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Bisciotti GN, Bisciotti A, Auci A, Bisciotti A, Eirale C, Corsini A, Volpi P. Achilles Tendon Repair after Tenorraphy Imaging and the Doughnut Metaphor. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5985. [PMID: 37297589 PMCID: PMC10253009 DOI: 10.3390/ijerph20115985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
After Achilles tendon tenorraphy, tendon tissue undergoes a long period of biological healing. During this period, tissue turnover shows heterogeneity between its peripheral and central regions. This case report concerns the description of the tendon healing process of an athlete who underwent an Achilles tendon tenorraphy. As the reparative processes progressed, magnetic resonance imaging (MRI) showed centralization of the hyperintensity area and the tendon assumed a doughnut-like appearance. At the same time, ultrasound (US) assessment showed a progressive reorganization of the tendon fibrillar structure. Therefore, for the athlete, MRI and US assessment together represent a useful tool for the decision-making process after Achilles tendon tenorraphy.
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Affiliation(s)
- Gian Nicola Bisciotti
- Paris Saint Germain Football Club (France), Kinemove Rehabilitation Centers, 54027 Pontremoli, Italy;
| | | | - Alessio Auci
- Azienda USL Toscana Nord-Ovest, 54100 Massa, Italy;
| | | | - Cristiano Eirale
- Paris Saint Germain Football Club, 78100 Saint Germain en Laye, France;
| | | | - Piero Volpi
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy (P.V.)
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Tarczyńska M, Szubstarski M, Gawęda K, Przybylski P, Czekajska-Chehab E. Outcomes of Open Repair Treatment for Acute Versus Chronic Achilles Tendon Ruptures: Long-Term Retrospective Follow-Up of a Minimum 10 Years-A Pilot Study. Med Sci (Basel) 2023; 11:medsci11020025. [PMID: 37092494 PMCID: PMC10123621 DOI: 10.3390/medsci11020025] [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: 01/08/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
The aim of the present study was to compare repaired Achilles tendon (AT) remodelling, whether its function was restored and what effects the surgery had on our patients' gait cycle in a long-term follow-up study. The study population comprised 30 human subjects treated acutely and chronically for AT ruptures, using the same surgical technique in all cases. The study group was divided into two subgroups regarding the age of their AT injury, i.e., how much time elapsed between the injury and when a correct diagnosis was made and when adequate treatment was applied. Following these criteria, persons presenting at less than 4 weeks postinjury were classified as acute rupture (AR) patients and those presenting at more than 4 weeks after injury were grouped as chronic rupture (CR) patients. Both patient groups were operated on using a surgical method favoured at least a decade ago, i.e., open repair through a posteromedial approach. The AT was augmented with a plantaris longus tendon autograft, followed by suturing using the pull-out suture technique. The results were measured using clinical, ultrasonographic (US) and pedobarographic methods. Our ultrasonographic and pedobarographic findings revealed differences between both patient groups, thus indicating that delayed surgery had negative impacts on treatment success, however, with good long-term functional score outcomes in both patient groups. Nevertheless, delayed treatment of AT ruptures did not leave individual gait phases unaffected, as it also affected the plantar surface and balance performance of the affected limb. As per the results, the Achilles tendon manifested decreased capacity following delayed treatment; however, its long-term functional outcomes were favourable, irrespective of whether it was for acute or chronic patients.
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Affiliation(s)
- Marta Tarczyńska
- Orthopaedic Surgery and Traumatology Department, Medical University of Lublin, 20-950 Lublin, Poland
| | - Mateusz Szubstarski
- Orthopaedic and Traumatology Department, District Hospital of Krasnik, 20-950 Lublin, Poland
| | - Krzysztof Gawęda
- Orthopaedic Surgery and Traumatology Department, Medical University of Lublin, 20-950 Lublin, Poland
| | - Piotr Przybylski
- 1st Department of Medical Radiology, Medical University of Lublin, 20-950 Lublin, Poland
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Drakonaki EE, Martinoli C, Vanhoenacker FM, Detoraki A, Dalili DE, Adriaensen M. The Beauty of Musculoskeletal Ultrasound: Spot Diagnoses. ROFO-FORTSCHR RONTG 2023; 195:385-392. [PMID: 36630982 DOI: 10.1055/a-1965-9961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Ultrasound is a powerful technique in musculoskeletal (MSK) imaging, and it can replace MR imaging in many specific clinical scenarios. This article will feature some common and less common spot diagnoses in musculoskeletal ultrasound. SPOT DIAGNOSIS Cases were collected by members of the Educational Committee of the ESSR ( European Society of Musculoskeletal Radiology) with expertise in musculoskeletal ultrasound. Sixteen clinical entities are discussed based on the features that allow US spot diagnosis. CONCLUSION Clinical history, location, and ultrasound appearance are the keys to spot diagnoses when performing musculoskeletal ultrasound. KEY POINTS · Musculoskeletal ultrasound can be the primary and only modality in common spot diagnoses in specific clinical settings.. · Clinical history, location, and ultrasound appearance are keys to spot diagnoses.. · Knowledge of spot diagnoses in musculoskeletal ultrasound facilitates daily clinical practice.. CITATION FORMAT · Drakonaki EE, Martinoli C, Vanhoenacker FM et al. The Beauty of Musculoskeletal Ultrasound: Spot Diagnoses. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1965-9961.
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Affiliation(s)
- Elena E Drakonaki
- Department of Anatomy, University of Crete School of Medicine, Heraklion, Greece.,Department of MSK imaging, Diagnostic and Interventional Ultrasound Practice, Heraklion, Greece
| | - Carlo Martinoli
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Filip Maria Vanhoenacker
- Department of Radiology, University Hospital Antwerp, Edegem (Antwerp), Belgium.,Department of Radiology, AZ Sint-Maarten Duffel-Mechelen, Belgium
| | - Anna Detoraki
- Medical School, Comenius University in Bratislava, Slovakia
| | - Daniel E Dalili
- Department of Radiology, Southend University Hospital, Mid and South Essex NHS Trust, Essex, United Kingdom of Great Britain and Northern Ireland
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Heerlen, Netherlands
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Rodriguez Sanz D, LOSA IGLESIAS MARTA, BECERRO DE BENGOA VALLEJO RICARDO, SORIANO MEDRANO ALFREDO, MORALES PONCE ANGEL, CALVO LOBO CESAR, San Antolin M, Ramirez Navarro PC, Garcia Garcia D. Actualización científica en ecografía y tendinopatía aquilea. Implicaciones anatómicas relacionadas, abordaje terapéutico y nuevas perspectivas basadas en la evidencia. REVISTA ESPAÑOLA DE PODOLOGÍA 2022. [DOI: 10.20986/revesppod.2022.1632/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Aminlari A, Stone J, McKee R, Subramony R, Nadolski A, Tolia V, Hayden SR. Diagnosing Achilles Tendon Rupture with Ultrasound in Patients Treated Surgically: A Systematic Review and Meta-Analysis. J Emerg Med 2021; 61:558-567. [PMID: 34801318 DOI: 10.1016/j.jemermed.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/11/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Achilles tendon rupture is a common injury with increasing incidence due to the rising popularity of high-velocity sports, continued physical activity of the aging American population, and use of fluoroquinolones and steroid injections. The diagnosis can often be missed or delayed, with up to 20% misdiagnosed, most commonly as an ankle sprain. OBJECTIVE The aim of our study was to systematically evaluate the reported sensitivity, specificity, and likelihood ratios of ultrasound for detecting Achilles tendon rupture in patients who were treated surgically. METHODS In January 2020, we performed a literature search of MEDLINE and EMBASE databases to identify eligible articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were original studies with at least five patients, which reported data on the sonographic diagnosis of Achilles tendon rupture (complete or partial) compared to surgery as the reference standard. RESULTS A total of 15 studies with 808 patients were included in the primary analysis. The sensitivity of ultrasound for detecting complete Achilles tendon ruptures was 94.8% (95% confidence interval [CI] 91.3-97.2%), specificity was 98.7% (95% CI 97.0-99.6%), positive likelihood ratio was 74.0 (95% CI 31.0-176.8), and negative likelihood ratio was 0.05 (95% CI 0.03-0.09), in patients who underwent surgical treatment. CONCLUSIONS The results from our study suggested that a negative ultrasound result may have the potential to rule out a complete, as well as a partial, Achilles tendon rupture.
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Affiliation(s)
- Amir Aminlari
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Jennifer Stone
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Ryan McKee
- University of California San Diego School of Medicine, La Jolla, California
| | - Rachna Subramony
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Adam Nadolski
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Vaishal Tolia
- Department of Emergency Medicine, University of California San Diego, La Jolla, California.
| | - Stephen R Hayden
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
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Zhou H, Chen C, Zhang Y, Ugbolue UC. Ultrasound Color Doppler Measures Neovascularization in Achilles Tendinopathy: Review. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: Color Doppler ultrasonography (CD) has been used to employ in Achilles tendinopathy, there is a need to measure neovascularization in Achilles tendinopathy to reach a consensus for CD application. The object of this systematic retrospect is to summarize
the literature regarding whether is a relationship between the neovascularization and Achilles tendinopathy by CD detecting. Method: The databases search of PubMed, Scopus, and Embase extracted 543 articles for title and abstract review. After deleting duplicate papers and evaluating
which one meets the inclusion criteria, a total of 8 articles were selected. Results and conclusion: Differentiate a physiological and pathological color Doppler flow in Achilles tendon is important to further clinically diagnose, since neovascularization in tissue structure can be
influenced by variation reasons. The standardized tenoangiography protocol be supposed to develop when assessment asymptomatic or symptomatic tendons.
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Affiliation(s)
- Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - Chaoyi Chen
- School of Health and Life Sciences, University of the West of Scotland, Scotland, G72 0LH, UK
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - Ukadike Chris Ugbolue
- School of Health and Life Sciences, University of the West of Scotland, Scotland, G72 0LH, UK
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Evaluation of Current Symptoms in Postoperative Achilles Tendons: A Multimodal Ultrasound Study. Healthcare (Basel) 2021; 9:healthcare9030288. [PMID: 33807841 PMCID: PMC8000856 DOI: 10.3390/healthcare9030288] [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: 01/28/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: It is unknown which imaging parameters are associated with clinical persistent symptoms in postoperative Achilles tendons. This study used B-Mode, Power Doppler (PD-US), Ultrasound Tissue Characterization (UTC) and Shear Wave Elastography (SWE) to investigate which imaging parameters are associated with persistent symptoms in postoperative Achilles tendon tissue. (2) Methods: Retrospective, cross-sectional, multimodal imaging study. Based on the VISA-A score, postoperative tendons were assigned to two groups: 1. asymptomatic (VISA-A ≥ 90, n = 18); 2. symptomatic (VISA-A < 90, n = 10). The following imaging parameters were analyzed: UTC (echo type I, II, III, IV), B-Mode (diameter, cross sectional area, calcification, fiber irregularity), PD-US (Öhberg score) and SWE (SWE 3 mm, SWE area) using a t-test and a Mann–Whitney U test. (3) Results: SWE and PD-US showed significantly reduced elasticity and increased neovascularization in symptomatic tendons (SWE 3 mm p = 0.031, SWE area p = 0.046, Öhberg score p < 0.001). The only significant correlation between imaging parameters and the VISA-A score was assessed for SWE 3 mm (r = 0.378; p = 0.047) and the Öhberg score (r = −0.737; p < 0.001). Conclusions: Symptomatic postoperative Achilles tendons showed increased neovascularization and lower SWE values than asymptomatic ones. Future studies should examine the diagnostic accuracy of PD-US and SWE in detecting current symptoms in postoperative Achilles tendons.
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Silvers CA, Lowe R, Cortez E. A Step in the Right Direction: Point-of-Care Ultrasound as an Evaluation Tool of Achilles Tendon Injuries in the Emergency Department. Cureus 2020; 12:e11823. [PMID: 33409065 PMCID: PMC7781505 DOI: 10.7759/cureus.11823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This report describes the diagnosis of an Achilles tendon tear in a female patient with an inconclusive physical exam, which was limited by the patient’s body habitus. Expedient use of point-of-care ultrasound supported the diagnosis of an Achilles tear with findings of a tendinous defect, fibrous stranding, and surrounding anechoic fluid, suggestive of localized hemorrhage. The patient was splinted in plantar flexion and had prompt orthopedic referral with MRI that verified Achilles tear.
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Affiliation(s)
- Chase A Silvers
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
| | - Robert Lowe
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
| | - Eric Cortez
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
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Thierfelder KM, Gemescu IN, Weber MA, Meier R. [Injuries of ligaments and tendons of foot and ankle : What every radiologist should know]. Radiologe 2019; 58:415-421. [PMID: 29654331 DOI: 10.1007/s00117-018-0383-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Injuries of the ligaments and tendons of the ankle and foot are among the most common musculoskeletal injuries. A correct and precise description of the pathology and possible accompanying injuries is essential for treatment planning by trauma and orthopedic surgeons. While X‑ray is used to exclude fractures, ultrasound is a very useful tool to assess the ligaments and tendons. For the radiologist, magnetic resonance imaging (MRI) is invaluable regarding the correct assessment of (partial) ruptures, as well as for evaluating accompanying injuries. The aim of the present overview is to provide the most relevant facts for radiologists regarding injuries of ligaments and tendons of the ankle and foot. A description of expected MRI findings and possible pitfalls are presented. For each ligament complex or tendon, we review the anatomy, followed by relevant facts on biomechanics and typical findings in case of injury. The lateral and medial ligament complex, syndesmosis, spring ligament complex, and the Lisfranc ligament are shown in detail. The Achilles tendon and the peroneal tendons are also discussed.
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Affiliation(s)
- K M Thierfelder
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | - I N Gemescu
- Department of Radiology and Medical Imaging, University Emergency Hospital Bukarest, Bukarest, Rumänien
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland
| | - R Meier
- Klinik für Radiologie, Isarklinikum München, München, Deutschland
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