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Bakılan F, Kuşcu SŞ, Ortanca B, Mutlu FŞ, Yıldız P, Armağan O. Ultrasonographic Achilles Tendon Measurements and Static and Dynamic Balance in Prediabetes. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1349. [PMID: 39202630 PMCID: PMC11356051 DOI: 10.3390/medicina60081349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/09/2024] [Accepted: 08/17/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: There is a lack of studies examining balance problems and Achilles tendon thickness in prediabetes despite their common occurrence in diabetes mellitus. The aim of this study was to evaluate Achilles tendon size and static and dynamic balance, as well as the role of the Achilles tendon in balance, in prediabetic patients. Materials and Methods: A total of 96 participants were divided into three groups: (1) the control group, consisting of participants without diabetes mellitus; (2) the prediabetes group; and (3) the diabetes mellitus group. Ultrasonographic measurements of Achilles tendon sizes (thickness, width and area) were performed. Dynamic balance was assessed using the Berg Balance Scale, and static balance (the Fall and Stability Indices) was assessed using a Tetrax device. The Self-Leeds Assessment of Neuropathic Symptoms and Signs was utilized to identify neuropathic pain. Results: In the prediabetes group, the median dynamic balance scores [54.0 (51.0-56.0)] were lower than those of the control group [55.0 (54.0-56.0)] but higher than those of the patients with diabetes mellitus [52.50 (49.0-54.25)]; however, this difference did not reach statistical significance. The ultrasonographic measurements of the Achilles tendon size were similar among the three groups. On the other hand, in the prediabetes group, a positive correlation was observed between the bilateral Achilles tendon anterior-posterior thickness and Fall Index score (p = 0.045), while a negative correlation was found between the left Achilles tendon anterior-posterior thickness and the Berg Balance Score (p = 0.045). Conclusions: In prediabetes, neither Achilles tendon size nor static or dynamic balance appears to be significantly affected. However, in prediabetic patients, increased Achilles tendon thickness appears to be associated with increased risk of falls and decreased balance.
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Affiliation(s)
- Fulya Bakılan
- Department of Physical Medicine and Rehabilitation, Eskişehir Osmangazi University, 26040 Eskişehir, Turkey; (S.Ş.K.); (B.O.); (O.A.)
| | - Sultan Şan Kuşcu
- Department of Physical Medicine and Rehabilitation, Eskişehir Osmangazi University, 26040 Eskişehir, Turkey; (S.Ş.K.); (B.O.); (O.A.)
| | - Burcu Ortanca
- Department of Physical Medicine and Rehabilitation, Eskişehir Osmangazi University, 26040 Eskişehir, Turkey; (S.Ş.K.); (B.O.); (O.A.)
| | - Fezan Şahin Mutlu
- Department of Biostatistics, Eskişehir Osmangazi University, 26040 Eskişehir, Turkey;
| | - Pınar Yıldız
- Department of Internal Medicine, Eskişehir Osmangazi University, 26040 Eskişehir, Turkey;
| | - Onur Armağan
- Department of Physical Medicine and Rehabilitation, Eskişehir Osmangazi University, 26040 Eskişehir, Turkey; (S.Ş.K.); (B.O.); (O.A.)
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Prajwal R, Sakalecha AK, Dudekula A, Varma N. Ultrasound Evaluation of Achilles Tendon Thickness in Diabetic Patients With and Without Foot Complications. Cureus 2024; 16:e62831. [PMID: 39040735 PMCID: PMC11260657 DOI: 10.7759/cureus.62831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction Diabetes mellitus (DM) is a multifaceted metabolic disorder distinguished by elevated blood sugar levels. Type 2-DM (T2DM) stands as a significant contributor to disability due to its widespread occurrence of microvascular and macrovascular complications. According to certain researchers, prolonged elevated blood sugar levels have been observed to trigger a sequence of irregular alterations in the Achilles tendon (AT). AT thickness is one such indicator of these alterations. Methods This was a prospective study carried out on 51 individuals which was further divided into 3 groups (Group A - Normal individuals, Group B - DM without foot complications, Group C - DM with foot complications) with 17 individuals in each as healthy, DM with foot complications and without complications at Sri Devaraj Urs Medical College over a period of one year. The patients' demographics, basic medical records, and laboratory test results were examined and analyzed. Results The mean age of the study participants was 55.41 + 10.25 years. There was no significant difference in age and gender between the three groups. There was a significant difference in mean AT thickness between the groups (p<0.05). The mean thickness of AT was higher in Group C compared to Group B. Group A had the least AT thickness. However, there was no correlation between the variables in individual groups. Conclusions Modifications in the AT's structure may occur before the onset of foot and ankle issues in individuals with diabetes. Hence, the thickening of the AT can be used as an early indicator of impending diabetic foot complications.
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Affiliation(s)
- Rishi Prajwal
- Radiodiagnosis, Sri Devaraj Urs Medical College, Kolar, IND
| | | | - Anees Dudekula
- Radiodiagnosis, Sri Devaraj Urs Medical College, Kolar, IND
| | - Nishanth Varma
- Radiodiagnosis, Sri Devaraj Urs Medical College, Kolar, IND
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Saroha A, Saran S, Saxena S, Kant R, Bhadoria AS. Ultrasonographic Evaluation of Thickness and Stiffness of Achilles Tendon and Plantar Fascia in Type 2 Diabetics Patients: A Cross-sectional Observation Study. J Med Ultrasound 2023; 31:282-286. [PMID: 38264597 PMCID: PMC10802861 DOI: 10.4103/jmu.jmu_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/25/2022] [Accepted: 12/13/2022] [Indexed: 01/25/2024] Open
Abstract
Background Diabetes mellitus (DM) can contribute to the development of foot ulcers, a known complication of DM with a high financial and social burden. Achilles tendon (AT) and plantar fascia (PF) are well known to play an important role in foot biomechanics. The present study focuses on the alteration in thickness and stiffness of the AT and PF in Type 2 DM patients compared with the normal controls. Methods A cross-sectional observational study was conducted with 55 DM patients and 55 healthy volunteers as controls. The thickness of the AT and PF were measured using B-mode ultrasound and stiffness was measured using shear wave elastography. Both the thickness and stiffness in the patient group and controls were compared. The values were also compared with the clinical and demographic profiles of the patients. Results DM patients had considerably thicker AT and PF than controls (P < 0.05); mean values of AT thickness for DM patients and controls were 5.66 ± 0.54 mm and 4.61 ± 0.39 mm, respectively, and for PF were 2.53 ± 0.51 mm and 1.97 ± 0.19 mm, respectively. Furthermore, the stiffness of AT and PF was significantly (P < 0.05) lower in DM patients compared to controls, suggestive of softening of AT and PF in Type 2 DM patients. Mean values of shear wave velocity for DM patients and controls in AT were 5.53 ± 0.54 m/s and 7.25 ± 0.61 m/s, respectively, and for PF, 4.53 ± 0.89 m/s and 6.28 ± 0.88 m/s, respectively. Conclusion We conclude that there is softening and thickening of the AT and PF in Type 2 DM patients, which can impair foot biomechanics.
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Affiliation(s)
- Amit Saroha
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sonal Saran
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sudhir Saxena
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ravi Kant
- Department of General Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ajeet Singh Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Huang X, Chen X, Chen X, Chi P, Wang P, Zhan X, Zou C, Wang L, Dong Y. Sound touch elastography of Achilles tendons in patients with type 2 diabetes mellitus versus healthy adults. Diabetol Metab Syndr 2023; 15:174. [PMID: 37599363 PMCID: PMC10440868 DOI: 10.1186/s13098-023-01148-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND The studies of the effect of diabetes on the stiffness of Achilles tendon (AT) tissue remain inconclusive, we believe it is necessary to find a reliable method which can be used to detect the stiffness changes of the AT in the diabetic state. The objective of the present study was to investigate the effectiveness of sound touch elastography (STE) as a tool for detecting diabetic Achilles tendinopathy. METHODS We conducted a retrospective review of 180 participants, consisting of 82 patients with type 2 diabetes mellitus (T2DM) and 98 healthy adults, who had undergone AT ultrasonography. Young 's modulus (E) values of the distal, middle, and proximal segments of bilateral ATs of all participants were measured using STE technique. The E values of each AT segment between the case and control group were compared. RESULTS The E values of the three segments of ATs in T2DM patients were lower than the healthy controls (P < 0.05). In both groups, the E values of the distal segments were lower than those of the middle segments, and the latter were lower than those of the proximal segments (P < 0.05). The E value of each segment of AT was inversely related to FPG, HbA1c, and diabetes duration (P < 0.05). The best cut-off points for the E values of the three segments of the AT for detecting diabetic tendinopathy were 347.44 kPa (AUC, 0.779), 441.57 kPa (AUC, 0.692), and 484.35 kPa (AUC, 0.676), respectively. CONCLUSION STE can be used as a complementary diagnostic tool for the diagnosis of diabetic Achilles tendinopathy.
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Affiliation(s)
- Xinxin Huang
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Xingyu Chen
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Xiu Chen
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Ping Chi
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Pengfei Wang
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Xiaomei Zhan
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China
| | - Chunpeng Zou
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China.
| | - Liang Wang
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China.
| | - Yanyan Dong
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 1111 Wenzhou Avenue, Longwan District, Wenzhou, 325000, China.
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Vaidya R, Lake SP, Zellers JA. Effect of Diabetes on Tendon Structure and Function: Not Limited to Collagen Crosslinking. J Diabetes Sci Technol 2023; 17:89-98. [PMID: 35652696 PMCID: PMC9846394 DOI: 10.1177/19322968221100842] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Diabetes mellitus (DM) is associated with musculoskeletal complications-including tendon dysfunction and injury. Patients with DM show altered foot and ankle mechanics that have been attributed to tendon dysfunction as well as impaired recovery post-tendon injury. Despite the problem of DM-related tendon complications, treatment guidelines specific to this population of individuals are lacking. DM impairs tendon structure, function, and healing capacity in tendons throughout the body, but the Achilles tendon is of particular concern and most studied in the diabetic foot. At macroscopic levels, asymptomatic, diabetic Achilles tendons may show morphological abnormalities such as thickening, collagen disorganization, and/or calcific changes at the tendon enthesis. At smaller length scales, DM affects collagen sliding and discrete plasticity due to glycation of collagen. However, how these alterations translate to mechanical deficits observed at larger length scales is an area of continued investigation. In addition to dysfunction of the extracellular matrix, tendon cells such as tenocytes and tendon stem/progenitor cells show significant abnormalities in proliferation, apoptosis, and remodeling capacity in the presence of hyperglycemia and advanced glycation end-products, thus contributing to the disruption of tendon homeostasis and healing. Improving our understanding of the effects of DM on tendons-from molecular pathways to patients-will progress toward targeted therapies in this group at high risk of foot and ankle morbidity.
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Affiliation(s)
- Rachana Vaidya
- Washington University School of
Medicine, St. Louis, MO, USA
| | | | - Jennifer A. Zellers
- Washington University School of
Medicine, St. Louis, MO, USA
- Jennifer A. Zellers, PT, DPT, PhD,
Washington University School of Medicine, 4444 Forest Park Ave., Suite
1101, St. Louis, MO 63108, USA.
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ÇAKIR PEKÖZ B, YILDIRIM A. Aşil tendonu gerinim oranı ile mitral anulus kalsifikasyonu varlığı arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1132997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Aşil tendonu (AT)- ultrasonografisi (US) ve gerinim elastografisi (SE) ile elde edilen AT- kalınlığı (T) ve AT- gerinim oranının (SR) mitral kapak kalsifikasyonlu (MAC) hastaları belirlemedeki önemini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya ekokardiyografi sonrası MAC tanısı alan 100 hasta (65 kadın, 35 erkek ve ortalama yaş 64.7 ± 12.1) ve kardiyovasküler risk faktörü benzer olan 50 kontrol (32 kadın, 18 erkek ve ortalama yaş 63.2 ± 12.8) alındı. Laboratuvar incelemeler ve AT US yapıldı. AT-T ve AT-SR hesaplandı.
Bulgular: MAC olan hastalarda AT-T ve AT-SR belirgin olarak yüksek olduğu bulundu. Logistic regresyon analizinde, AT-T ve AT-SR değerlerinin MAC olma riskini bağımsız olarak belirlediği bulundu. Bu analize göre AT-T (her 1 mm) ve AT-SR (her 0.1)’nin MAC olma riskini sırası ile %69.9 ve %12.7 oranlarında artırdığı saptandı. AT-T ve AT-SR değerlerinin MAC olan hastaları belirlemesi açısından ROC analizi yapıldığında, ROC eğri altında kalan alanın sırası ile 0.684 ve 0.819 belirlendi. Aynı analizde, AT-SR için sınır değer 1.25 olarak alındığında %94.1 sensitivite ve %76.2 spesivite ile MAC varlığını belirlediği tespit edildi.
Sonuç: AT SE incelemesinde saptanan AT-SR, MAC olan hastaları önceden belirlemede kullanılabilecek basit, ucuz, tekrarlanabilir ve non-invaziv bir parametredir. Bu durum MAC ve AT-SR artışının benzer fizyopatolojik mekanizma ile meydana gelebilmesinin bir sonucu olabilir.
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Affiliation(s)
- Burçak ÇAKIR PEKÖZ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Arafat YILDIRIM
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Human Achilles tendon mechanical behavior is more strongly related to collagen disorganization than advanced glycation end-products content. Sci Rep 2021; 11:24147. [PMID: 34921194 PMCID: PMC8683434 DOI: 10.1038/s41598-021-03574-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/03/2021] [Indexed: 12/25/2022] Open
Abstract
Diabetes is associated with impaired tendon homeostasis and subsequent tendon dysfunction, but the mechanisms underlying these associations is unclear. Advanced glycation end-products (AGEs) accumulate with diabetes and have been suggested to alter tendon function. In vivo imaging in humans has suggested collagen disorganization is more frequent in individuals with diabetes, which could also impair tendon mechanical function. The purpose of this study was to examine relationships between tendon tensile mechanics in human Achilles tendon with accumulation of advanced glycation end-products and collagen disorganization. Achilles tendon specimens (n = 16) were collected from individuals undergoing lower extremity amputation or from autopsy. Tendons were tensile tested with simultaneous quantitative polarized light imaging to assess collagen organization, after which AGEs content was assessed using a fluorescence assay. Moderate to strong relationships were observed between measures of collagen organization and tendon tensile mechanics (range of correlation coefficients: 0.570-0.727), whereas no statistically significant relationships were observed between AGEs content and mechanical parameters (range of correlation coefficients: 0.020-0.210). Results suggest that the relationship between AGEs content and tendon tensile mechanics may be masked by multifactorial collagen disorganization at larger length scales (i.e., the fascicle level).
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Korkmaz BY, Akturk M, Ucar M, Altınova AE, Can MA, Arslan E, Tokgoz N, Toruner F. Irregularity in Plantar Fascia, Muscle Edema and Tendon Thickness in Patients with High-Risk for Diabetic Foot. Exp Clin Endocrinol Diabetes 2021; 130:525-531. [PMID: 34781374 DOI: 10.1055/a-1642-2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To investigate the alterations in the plantar fascia (PF), intrinsic muscles, and tendons in the feet of patients at high risk for developing diabetic foot. METHODS The healthy feet of 22 patients with type 2 diabetes, who had developed diabetic foot ulcers on a single foot without any pathology on the contralateral extremity, and those of 22 healthy volunteers were evaluated by magnetic resonance imaging. The volume of the Achilles tendon (AT), the surface area of the PF, the thickness of AT, flexor hallucis longus, flexor digitorum longus, tibialis posterior, and peroneus longus tendons, irregularity in the PF, and edema of intrinsic foot muscles were examined. RESULTS Nineteen patients (86%) had irregularity in the PF, whereas none of the healthy controls had any (p<0.001). Intrinsic muscle edema was more common in the group with diabetes (p=0.006). The volume of AT and the surface area of PF were decreased in patients with peripheral arterial disease (PAD) (p<0.05). Patients with diabetes mellitus but without PAD had a larger surface area of PF than that of controls (p<0.05). There were no differences in the volume of AT, the surface area of the PF, and other tendon thickness between the groups. CONCLUSION Irregularity in the PF and muscle edema may indicate a high risk for the diabetic foot. The presence of PAD may lead to regression in the structure of AT and PF.
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Affiliation(s)
- Busra Yurumez Korkmaz
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mujde Akturk
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Ucar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Alev Eroglu Altınova
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ali Can
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emre Arslan
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nil Tokgoz
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Fusun Toruner
- Department of Endocrinology and Metabolism, Gazi University Faculty of Medicine, Ankara, Turkey
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Khor BYC, Woodburn J, Newcombe L, Barn R. Plantar soft tissues and Achilles tendon thickness and stiffness in people with diabetes: a systematic review. J Foot Ankle Res 2021; 14:35. [PMID: 33910602 PMCID: PMC8080343 DOI: 10.1186/s13047-021-00475-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Diabetes mellitus is associated with changes in soft tissue structure and function. However, the directionality of this change and the extent to which either tissue thickness or stiffness contributes to the pathogenesis of diabetes-related foot ulcerations is unclear. Hence, this systematic review aims to summarise the existing evidence for soft tissue structural differences in the feet of people with and without diabetes. METHODS In compliance with MOOSE and PRISMA guidelines, AMED, CINAHL, MEDLINE, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database, and Web of Science electronic databases were systematically searched for studies published from database inception until 1st October 2020 [Prospero CRD42020166614]. Reference lists of included studies were further screened. Methodological quality was appraised using a modified critical appraisal tool for quantitative studies developed by McMaster University. RESULTS A total of 35 non-randomised observational studies were suitable for inclusion. Within these, 20 studies evaluated plantar tissue thickness, 19 studies evaluated plantar tissue stiffness, 9 studies evaluated Achilles tendon thickness and 5 studies evaluated Achilles tendon stiffness outcomes. No significant differences in plantar tissue thickness were found between people with and without diabetes in 55% of studies (11/20), while significantly increased plantar tissue stiffness was found in people with diabetes in 47% of studies (9/19). Significantly increased Achilles tendon thickness was found in people with diabetes in 44% of studies (4/9), while no significant differences in Achilles tendon stiffness were found between people with and without diabetes in 60% of studies (3/5). CONCLUSIONS This systematic review found some evidence of soft tissue structural differences between people with and without diabetes. However, uncertainty remains whether these differences independently contribute to diabetes-related foot ulcerations. The heterogeneity of methodological approaches made it difficult to compare across studies and methodological quality was generally inadequate. High-quality studies using standardised and validated assessment techniques in well-defined populations are required to determine more fully the role of structural tissue properties in the pathogenesis of diabetes-related foot ulcerations.
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Affiliation(s)
- Benedictine Yen Chen Khor
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK.
| | - James Woodburn
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia
| | - Lisa Newcombe
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - Ruth Barn
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
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White S, McCullough MBA, Akangah PM. The Structural Effects of Diabetes on Soft Tissues: A Systematic Review. Crit Rev Biomed Eng 2021; 49:11-27. [PMID: 35993948 DOI: 10.1615/critrevbiomedeng.2022043200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hyperglycemia, which is associated with diabetes, increases the production of advanced glycation end products. Advanced glycation end products lead to the structural degradation of soft tissues. The structural degradation of diabetic soft tissues has been investigated in humans, rodents, and canines. Therefore, the objective of this review is to unify the various contributions to diabetes research through the mechanical properties and geometric characteristics of soft tissues. A systematic review was performed and identified the effects of diabetes on mechanical and geometric properties of soft tissues via experimental testing or in vivo - driven finite element analysis. The literature concludes that diabetes contributes to major structural changes in soft tissues but does not cause the same structural changes in all soft tissues (e.g., diabetic tendons are weaker and diabetic plantar tissues are tougher). Diabetes stiffens and toughens soft tissues, thus altering viscoelastic behavior (e.g., poor strain and stress response). However, diabetes management routines can prevent or minimize the effects of diabetes on the mechanical and geometric properties of soft tissues. Unification of the structural effects of diabetes on soft tissues will contribute to the pathophysiology of diabetes.
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Affiliation(s)
- Shunafrica White
- Department of Mechanical Engineering, North Carolina Agricultural and Technical State University
| | - Matthew B A McCullough
- Department of Chemical, Biological, and Bioengineering at North Carolina Agricultural and Technical State University
| | - Paul M Akangah
- Department of Mechanical Engineering, North Carolina Agricultural and Technical State University
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Lu PP, Chen MH, Dai GC, Li YJ, Shi L, Rui YF. Understanding cellular and molecular mechanisms of pathogenesis of diabetic tendinopathy. World J Stem Cells 2020; 12:1255-1275. [PMID: 33312397 PMCID: PMC7705468 DOI: 10.4252/wjsc.v12.i11.1255] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
There is accumulating evidence of an increased incidence of tendon disorders in people with diabetes mellitus. Diabetic tendinopathy is an important cause of chronic pain, restricted activity, and even tendon rupture in individuals. Tenocytes and tendon stem/progenitor cells (TSPCs) are the dominant cellular components associated with tendon homeostasis, maintenance, remodeling, and repair. Some previous studies have shown alterations in tenocytes and TSPCs in high glucose or diabetic conditions that might cause structural and functional variations in diabetic tendons and even accelerate the development and progression of diabetic tendinopathy. In this review, the biomechanical properties and histopathological changes in diabetic tendons are described. Then, the cellular and molecular alterations in both tenocytes and TSPCs are summarized, and the underlying mechanisms involved are also analyzed. A better understanding of the underlying cellular and molecular pathogenesis of diabetic tendinopathy would provide new insight for the exploration and development of effective therapeutics.
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Affiliation(s)
- Pan-Pan Lu
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Min-Hao Chen
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Guang-Chun Dai
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Ying-Juan Li
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
| | - Liu Shi
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
| | - Yun-Feng Rui
- Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- Orthopaedic Trauma Institute (OTI), Southeast University, Nanjing 210009, Jiangsu Province, China
- Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- School of Medicine, Southeast University, Nanjing 210009, Jiangsu Province, China
- China Orthopedic Regenerative Medicine Group, Hangzhou 310000, Zhejiang Province, China
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12
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Harish C S, Dixit R, Singh S, Garg S. Sonoelastographic Evaluation of the Achilles Tendon in Patients With Type 2 Diabetes Mellitus. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2989-2997. [PMID: 32819782 DOI: 10.1016/j.ultrasmedbio.2020.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
Diabetic foot is one of the dreaded complications of diabetes mellitus (DM). Alterations of the Achilles tendon (AT) may contribute to development of foot ulcers in diabetic patients. We evaluated the sonoelastographic abnormalities of the AT in 61 healthy volunteers and 81 patients with type 2 DM. The patients were further divided into those with and without peripheral neuropathy (PN). The AT thickness was measured in the proximal, middle and distal portions. Alterations in echo pattern were noted. The patients were found to have thicker tendons than the healthy volunteers (p < 0.01). Alterations in the echo pattern of the AT were more common in patients compared with healthy volunteers (p < 0.01). The shear wave velocity in the distal one-third of the AT was measured using shear wave elasticity imaging. Mean shear wave velocity values obtained were lower in patients compared with healthy volunteers (p < 0.001). No significant difference was found in the sonoelastographic findings of the AT in patients with and without PN. We conclude that there is softening, thickening and alterations in echo pattern of the AT in the form of hypoechogenicity, loss of fibrillar pattern and calcification at insertion in patients with type 2 DM, and these alterations could occur independent of onset of PN.
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Affiliation(s)
- Sneha Harish C
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Jai Prakash Hospital, New Delhi, India.
| | - Rashmi Dixit
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Jai Prakash Hospital, New Delhi, India
| | - Sapna Singh
- Department of Radiodiagnosis, Maulana Azad Medical College and Lok Nayak Jai Prakash Hospital, New Delhi, India
| | - Sandeep Garg
- Department of Medicine, Maulana Azad Medical College and Lok Nayak Jai Prakash Hospital, New Delhi, India
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Koc AS, Pekoz BC, Donmez Y, Yasar S, Ardic M, Gorgulu FF, Icen YK, Sumbul HE, Koc M. Usability of Achilles tendon strain elastography for the diagnosis of coronary artery disease. J Med Ultrason (2001) 2019; 46:343-351. [PMID: 30783822 DOI: 10.1007/s10396-019-00931-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/15/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE There are close relationships between major coronary artery disease (CAD) risk factors and Achilles tendon thickness (AT-T) and AT strain ratio (AT-SR). Our aim was to evaluate the diagnostic importance of AT-T and AT-SR as obtained by ultrasonography (USG) and strain elastography (SE) for predicting CAD. MATERIALS AND METHODS One hundred and eighty-four patients scheduled to undergo coronary angiography were included in the study. Achilles tendon USG (B-mode and SE) and laboratory tests were performed on all patients. The patients were divided into two groups, i.e., patients with and without CAD. RESULTS The patients with CAD (72.8%) were more likely to be male, exhibited higher frequencies of diabetes mellitus (DM) and hyperlipidemia, exhibited higher levels of basal creatinine and glucose, and had higher AT-T and AT-SR values (p < 0.05 for all). Age, DM, AT-T, and AT-SR independently predicted the probability of CAD in a logistic regression analysis (p < 0.05 for all). Age (each year), DM (presence), AT-T (each 1 mm), and AT-SR (each 0.1) increased the CAD risk by 3.4%, 2.9 times, 47.1%, and 16.0%, respectively. ROC analysis revealed AUCs of 0.665 and 0.730 for the AT-T and AT-SR values, respectively (p < 0.05). The AT-SR cutoff value of 1.2 predicted the presence of CAD with 75.4% sensitivity and 72.7% specificity. CONCLUSIONS AT-SR is a simple, inexpensive, noninvasive, reproducible, and objective parameter for the prediction of CAD. We think that AT-SR evaluation should become a part of conventional USG assessments in patients who are at a high risk of CAD.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey.
| | - Burcak Cakir Pekoz
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Yurdaer Donmez
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Simge Yasar
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mustafa Ardic
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Feride Fatma Gorgulu
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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14
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İyidir ÖT, Rahatlı FK, Bozkuş Y, Ramazanova L, Turnaoğlu H, Nar A, Tütüncü NB. Acoustic Radiation Force Impulse Elastography and Ultrasonographic Findings of Achilles Tendon in Patients With and Without Diabetic Peripheral Neuropathy: A Cross-Sectional Study. Exp Clin Endocrinol Diabetes 2019; 129:99-103. [PMID: 30786314 DOI: 10.1055/a-0840-3292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS We aimed to evaluate the elastographic features of Achilles tendon with Acoustic Radiation Force Impulse in patients with and without diabetic neuropathy. METHODS According to the presence of peripheral neuropathy, 45 patients with type 2 diabetes were divided into 2 subgroups. Those with peripheral neuropathy were defined as group I (22 patients) and those without peripheral neuropathy were defined as group II (23 patients). A total of thirty age-, gender-, and body mass index-matched healthy individuals were selected as controls. All participants underwent both ultrasonographic and Acoustic Radiation Force Impulse elastographic examination in order to evaluate Achilles Tendon thickness and stiffness. RESULTS Achilles tendon thicknesses were similar between groups (p=0.991). Achilles tendon thicknesses of both patient groups were significantly higher than the control group (group I vs control p=0.01; group II vs control p=0.006). Stiffness values of Achilles tendons were similar between the control group and group II (p=0.993). Shear Wave Velocity was significantly lower in group I than group IIand control group (p<0.001). CONCLUSION Diabetic patients with neuropathy have thicker and softer Achilles tendon while the elasticity of Achilles tendon in diabetic patients without neuropathy is similar to the healthy controls. Softening of the Achilles tendon may be an early sign of diabetic foot and reveal the patients with a risk of diabetic foot.
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Affiliation(s)
- Özlem Turhan İyidir
- Department of Endocrinology and Metabolism, Başkent University, Ankara, Turkey
| | | | - Yusuf Bozkuş
- Department of Endocrinology and Metabolism, Başkent University, Ankara, Turkey
| | - Lala Ramazanova
- Department of Endocrinology and Metabolism, Başkent University, Ankara, Turkey
| | - Hale Turnaoğlu
- Department of Radiology, Başkent University, Ankara, Turkey
| | - Aslı Nar
- Department of Endocrinology and Metabolism, Başkent University, Ankara, Turkey
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Prado-Costa R, Rebelo J, Monteiro-Barroso J, Preto AS. Ultrasound elastography: compression elastography and shear-wave elastography in the assessment of tendon injury. Insights Imaging 2018; 9:791-814. [PMID: 30120723 PMCID: PMC6206379 DOI: 10.1007/s13244-018-0642-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/22/2018] [Accepted: 06/21/2018] [Indexed: 12/27/2022] Open
Abstract
Ultrasound elastography (USE) is a recent technology that has experienced major developments in the past two decades. The assessment of the main mechanical properties of tissues can be made with this technology by characterisation of their response to stress. This article reviews the two major techniques used in musculoskeletal elastography, compression elastography (CE) and shear-wave elastography (SWE), and evaluates the studies published on major electronic databases that use both techniques in the context of tendon pathology. CE accounts for more studies than SWE. The mechanical properties of tendons, particularly their stiffness, may be altered in the presence of tendon injury. CE and SWE have already been used for the assessment of Achilles tendons, patellar tendon, quadriceps tendon, epicondylar tendons and rotator cuff tendons and muscles. Achilles tendinopathy is the most studied tendon injury with USE, including the postoperative period after surgical repair of Achilles rupture tendon. In relation to conventional ultrasound (US), USE potentially increases the sensitivity and diagnostic accuracy in tendinopathy, and can detect pathological changes before they are visible in conventional US imaging. Several technical limitations are recognised, and standardisation is necessary to ensure repeatability and comparability of the results when using these techniques. Still, USE is a promising technique under development and may be used not only to promote an early diagnosis, but also to identify the risk of injury and to support the evaluation of rehabilitation interventions. KEY POINTS: • USE is used for the assessment of the mechanical properties of tissues, including the tendons. • USE increases diagnostic performance when coupled to conventional US imaging modalities. • USE will be useful in early diagnosis, tracking outcomes and monitoring treatments of tendon injury. • Technical issues and lack of standardisation limits USE use in the assessment of tendon injury.
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Affiliation(s)
- Rui Prado-Costa
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Rebelo
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal.
| | - João Monteiro-Barroso
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Sofia Preto
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal
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16
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Sconfienza LM, Albano D, Allen G, Bazzocchi A, Bignotti B, Chianca V, Facal de Castro F, Drakonaki EE, Gallardo E, Gielen J, Klauser AS, Martinoli C, Mauri G, McNally E, Messina C, Mirón Mombiela R, Orlandi D, Plagou A, Posadzy M, de la Puente R, Reijnierse M, Rossi F, Rutkauskas S, Snoj Z, Vucetic J, Wilson D, Tagliafico AS. Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 2018; 28:5338-5351. [DOI: 10.1007/s00330-018-5474-3] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/02/2018] [Accepted: 04/11/2018] [Indexed: 12/11/2022]
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17
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Fusini F, Langella F, Busilacchi A, Tudisco C, Gigante A, Massé A, Bisicchia S. Real-time sonoelastography: principles and clinical applications in tendon disorders. A systematic review. Muscles Ligaments Tendons J 2018; 7:467-477. [PMID: 29387640 DOI: 10.11138/mltj/2017.7.3.467] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Sonoelastography (SE) is a new ultrasound-based method adopted in an increased number of scientific reports to analyse normal and pathological tendons. The aim of this study is to provide a systematic overview of clinical applications of SE in normal and pathological tendons. Methods A systematic research of PubMed, Ovid, and Cochrane Library electronic databases was performed according to PRISMA guideline. Two Authors searched and evaluated the articles independently; a third Author was involved to solve any disagreement. The Oxford Level of Evidence (LoE) was used to assess each article. Results There is an increasing interest in the application of SE in the evaluation of healthy and diseased tendons. Many different tendons are amenable for SE evaluation, such as the Achilles and patellar tendons, rotator cuff, common extensor tendons, quadriceps tendon, and the plantar fascia. Conclusion SE appears to be a very useful diagnostic tool, in particular in tendon pathology. This is a dynamic examination, provides an immediate evaluation of the tissue elasticity, and may be useful in recognizing tendon abnormalities and in implementing the information available with conventional US. Level of evidence IV.
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Affiliation(s)
- Federico Fusini
- University of Turin, School of Orthopaedic and Traumatology, Turin, Italy
| | - Francesco Langella
- Clinical Orthopedics, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Busilacchi
- Clinical Orthopedics, Department of Molecular Pathology and Innovative Therapies, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Cosimo Tudisco
- Department of Orthopaedic Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Gigante
- Clinical Orthopedics, Department of Molecular Pathology and Innovative Therapies, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Alessandro Massé
- University of Turin, School of Orthopaedic and Traumatology, Turin, Italy
| | - Salvatore Bisicchia
- Orthopaedics and Traumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy
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18
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Ultrasound elastography in tendon pathology: state of the art. Skeletal Radiol 2017; 46:1643-1655. [PMID: 28765991 DOI: 10.1007/s00256-017-2726-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/30/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
Elastography assesses the biomechanical and structural properties of tissues by measuring their stiffness. Despite promising results, elastography has not yet earned its place in the daily practice of musculoskeletal radiologists. The purpose of this article is to present and examine the data available to date on ultrasound elastography of the tendons through a review of the literature to provide musculoskeletal radiologists with an overview that may help them better understand and use elastography routinely. The most common techniques in ultrasound elastography are described. Then, the aspects of the physiologic and pathologic tendon are presented and discussed. One must make this technique one's own to better apprehend its contribution to the musculoskeletal imaging field, while bearing in mind that further research will be required before admitting elastography as a reliable and validated tool able to optimize our daily clinical practice.
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19
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Zhang Q, Cai Y, Hua Y, Shi J, Wang Y, Wang Y. Sonoelastography shows that Achilles tendons with insertional tendinopathy are harder than asymptomatic tendons. Knee Surg Sports Traumatol Arthrosc 2017; 25:1839-1848. [PMID: 27342984 DOI: 10.1007/s00167-016-4197-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/07/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE To seek differences of Achilles tendon hardness between insertional tendinopathy (IT) and asymptomatic controls by using computer-assisted quantification on axial-strain sonoelastography (ASE). METHODS The study consisted of 37 non-athletic patients presenting with Achilles tendon pain in one or two tendons. Both tendons were examined clinically. Among the 74 tendons, 16 were diagnosed and categorized into an IT group and 29 into an asymptomatic group. The remaining 29 tendons were excluded due to non-insertional tendinopathy, ruptures, previous surgery or mixed disorders. The tendons in the IT and asymptomatic groups were examined with both ASE and conventional ultrasound. Computer-assisted quantification on ASE was conducted to extract parameters of tendon hardness, including the 20th percentile (H20), median (H50) and skewness (Hsk) of the hardness within tendon, as well as the ratio of the mean hardness within tendon to that outside tendon (Hratio). RESULTS The H20 (p = 0.003), H50 (p = 0.004) and Hratio (p = 0.002) were larger and Hsk (p = 0.001) was smaller at distal thirds of IT tendons than those of asymptomatic tendons. For differentiation between two groups, the Hsk achieved the best value (0.815) of area under the receiver operating characteristic curve, with a sensitivity of 81.3 %, a specificity of 86.2 % and an accuracy of 84.4 %. CONCLUSIONS Computer-assisted quantification on ASE shows that IT tendons are harder than asymptomatic tendons. It might act as a potentially useful technique for identification and risk stratification of IT patients and thus be valuable in day-by-day clinical practice for monitoring IT progression and for evaluating therapeutic effects. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Qi Zhang
- Institute of Biomedical Engineering, Shanghai University, Shanghai, 200444, China
| | - Yehua Cai
- Department of Ultrasound, Huashan Hospital, Fudan University, No. 12, Urumqi Middle Road, Shanghai, 200438, China.
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, No. 12, Urumqi Middle Road, Shanghai, 200438, China.
| | - Jun Shi
- Institute of Biomedical Engineering, Shanghai University, Shanghai, 200444, China
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University, Shanghai, 200433, China
| | - Yi Wang
- Department of Ultrasound, Huashan Hospital, Fudan University, No. 12, Urumqi Middle Road, Shanghai, 200438, China
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20
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Balaban M, Idilman IS, Ipek A, Ikiz SS, Bektaser B, Gumus M. Elastographic Findings of Achilles Tendons in Asymptomatic Professional Male Volleyball Players. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2623-2628. [PMID: 27872419 DOI: 10.7863/ultra.15.11077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/11/2016] [Accepted: 03/18/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Elastography is a new sonographic technique that evaluates the elasticity of different tissues such as the Achilles tendon. In this study, we aimed to investigate the elastographic findings of Achilles tendons in professional athletes in comparison with healthy volunteers. METHODS Twenty-one professional male volleyball players with no history of Achilles trauma were included in this study. Twenty-one healthy male volunteers with similar ages and body mass indices were selected as control participants. All participants underwent sonographic and elastographic evaluations of the Achilles tendons to evaluate Achilles tendon thickness and stiffness. RESULTS We observed thickening in many of the thirds of the Achilles tendons (right proximal, right middle, left middle, and left distal thirds) of athletes in comparison with healthy volunteers. We did not detect any abnormalities according to the sonographic evaluations in both athletes and healthy volunteers. In the elastographic evaluations, we observed softening in the middle thirds of the Achilles tendons of athletes according to the main types (P < .001) and subtypes (P < .001 for right; and P = .002 for left middle third). There was no difference observed in the elastographic evaluations of the proximal and distal thirds. CONCLUSIONS On sonography and elastography, we observed thickening and softening in Achilles tendons of athletes in comparison with healthy volunteers who had similar ages and body mass indices. These changes could be associated with early tendon degeneration. Further longitudinal studies may support this consideration.
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Affiliation(s)
- Mehtap Balaban
- Department of Radiology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Ilkay S Idilman
- Department of Radiology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Ali Ipek
- Department of Radiology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Sinem Sigit Ikiz
- Department of Radiology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Bulent Bektaser
- Department of Orthopedics and Traumatology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
| | - Mehmet Gumus
- Department of Radiology, Ankara Atatürk Education and Research Hospital, Ankara, Turkey
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