Quantitative analysis of patellar tendon size and structure in asymptomatic professional players: sonographic study

Determination of differences in ultrasound parameters for patellar tendons in males with unilateral patellar tendinopathy-An ancillary analysis of data from two randomized controlled trials

PURPOSE

To investigate power Doppler (PD) activity and tendon structure (between the injured and contralateral limb) in patients with unilateral patellar tendinopathy (PT) using ultrasonography (US). Secondly, the aim was to determine the intra-rater reliability of the PD activity and tendon structure.

METHODS

This study analyzed US baseline data from 57 male participants with symptomatic unilateral PT who had been enrolled in one of two randomized clinical trials. Data were analyzed to examine if systematic differences existed between injured and contralateral limbs using Fiji ImageJ.

RESULTS

The PD activity of the symptomatic tendon was larger 25.6 (Q1 = 14.9; Q3 = 41.6) mm2 than the asymptomatic 0 (Q1 = 0.0; Q3 = 0.0) mm2 (p < 0.001). There was a significantly greater tendon thickness at the proximal (2.5 mm 95% CI [2.0; 3.0]), mid (0.8 mm 95% CI [0.5; 1.1]), and distal (0.2 mm 95% CI [0.1; 0.4]) part of the tendon for the symptomatic compared to the asymptomatic tendon. Intra-rater reliability for PD activity and tendon structure ranged from moderate-to-excellent (0.74; 0.99).

CONCLUSION

These results provide mean estimates for tendon thickness of symptomatic and asymptomatic tendons, that can be used for clinicians to reliably estimate pathological tendon thickness.

Muscular Echovariation as a New Biomarker for the Classification of Soleus Muscle Pathology: A Cross-Sectional Study

Background: Soleus injury is one of the most common soft tissue tears during sport activities. Current classifications of muscle tears are based on symptoms and tear size and they do not contribute suitable evidence-based treatment protocols. The objective of this study was to analyze the most frequent echotexture findings of patients with soleus muscle injury, located in the central intramuscular tendon (IMT), and healthy people to determine whether they behave differently and to propose an ultrasound (US)-based classification. Methods: eighty-four athletes, who played in sport activities comprising lower limbs. Echotexture characteristics of soleus muscle were reviewed for 84 subjects. They were divided based on the muscle echogenicity in three groups (Injury Type 1 group, Injury type 2 group and healthy group). Echointensity (EI) and Echovariation (EV) were taken in all groups like quantitative US variable. Results. The Injury Type 1 group was identified by a hypoechoic area and characterized by a higher EV; and Injury Type 2 group was identified by a fibrotic area and characterized by a lower EV. The echogenic pattern of healthy people obtained an intermediate value of EV between both injured soleus types. Conclusions. EV may be useful to classify different types of soleus muscle pathology according to the echogenicity pattern. An innovative proposed US-based classification system for soleus tears may be used to guide treatment decisions for patients with central tendon injury of soleus muscle.

Ultrasound Imaging Evaluation of Textural Features in Athletes with Soleus Pathology-A Novel Case-Control Study

Background: the aim of this study was to compare the echotexture of patients with soleus muscle injury and age matched controls. Methods: a sample of 62 athletes was recruited at the private clinic and was divided in two group: a healthy group (n = 31) and a soleus pathology group whose athletes had soleus muscle injury, located in the central tendon (n = 31). The muscle thickness (MTh), echointensity (EI) and echovariation (EV) were analyzed. An intra-rater reliability test (Intraclass Correlation Coefficient-ICC) was performed in order to analyze the reliability of the values of the measurements. Results: Sociodemographic variables did not show statistically significant differences (p > 0.05). Ultrasound imaging measurements who reported statistically significant differences were EI (p = 0.001) and standard deviation (SD) (p = 0.001). MTh and EV variables did not show statistically significant differences (p = 0.381 and p = 0.364, respectively). Moreover, reliability values for the MTh (ICC = 0.911), EI (ICC = 0.982), SD (ICC = 0.955) and EV (ICC = 0.963). Based on these results the intra-rater reliability was considered excellent. Conclusion: Athletes with a central tendon injury of soleus muscle showed a lower EI when they were compared to healthy athletes. The echogenicity showed by the quantitative ultrasound imaging measurement may be a more objective parameter for the diagnosis and follow-up the soleus muscle injuries.

Patellar tendon morphology in trans-tibial amputees utilizing a prosthesis with a patellar-tendon-bearing feature

A patellar-tendon-bearing (PTB) bar is a common design feature used in the socket of trans-tibial prostheses to place load on the pressure-tolerant tissue. As the patellar tendon in the residual limb is subjected to the perpendicular compressive force not commonly experienced in normal tendons, it is possible for tendon degeneration to occur over time. The purpose of this study was to compare patellar tendon morphology and neovascularity between the residual and intact limbs in trans-tibial amputees and healthy controls. Fifteen unilateral trans-tibial amputees who utilized a prosthesis with a PTB feature and 15 age- and sex- matched controls participated. Sonography was performed at the proximal, mid-, and distal portions of each patellar tendon. One-way ANOVAs were conducted to compare thickness and collagen fiber organization and a chi-square analysis was used to compare the presence of neovascularity between the three tendon groups. Compared to healthy controls, both tendons in the amputees exhibited increased thickness at the mid- and distal portions and a higher degree of collagen fiber disorganization. Furthermore, neovascularity was more common in the tendon of the residual limb. Our results suggest that the use of a prosthesis with a PTB feature contributes to morphological changes in bilateral patellar tendons.