PMCID: PMC2948870 DOI: 10.1016/j.ultrasmedbio.2010.07.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/22/2010] [Accepted: 07/26/2010] [Indexed: 05/29/2023]
Abstract
Rehabilitation after spinal cord injury (SCI) aims to preserve the integrity of the paralyzed musculoskeletal system. The suitability of ultrasound (US) for delineating training-related muscle/tendon adaptations after SCI is unknown. The purpose of this study was to quantify within- and between-operator reliability for US and to determine its responsiveness to post-training muscle/tendon adaptations in SCI subjects. Two novice operators and one experienced operator obtained sonographic images of the vastus lateralis, patellar tendon, soleus, and Achilles tendon from seven SCI subjects and 16 controls. For control subjects, within-operator concordance (ICC [3,1]) ranged from 0.58 to 0.95 for novice operators and exceeded 0.86 for the experienced operator. Between-operator concordance (ICC [2,1]) ranged from 0.62 to 0.74. Ultrasound detected muscle hypertrophy (p < 0.05) following electrical stimulation training in subjects with SCI (responsiveness) but did not detect differences in tendon thickness. These error estimates support the utility of US in future post-SCI training studies.
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Affiliation(s)
- Shauna Dudley-Javoroski
- Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City Iowa
| | - Tara McMullen
- Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City Iowa
| | | | - Lauren M. Peranich
- Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City Iowa
| | - Richard K. Shields
- Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City Iowa
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Poltawski L, Jayaram V, Watson T. Measurement issues in the sonographic assessment of tennis elbow. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:196-204. [PMID: 20186762 DOI: 10.1002/jcu.20676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Sonography is increasingly being used for assessment in tennis elbow research and clinical practice, but there are a lack of data regarding its validity, reliability, and responsiveness to change for this application. Studies using the modality were reviewed to establish current levels of evidence for these measurement properties. There is reasonable evidence regarding its validity for identifying tennis elbow tendinopathy, but a lack of data addressing its reliability and responsiveness. Practical issues affecting image quality are discussed, and recommendations for further investigation are suggested, to enhance the credible use of sonography with this debilitating condition.
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Affiliation(s)
- Leon Poltawski
- School of Health and Emergency Professions, University of Hertfordshire, Hatfield, AL10 9AB, UK
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Kumm J, Tamm A, Lintrop M, Tamm A. Association between ultrasonographic findings and bone/cartilage biomarkers in patients with early-stage knee osteoarthritis. Calcif Tissue Int 2009; 85:514-22. [PMID: 19862466 DOI: 10.1007/s00223-009-9302-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 09/29/2009] [Indexed: 11/30/2022]
Abstract
Little is known regarding the association between ultrasonographic (US) findings and biomarkers of bone and cartilage in individuals with knee osteoarthritis (OA). We investigated (1) US findings in early-stage knee OA and (2) the association between US findings and bone/cartilage biomarkers. A population cohort aged 35-55 years (n = 106) with early-stage knee OA was investigated. US examination was performed according to European League against Rheumatism (EULAR) guidelines using a 7.5-MHz probe. Biomarkers of bone resorption (CTx-I) and formation (PINP), cartilage resorption (U-CTx-II) and synthesis (S-PIIANP), and general bone and cartilage biomarkers (OC, COMP) were assessed. The most prevalent US findings were tendon calcification, synovial thickening, and suprapatellar effusion. In women, the presence of tendon calcification and Baker's cysts could predict 36% of the variability in U-CTx-II levels. The presence of osteophytes and tendon calcification predicted up to 38% of the variability of PIIANP concentration. Defects in subchondral bone, meniscal changes, and effusion predicted up to 29% of the variability in COMP levels. Tendon calcification was related to cartilage synthesis (based on PIIANP levels) in men and to cartilage degradation (based on U-CTx-II concentrations) in women. US signs of synovitis were reflected metabolically by markers of joint tissue metabolism. Tendon calcification, synovial thickening, and effusion were common US findings in early-stage knee OA. US-detectable findings were substantially responsible for the variability in bone and cartilage biomarkers, associations reflective of the active metabolism of soft tissues in early-stage OA.
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Affiliation(s)
- Jaanika Kumm
- Clinic of Internal Medicine, University of Tartu, L. Puusepa 6-222, Tartu, 51014, Estonia.
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