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Ceker E, Fadiloglu A, Cataltepe E, Sendur HN, Allahverdiyeva S, Varan HD. Predictive ability of Achilles tendon elastography for frailty in older adults. Eur Geriatr Med 2024:10.1007/s41999-024-01023-9. [PMID: 39090315 DOI: 10.1007/s41999-024-01023-9] [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: 05/31/2024] [Accepted: 07/12/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE The Achilles tendon (AT) is the largest and strongest tendon in the human body, and its elasticity is known to be affected by the aging process. However, the relation between AT stiffness and frailty in older individuals remains uncertain. This study aims to explore the potential of Achilles tendon shear wave elastography (AT-SWE) as a tool for assessing physical frailty in older adults. METHODS A total of 148 patients aged 65 years and over were included in this cross-sectional study. Patients with heart failure, AT injury, stroke history, active malignancy, and claudication were excluded. All patients underwent a comprehensive geriatric assessment. Physical frailty assessment was performed with the fried frailty phenotype. Achilles tendon elastography was measured by ultrasound. RESULTS The mean age of the participants was 73.8 years and 62.2% were female. 30.4% of the participants were defined as frail. Achilles tendon shear wave elastography measurements were statistically lower in the frail group (p < 0.05). In the multivariate regression analysis, AT-SWE demonstrated a statistically significant association with frailty independent of confounding factors (OR 0.982, 95% CI 0.965-0.999, p value = 0.038). In the ROC curve analysis, the area under the curve for AT-SWE was 0.647 (95% CI, 0.564-0.724, p < 0.01) and the optimum cut-off point was 124.1 kilopascals. CONCLUSION These findings highlight the value of AT-SWE as a non-invasive and objective tool for predicting frailty in older adults.
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Affiliation(s)
- Eda Ceker
- Faculty of Medicine, Department of Geriatric Medicine, Gazi University, 06560, Ankara, Turkey.
| | - Ayse Fadiloglu
- Faculty of Medicine, Department of Geriatric Medicine, Gazi University, 06560, Ankara, Turkey
| | - Esra Cataltepe
- Faculty of Medicine, Department of Geriatric Medicine, Gazi University, 06560, Ankara, Turkey
| | - Halit Nahit Sendur
- Faculty of Medicine, Department of Radiology, Gazi University, Ankara, Turkey
| | | | - Hacer Dogan Varan
- Faculty of Medicine, Department of Geriatric Medicine, Gazi University, 06560, Ankara, Turkey
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Zellers JA, Li R, Vaidya R, Lohse K, North A, Cui S, Houston B, Chen M, Zheng J, Baxter J. Minimal effect of scanning parameters on ultrasound shear wave elastography variability in tendons. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39031721 DOI: 10.1002/ksa.12325] [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: 01/09/2024] [Revised: 05/30/2024] [Accepted: 06/06/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Ultrasound shear wave elastography has potential use in assessing tendon tissue; however, reducing measurement variability remains challenging. The primary purpose of this study was to identify the amount of variability accounted for by ultrasound parameter (frequency, harmonics and CrossXBeam) settings on shear wave speed at two testing sites. METHODS Shear wave elastography images of the Achilles tendon were obtained from individuals with healthy tendons (n = 28) at two testing sites with standardised image acquisition/postprocessing protocols. Images were acquired at a range of frequencies (7-15 MHz) with CrossXBeam (a filtering technique) and harmonics settings toggled on and off. Variance decomposition analysis was performed to identify the amount of variability in shear wave speed accounted for by scan acquisition settings and testing sites. RESULTS Shear wave speed variance was primarily attributed to participants (56.87% of variance; residual error: 35%). All scanning parameters, testing site and interaction terms each accounted for less than 2.5% of the variance. A statistically significant, negative relationship was observed between shear wave speed and image quality (p = 0.001) suggesting poor image quality yields higher shear wave speed estimates. CONCLUSION The findings of this study suggest that natural variation in Achilles tendon mechanics between individuals without tendon pathology accounts for most of the shear wave speed variability. Optimising image quality, which may be observed in higher frequencies, should be considered to improve shear wave speed estimation. Clinically, this study highlights the need to take multiple images, maintain consistent ultrasound settings when tracking patient progress over time and use caution when comparing raw values from tendon scans performed in different clinics with shear wave elastography. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Ran Li
- Mallinkrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Rachana Vaidya
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Andrew North
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephane Cui
- Department of Biology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Bryson Houston
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Menghan Chen
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jie Zheng
- Mallinkrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Josh Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Pelea MA, Serban O, Badarinza M, Gutiu R, Fodor D. Shear-Wave Elastography of the Achilles tendon: reliability analysis and impact of parameters modulating elasticity values. J Ultrasound 2024:10.1007/s40477-024-00877-w. [PMID: 38613661 DOI: 10.1007/s40477-024-00877-w] [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: 01/18/2024] [Accepted: 01/31/2024] [Indexed: 04/15/2024] Open
Abstract
PURPOSE Shear wave elastography (SWE) has seen many advancements in Achilles tendon evaluation in recent years, yet standardization of this technique is still problematic due to the lack of knowledge regarding the optimal way to perform the examination. The purpose of this study was to evaluate the effects of ankle position, probe frequency and physical effort on the shear modulus of the Achilles tendon, but also to determine the intra and inter-observer reliability of the technique. METHODS 37 healthy volunteers were included; SWE protocol was performed by two examiners. We analyzed the shear modulus of the tendon with the ankle in neutral, maximum dorsiflexion and maximum plantar flexion using two different high frequency probes. Afterwards, the subjects performed a brief physical exercise and SWE measurements were repeated. RESULTS The L18-5 probe showed the highest ICC values (ICC = 0.798, 95% CI 0.660-0.880, p < 0.001) when positioned at 2 cm from the calcaneal insertion with the ankle in a neutral state. Conversely, utilizing the same L18-5 probe at 1 cm from the insertion during maximum plantar flexion of the ankle resulted in the lowest ICC (ICC = 0.422, 95% CI 0.032-0.655, p = 0.019). Significant variations in elasticity values were noted among different ankle positions and probe types, while no significant changes in elasticity were observed post-physical exercise. CONCLUSION Ankle position and probe frequency are factors that influence elasticity values of the Achilles tendon. An ankle position between 10 and 20 degrees of plantar flexion is the most suitable for SWE evaluation. However, more research focusing on Achilles tendon SWE is essential due to the challenges encountered in standardizing this region.
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Affiliation(s)
- Michael-Andrei Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania
| | - Maria Badarinza
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania.
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Iida N, Thoreson AR, Reisdorf RL, Tsukamoto I, El Hor H, Zhao C. Relationship Between the Changes of Tendon Elastic Moduli With Ultrasound Shear Wave Elastography and Mechanical Compression Test. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:586-591. [PMID: 38272742 DOI: 10.1016/j.ultrasmedbio.2024.01.001] [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: 09/05/2023] [Revised: 12/07/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the consistency of the changes in the elastic modulus measured with ultrasound shear wave elastography (SWE) with changes measured through mechanical testing using tendons that were artificially altered by chemical modifications. METHODS Thirty-six canine flexor digitorum profundus tendons were used for this experiment. To mimic tendon mechanical property changes induced by tendinopathy conditions, tendons were treated with collagenase to soften the tissue by collagen digestion or with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride (EDC) to stiffen the tissues through chemical crosslinking. Tendons were randomly assigned to one of three groups: immersion in phosphate-buffered saline (PBS) as a control group (n = 12), collagenase treatment (n = 12) or EDC treatment (n = 12). Immediately following SWE measurement of each tendon, mechanical compression testing was performed as a gold standard to validate the SWE measurement. Both tests were conducted before and after treatment. RESULTS The compressive modulus and SWE shear modulus significantly decreased after collagenase treatment. Conversely, both moduli significantly increased after EDC treatment. There was no significant difference in either modulus before or after PBS treatment. As a result of a regression analysis with the percentage change of the compressive modulus as the dependent variable and SWE shear modulus as the independent variable, the best-fit regression was found to be an exponential function and the coefficient of determination was 0.687. CONCLUSION The changes in the compressive moduli and SWE shear moduli in tendons induced by chemical treatments were correlated by approximately 70%.
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Affiliation(s)
- Naoya Iida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Ichiro Tsukamoto
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hicham El Hor
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Billy J, Bensamoun SF, Mercier J, Durand S. Applications of ultrasound elastography to hand and upper limb disorders. HAND SURGERY & REHABILITATION 2024; 43:101636. [PMID: 38215880 DOI: 10.1016/j.hansur.2024.101636] [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: 11/15/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/14/2024]
Abstract
Ultrasound elastography is a recently developed method for accurate measurement of soft tissue stiffness in addition to the clinician's subjective evaluation. The present review briefly describes the ultrasound elastography techniques and outlines clinical applications for tendon, muscle, nerve, skin and other soft tissues of the hand and upper limb. Strain elastography provides a qualitative evaluation of the stiffness, and shear-wave elastography generates quantitative elastograms superimposed on a B-mode image. The stiffness in degenerative tendinopathy and/or tendon injury was significantly lower than in a normal tendon in several studies. Elastography is also a reliable method to evaluate functional muscle activity, compared to conventional surface electromyography. The median nerve is consistently stiffer in patients with carpal tunnel syndrome than in healthy subjects, on whatever ultrasound elastography technique. Elastography distinguishes normal skin from scars and can be used to evaluate scar severity and treatment. Elastography has huge clinical applications in musculoskeletal tissues. Continued development of systems and increased training of clinicians will expand our knowledge of elastography and its clinical applications in the future.
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Affiliation(s)
- Jessica Billy
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sabine F Bensamoun
- Sorbonne University, Université de Technologie de Compiègne, CNRS UMR 7338, Biomechanics and Bioengineering, Compiègne, France
| | - Julie Mercier
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Sébastien Durand
- Department of Hand Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
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Liu M, Zheng Q, Zheng Y, Yao Y, Wang R, Ta D, Jiang L. Combined Assessment of 2-D Ultrasound and Real-Time Shear Wave Elastography of Low-Intensity Pulsed Ultrasound Therapy Efficacy in Rabbits with Achilles Tendinopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:407-413. [PMID: 38129224 DOI: 10.1016/j.ultrasmedbio.2023.12.001] [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: 07/18/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Low-intensity pulsed ultrasound (LIPUS) has been gradually used to treat Achilles tendinopathy. However, there are limited non-invasive and efficient instruments for monitoring LIPUS efficacy in Achilles tendinopathy. The purpose of this study was to assess the therapeutic effectiveness of LIPUS after Achilles tendinopathy by 2-D ultrasound and real-time shear wave elastography (SWE). METHODS Ninety New Zealand white rabbits were divided into control, sham and LIPUS groups after tendinopathy modeling. On days 1, 4, 7, 14 and 28, the Achilles tendon thickness and SWE Young's modulus on the long axis were measured. The tissues of the Achilles tendon were then evaluated histologically. RESULTS The mean SWE values increased while the average thickness and histologic scores decreased, especially in the LIPUS group (9.5% and 80.7% on day 28, respectively). The SWE values in the LIPUS group were significantly lower than those in the control group on day 1 (121.0 kPa vs. 177.6 kPa) and peaked on day 7 (173.7 kPa, p < 0.001). By day 28, the SWE value had approached that of the control (191.2 kPa vs. 192.4 kPa), and had been significantly higher than that in the sham group since day 7. SWE values and histologic scores were correlated (r = -0.792, p < 0.01). The average thickness decreased in the three groups but did not differ significantly. CONCLUSION Two-dimensional ultrasound is beneficial to the diagnosis of Achilles tendinopathy. SWE could quantify changes in Achilles tendon stiffness non-invasively during LIPUS treatment, enabling the study of early Achilles tendon healing after LIPUS treatment.
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Affiliation(s)
- Mengyao Liu
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Zheng
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yiwen Zheng
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijing Yao
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Wang
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dean Ta
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China; Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lixin Jiang
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Albano D, Basile M, Gitto S, Messina C, Longo S, Fusco S, Snoj Z, Gianola S, Bargeri S, Castellini G, Sconfienza LM. Shear-wave elastography for the evaluation of tendinopathies: a systematic review and meta-analysis. LA RADIOLOGIA MEDICA 2024; 129:107-117. [PMID: 37907673 DOI: 10.1007/s11547-023-01732-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To compare pathologic and healthy tendons using shear-wave elastography (SWE). METHODS A systematic review with meta-analysis was done searching Pubmed and EMBASE up to September 2022. Prospective, retrospective and cross-sectional studies that used SWE in the assessment of pathologic tendons versus control were included. Our primary outcome were SWE velocity (m/s) and stiffness (kPa). Methodological quality was assessed by the methodological index for non-randomized studies (MINORS). We used the mean difference (MD) with corresponding 95% confidence intervals (CIs) to quantify effects between groups. We performed sensitivity analysis in case of high heterogeneity, after excluding poor quality studies according to MINORS assessment. We used Grades of Recommendation, Assessment, Development and Evaluation to evaluate the certainty of evidence (CoE). RESULTS Overall, 16 studies with 676 pathologic tendons (188 Achilles, 142 patellar, 96 supraspinatus, 250 mixed) and 723 control tendons (484 healthy; 239 contralateral tendon) were included. Five studies (31.3%) were judged as poor methodological quality. Shear-wave velocity and stiffness meta-analyses showed high heterogeneity. According to a sensitivity analysis, pathologic tendons had a lower shear wave velocity (MD of - 1.69 m/s; 95% CI 1.85; - 1.52; n = 274; I2 50%) compared to healthy tendons with very low CoE. Sensitivity analysis on stiffness still showed high heterogeneity. CONCLUSION Pathological tendons may have reduced SWE velocity compared to controls, but the evidence is very uncertain. Future robust high-quality longitudinal studies and clear technical indications on the use of this tool are needed. PROTOCOL PROSPERO identifier: CRD42023405410 CLINICAL RELEVANCE STATEMENT: SWE is a relatively recent modality that may increase sensitivity and diagnostic accuracy of conventional ultrasound imaging promoting early detection of tendinopathy. Non-negligible heterogeneity has been observed in included studies, so our findings may encourage the conduct of future high-quality longitudinal studies which can provide clear technical indications on the use of this promising tool in tendon imaging.
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Affiliation(s)
- Domenico Albano
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy.
| | - Mariachiara Basile
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Gitto
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Longo
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Fusco
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Ziga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine - Department of Radiology, University of Ljubljana, Ljubljana, Slovenia
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
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Horvat U, Kozinc Ž. The Use of Shear-Wave Ultrasound Elastography in the Diagnosis and Monitoring of Musculoskeletal Injuries. Crit Rev Biomed Eng 2024; 52:15-26. [PMID: 38305275 DOI: 10.1615/critrevbiomedeng.2023049807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Ultrasound elastography is a valuable method employed to evaluate tissue stiffness, with shear-wave elastography (SWE) recently gaining significance in various settings. This literature review aims to explore the potential of SWE as a diagnostic and monitoring tool for musculoskeletal injuries. In total, 15 studies were found and included in the review. The outcomes of these studies demonstrate the effectiveness of SWE in detecting stiffness changes in individuals diagnosed with Achilles tendinopathy, Achilles tendon rupture, rotator cuff rupture, tendinosis of the long head of the biceps tendon, injury of the supraspinatus muscle, medial tibial stress syndrome, and patellar tendinopathy. Moreover, SWE proves its efficacy in distinguishing variations in tissue stiffness before the commencement and after the completion of rehabilitation in cases of Achilles tendon rupture and patellar tendinopathy. In summary, the findings from this review suggest that SWE holds promise as a viable tool for diagnosing and monitoring specific musculoskeletal injuries. However, while the field of ultrasound elastography for assessing musculoskeletal injuries has made considerable progress, further research is imperative to corroborate these findings in the future.
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Affiliation(s)
- Urša Horvat
- Univerza na Primorskem, Fakulteta za vede o zdravju, Polje 42, Izola, Slovenija
| | - Žiga Kozinc
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola, Slovenia; University of Primorska, Andrej Marušič Institute, Muzejski trg 2, SI-6000 Koper, Slovenia
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Uehara H, Itoigawa Y, Wada T, Morikawa D, Koga A, Maruyama Y, Ishijima M. Shear wave elastography correlates to degeneration and stiffness of the long head of the biceps tendon in patients undergoing tenodesis with arthroscopic shoulder surgery. J Shoulder Elbow Surg 2024; 33:e31-e41. [PMID: 37327988 DOI: 10.1016/j.jse.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/11/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Tendinopathy of the long head of the biceps (LHB) tendon causes degeneration and changes its stiffness. However, a reliable means of diagnosis has not been established. Shear wave elastography (SWE) provides quantitative tissue elasticity measurements. In this study, the relationship of preoperative SWE values with biomechanically measured stiffness and degeneration of the LHB tendon tissue was investigated. METHODS LHB tendons were obtained from 18 patients who underwent arthroscopic tenodesis. SWE values were measured preoperatively at 2 sites, proximal to and within the bicipital groove of the LHB tendon. The LHB tendons were detached immediately proximal to the fixed sites and at their superior labrum insertion. Tissue degeneration was histologically quantified using the modified Bonar score. Tendon stiffness was determined using a tensile testing machine. RESULTS The SWE values of the LHB tendon were 502.1 ± 113.6 kPa proximal to the groove and 439.4 ± 123.3 kPa within the groove. The stiffness was 39.3 ± 19.2 N/mm. The SWE values displayed a moderate positive correlation with the stiffness proximal to the groove (r = 0.80) and within it (r = 0.72). The SWE value of the LHB tendon within the groove showed a moderate negative correlation with the modified Bonar score (r = -0.74). CONCLUSIONS These findings suggest that preoperative SWE values of the LHB tendon correlate moderately positively with stiffness and moderately negatively with tissue degeneration. Therefore, SWE may predict LHB tendon tissue degeneration and changes in stiffness caused by tendinopathy.
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Affiliation(s)
- Hirohisa Uehara
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Tomoki Wada
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akihisa Koga
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Althoff AD, Vance K, Plain M, Reeves RA, Pierce J, Gwathmey FW, Werner BC. Evaluation of Achilles Tendon Stiffness as Measured by Shear Wave Elastography in Female College Athletes Compared With Nonathletes. Sports Health 2024; 16:12-18. [PMID: 36856196 PMCID: PMC10732119 DOI: 10.1177/19417381231153657] [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] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND We sought to utilize a noninvasive technology to assess the effects of activity on Achilles tendon stiffness and define baseline Achilles tendon stiffness in female college athletes compared with nonathletes using tendon shear wave velocity as a marker for tendon stiffness. HYPOTHESIS Training status and exercise may affect Achilles tendon stiffness. STUDY DESIGN LEVEL OF EVIDENCE Level 4. METHODS A total of 32 college-age female athletes were prospectively enrolled (n = 17 varsity athletes and n = 15 nonathletes). Demographic characteristics, activity level, and previous injuries were recorded. Sonographic shear wave elastography (SWE) was used to assess Achilles tendon shear wave velocity bilaterally for all subjects, both at baseline and after 2 minutes of exercise. Student t tests were used to compare the mean elastography measurements between participants stratified by athlete status and pre/postexercise stimulus. Analysis of variance (ANOVA) was used to compare the mean proximal, middle, and distal Achilles tendon elastography measurements. RESULTS As seen by a greater mean shear wave velocity (8.60 ± 1.58 m/s vs 8.25 ± 1.89 m/s; P = 0.02), athletes had stiffer tendons than nonathletes. Exercise stimulus decreased average tendon shear wave velocity (8.57 ± 1.74 m/s vs 8.28 ± 1.72 m/s; P = 0.05). Tendon shear wave velocity was greatest proximally and least distally with significant differences between each region (P < 0.001). In addition, there was a significant 2-way interaction between weekly training status and foot dominance (P = 0.01). Post hoc analysis showed that this result was due to differences in tendon shear wave velocity between the dominant and nondominant lower extremity in nonathletes (7.73 ± 2.00 m/s vs 8.76 ± 1.62 m/s; P < 0.001). CONCLUSION Female varsity collegiate athletes have higher baseline Achilles tendon stiffness as measured by SWE compared with nonathletes. Mean tendon stiffness varies based on Achilles measurement location. SWE is a quick, cost-effective, and noninvasive imaging modality that can be used to evaluate tendon stiffness and elasticity. CLINICAL RELEVANCE SWE is an efficient and noninvasive imaging modality that can evaluate dynamic tendon stiffness and elasticity. SWE may be helpful to assess injuries in female college athletes and may play a role in risk stratification or clinical follow-up. In theory, SWE could be used to identify athletes with increased elasticity as a marker for potential risk for rupture in this population.
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Affiliation(s)
- Alyssa D. Althoff
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Kayleigh Vance
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Megan Plain
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Russell A. Reeves
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jennifer Pierce
- Department of Radiology, University of Virginia, Charlottesville, Virginia
| | - Frank W. Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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11
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Takaba K, Takenaga T, Tsuchiya A, Takeuchi S, Fukuyoshi M, Nakagawa H, Matsumoto Y, Saito M, Futamura H, Futamura R, Sugimoto K, Murakami H, Yoshida M. Plantar flexion with inversion shows highest elastic modulus of calcaneofibular ligament using ultrasound share wave elastography. J Ultrasound 2023; 26:765-770. [PMID: 35513766 PMCID: PMC10632312 DOI: 10.1007/s40477-022-00687-y] [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: 03/12/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The functional role of the calcaneofibular ligament (CFL) is still controversial. We aimed to investigate the anatomical features of the CFL on sonography and the elastic modulus of the CFL in different ankle positions using ultrasound shear-wave elastography (SWE). METHODS In 14 cadaveric ankles, the angle of the CFL with respect to the long axis of the fibula was measured in the following ankle positions: neutral (N), 30° plantar flexion (PF), and 20° dorsiflexion (DF). In addition, in 24 ankles of healthy adult volunteers, the elastic modulus of the CFL was evaluated with ultrasound SWE in the following ankle positions: neutral (N), 30° plantar flexion with inversion (PI), 30° plantar flexion with eversion (PE), 20° dorsiflexion with inversion (DI), and 20° dorsiflexion with eversion (DE). RESULTS The mean angle of the CFL in N, PF, and DF positions was 139.9° ± 12.7°, 121.3° ± 14.1°, and 158.6° ± 13.1°, respectively. The angle of the CFL in N was significantly greater than that in PF and smaller than that in DF (P < 0.0001, both). The mean elastic modulus of the CFL in the N, PI, PE, DI, and DE positions was: 63.6 ± 50.8, 148.0 ± 39.4, 75.8 ± 40.6, 88.1 ± 31.6, and 61.7 ± 29.4 kPa, respectively. The elastic modulus in PI was significantly higher than in other positions, while the values obtained in DI and DE were also significantly different (P < 0.001, both). CONCLUSIONS The angle of the CFL increased with DF. Moreover, ultrasound SWE showed that the CFL was tensed and likely to be injured in the PI position.
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Affiliation(s)
- Keishi Takaba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Tetsuya Takenaga
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Atsushi Tsuchiya
- Arthroscopy and Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan
| | - Satoshi Takeuchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
- Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | | | | | | | | | | | | | | | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Masahito Yoshida
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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12
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Schneebeli A, Barbero M, Filardo G, Testa E, Riegger M, Sangiorgio A, Cescon C, Soldini E, Falla D. Shear Wave Tensiometry Can Detect Loading Differences Between Operated and Unaffected Achilles Tendon. Foot Ankle Int 2023; 44:1295-1304. [PMID: 37924256 DOI: 10.1177/10711007231201156] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
BACKGROUND The clinically relevant healing process of a ruptured and repaired Achilles tendon (AT) can last more than a year. The purpose of this cross-sectional study was to test if shear wave tensiometry is able to detect AT loading changes between a surgically managed AT rupture versus the unaffected contralateral tendon. Our secondary aims were to evaluate differences in mechanical properties when measured with myotonometry and morphological properties of the tendons measured with ultrasonographic imaging. METHODS Twenty-one patients with surgically treated AT ruptures were investigated 12-37 months after surgery. Tendon load was measured using a shear wave tensiometer composed of an array of 4 accelerometers fixed on the tendon. Shear wave speed along the Achilles tendon was evaluated at different levels of ankle torque for both the operated and the unaffected side. Mechanical properties of the tendons were evaluated using MyotonPRO and morphological properties using ultrasonographic imaging. Friedman test was used to assess differences in AT wave speed, stiffness, thickness, and cross-sectional area between the operated and the unaffected tendon. RESULTS We found a significant shear wave speed difference between sides at every ankle joint torque (P < .05) with a large effect size for the lowest ankle torque and small to medium effect sizes for higher ankle torque. Stiffness, thickness, and cross-sectional area of the operated tendon remained significantly higher compared to the unaffected side. CONCLUSION In this cohort, we found that shear wave tensiometry can detect differences between operated and unaffected AT during a standardized loading procedure. The shear wave speed along the operated tendon, as well as the mechanical and morphologic properties, remains higher for 1-3 years after a rupture. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Alessandro Schneebeli
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Enrique Testa
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Martin Riegger
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Alessandro Sangiorgio
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Corrado Cescon
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Emiliano Soldini
- Competence Centre for Healthcare Practices and Policies, Department of Business Economics, Health, and Social Care, University of Applied. Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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13
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Römer C, Legerlotz K, Czupajllo J, Fischer T, Wolfarth B, Lerchbaumer MH. Acute Effects of Running on Shear Wave Elastography Measures of the Achilles Tendon and Calf Muscles in Professional Female Handball and Volleyball Players. Diagnostics (Basel) 2023; 13:2957. [PMID: 37761324 PMCID: PMC10530130 DOI: 10.3390/diagnostics13182957] [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: 07/06/2023] [Revised: 08/27/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Shear Wave Elastography (SWE) is currently used to detect tissue pathologies, i.e., tendinopathy. For preventive medicine, it is important to examine the sensitivity of SWE and to investigate how stiffness measures are affected by methodological variables. The aim of this study is to examine shear wave elastography (SWE) measures in order to compare the pre- and post-running values and to determine the correlation between the shear wave speed values (m/s). SWE examinations of the Achilles tendon (AT), soleus muscle (MS) and gastrocnemius muscle (MG)) were performed in 24 healthy professional female athletes. Measurements of the shear wave speed (m/s) were taken before and after incremental treadmill running until exhaustion. Correlations were investigated using the Pearson correlation coefficient and were examined for significance using the Student's t-test. The pre- and post-exercise shear wave speed did not differ. The pre-exercise and post-exercise stiffness for MS (r = 0.613), MG (r = 0.609) and AT (r = 0.583) correlated strongly. The pre-exercise values and changes in stiffness showed a significant correlation (p < 0.001). In professional athletes, acute exercise induces different tissue stiffness changes in AT, MS and MG for each individual. Thus, exercise activity immediately prior to the SWE measurement needs to be factored in when evaluating tissue stiffness.
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Affiliation(s)
- Claudia Römer
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Thomas Fischer
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
- Department of Radiology, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
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14
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Hogaboom N, Shaw J, Barrance P, Capella T, Malanga G. A pilot study testing an Achilles tendinopathy human cadaver model using intratendinous injection of collagenase. Clin Biomech (Bristol, Avon) 2023; 107:106034. [PMID: 37413812 DOI: 10.1016/j.clinbiomech.2023.106034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Achilles tendinopathy is one of the most frequently occurring soft-tissue injuries. Despite decades of research, there is still much that is unknown about the progression of tendinopathy. Animal models, such as collagenase injection, allow researchers to gain insight into disease progression and investigate clinical interventions, yet are limited in their direct application to humans. Establishment of a cadaver model of tendinopathy would provide another method of investigating clinical interventions in human tissues. The purpose of this study is to develop such a model and evaluate biomechanical changes in cadaveric Achilles tendons using ultrasound elastography. METHODS Achilles tendons of five female foot/ankle cadavers were injected with two different concentrations (three with 10 mg/mL, two 20 mg/mL) of collagenase and incubated for 24 h. Ultrasound elastography images were collected at baseline, 16 and 24 h post-injection. Elasticity of tendons was calculated using a custom image analysis program. FINDINGS Elasticity decreased over time in both dosage groups. In the 10 mg/mL group, mean elasticity decreased from 642 ± 246 kPa at baseline to 392 ± 38.3 kPa at 16 h and 263 ± 87.3 kPa at 24 h. In the 20 mg/mL group, mean elasticity decreased from 628 ± 206 kPa at baseline to 176 ± 152 kPa at 16 h and 188 ± 120 kPa at 24 h. INTERPRETATION Injection of collagenase into cadaveric Achilles tendons resulted in decreases in elasticity. Decreases were observed in tendons that received injections with both 10 and 20 mg/mL collagenase dosages. Further biomechanical and histological testing is needed to evaluate this cadaveric tendinopathy.
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Affiliation(s)
- Nathan Hogaboom
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, 183 South Orange Avenue, Suite F-1560, Newark, NJ 07101, USA.
| | - Jonathan Shaw
- Tendonova, 3050 Business Park Drive, Suite A-2, Norcross, GA 30071, USA
| | - Peter Barrance
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, 183 South Orange Avenue, Suite F-1560, Newark, NJ 07101, USA
| | - Teresa Capella
- New Jersey Regenerative Institute, 197 Ridgedale Avenue, Suite 210, Cedar Knolls, NJ 07927, USA
| | - Gerard Malanga
- Tendonova, 3050 Business Park Drive, Suite A-2, Norcross, GA 30071, USA; New Jersey Regenerative Institute, 197 Ridgedale Avenue, Suite 210, Cedar Knolls, NJ 07927, USA
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15
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Yoshida K, Itoigawa Y, Morikawa D, Maruyama Y, Ishijima M. Chronologic Changes in the Elastic Modulus of a Healing Achilles Tendon Rupture Measured Using Shear Wave Elastography. Foot Ankle Int 2023; 44:243-250. [PMID: 36788728 DOI: 10.1177/10711007221151083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Shear wave elastography (SWE) has been used to examine the elasticity of a ruptured Achilles tendon; however, the healing process of a ruptured tendon has not been studied yet. This study aimed to detail the change in mechanical properties of a healing Achilles tendon rupture managed conservatively or surgically using SWE. METHODS Using a prospective cohort study design, we evaluated the patients treated conservatively (conservative group) and surgically (surgical group) with the "gift-box" technique for an isolated index acute Achilles tendon rupture during their healing process. SWE measurements were taken of both the injured and uninjured sides every 4 weeks up to 24, 36, and 48 weeks after treatment. Additionally, tendon thickness and power Doppler (PD) grade were measured at the same time points as SWE measurements. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot rating system score and Achilles tendon Total Rupture Score (ATRS) were compared at 24 and 48 weeks. RESULTS The ruptured Achilles tendon obtained an SWE value comparable with the unruptured side at 12 weeks in the conservative group and at 4 weeks with surgical group. The surgical group had significantly higher SWE values up to 24 weeks compared with the conservative group. Additionally, this group had a significantly larger increase in tendon thickness in nearly all periods. Both treatment groups were comparable regarding the PD grade, AOFAS score, and ATRS. CONCLUSION SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Our analysis using SWE has revealed the detailed chronologic changes in SWE values and related mechanical properties of a healing Achilles tendon rupture, which can be used for devising appropriate rehabilitation protocols. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Keiichi Yoshida
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan.,Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Daichi Morikawa
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan.,Department of Medicine for Orthopedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
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16
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Hussien AA, Niederoest B, Bollhalder M, Goedecke N, Snedeker JG. The Stiffness-Sensitive Transcriptome of Human Tendon Stromal Cells. Adv Healthc Mater 2023; 12:e2101216. [PMID: 36509005 DOI: 10.1002/adhm.202101216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/20/2022] [Indexed: 12/14/2022]
Abstract
Extracellular matrix stiffness is a major regulator of cellular states. Stiffness-sensing investigations are typically performed using cells that have acquired "mechanical memory" through prolonged conditioning in rigid environments, e.g., tissue culture plastic (TCP). This potentially masks the full extent of the matrix stiffness-driven mechanosensing programs. Here, a biomaterial composed of 2D mechanovariant silicone substrates with simplified and scalable surface biofunctionalization chemistry is developed to facilitate large-scale cell culture expansion processes. Using RNA sequencing, stiffness-mediated mechano-responses of human tendon-derived stromal cells are broadly mapped. Matrix elasticity (E.) approximating tendon microscale stiffness range (E. ≈ 35 kPa) distinctly favors transcriptional programs related to chromatin remodeling and Hippo signaling; whereas compliant stiffnesses (E. ≈ 2 kPa) are enriched in processes related to cell stemness, synapse assembly, and angiogenesis. While tendon stromal cells undergo dramatic phenotypic drift on conventional TCP, mechanovariant substrates abrogate this activation with tenogenic stiffnesses inducing a transcriptional program that strongly correlates with established tendon tissue-specific expression signature. Computational inference predicts that AKT1 and ERK1/2 are major stiffness-sensing signaling hubs. Together, these findings highlight how matrix biophysical cues may dictate the transcriptional identity of tendon cells, and how matrix mechano-reciprocity regulates diverse sets of previously underappreciated mechanosensitive processes in tendon fibroblasts.
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Affiliation(s)
- Amro A Hussien
- Institute for Biomechanics, ETH Zurich, Zurich, 8092, Switzerland.,Balgrist University Hospital, University of Zurich, Zurich, 8008, Switzerland
| | - Barbara Niederoest
- Institute for Biomechanics, ETH Zurich, Zurich, 8092, Switzerland.,Balgrist University Hospital, University of Zurich, Zurich, 8008, Switzerland
| | - Maja Bollhalder
- Institute for Biomechanics, ETH Zurich, Zurich, 8092, Switzerland.,Balgrist University Hospital, University of Zurich, Zurich, 8008, Switzerland
| | - Nils Goedecke
- Institute for Biomechanics, ETH Zurich, Zurich, 8092, Switzerland.,Balgrist University Hospital, University of Zurich, Zurich, 8008, Switzerland
| | - Jess G Snedeker
- Institute for Biomechanics, ETH Zurich, Zurich, 8092, Switzerland.,Balgrist University Hospital, University of Zurich, Zurich, 8008, Switzerland
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17
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Li F, Wang K, Liu Z. In Vivo Biomechanical Measurements of the Cornea. BIOENGINEERING (BASEL, SWITZERLAND) 2023; 10:bioengineering10010120. [PMID: 36671692 PMCID: PMC9854753 DOI: 10.3390/bioengineering10010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023]
Abstract
In early corneal examinations, the relationships between the morphological and biomechanical features of the cornea were unclear. Although consistent links have been demonstrated between the two in certain cases, these are not valid in many diseased states. An accurate assessment of the corneal biomechanical properties is essential for understanding the condition of the cornea. Studies on corneal biomechanics in vivo suggest that clinical problems such as refractive surgery and ectatic corneal disease are closely related to changes in biomechanical parameters. Current techniques are available to assess the mechanical characteristics of the cornea in vivo. Accordingly, various attempts have been expended to obtain the relevant mechanical parameters from different perspectives, using the air-puff method, ultrasound, optical techniques, and finite element analyses. However, a measurement technique that can comprehensively reflect the full mechanical characteristics of the cornea (gold standard) has not yet been developed. We review herein the in vivo measurement techniques used to assess corneal biomechanics, and discuss their advantages and limitations to provide a comprehensive introduction to the current state of technical development to support more accurate clinical decisions.
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Affiliation(s)
- Fanshu Li
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Health Science Center, Peking University, Beijing 100191, China
| | - Kehao Wang
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, Beihang University, Beijing 100191, China
| | - Ziyuan Liu
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Health Science Center, Peking University, Beijing 100191, China
- Correspondence:
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18
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Hao CJ, Xiao WL, Zhang QB, Tan XM. Viscoelasticity in trapezius myofascial pain syndrome: quantitative assessment using Real-Time Shear-Wave Elastography. Ann Med 2023; 55:2252442. [PMID: 37676997 PMCID: PMC10486288 DOI: 10.1080/07853890.2023.2252442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVE To investigate the differences in the viscoelastic properties between normal trapezius muscles and those in patients with trapezius myofascial pain syndrome (MPS) using real-time shear-wave elastography (SWE). MATERIALS AND METHODS This study included 31 patients with trapezius MPS and 31 volunteers. Sixty-one trapezius muscles (41 and 20 on the affected and non-affected side, respectively) of patients with MPS and 62 normal trapezius muscles in volunteers were assessed. Conventional ultrasonic parameters, including skeletal muscle thickness, resistance index (RI), and mean shear wave velocity (SWVmean) of trapezius muscles, were obtained in the seated position with the shoulders and neck relaxed. The daily neck leaning time (unit:hours) of all participants was obtained using a questionnaire. RESULTS Ultrasound showed no statistically significant differences in thickness or RI of the trapezius muscles of the affected and non-affected sides in MPS patients versus normal trapezius muscles (p = 0.976 and 0.106, respectively). In contrast, the SWVmean of trapezius muscles in patients with MPS was significantly higher than that of normal trapezius muscles in both the affected and non-affected sides (4.41 ± 1.02 m/s vs. 3.35 ± 0.79 m/s, p < 0.001; 4.05 ± 0.63 m/s vs. 3.35 ± 0.79 m/s, p = 0.002). There was no significant difference between the SWVmean of the trapezius muscles on the affected and non-affected sides in patients with MPS (4.41 ± 1.02 m/s vs. 4.05 ± 0.63 m/s, p = 0.225). Correlation analysis showed that daily neck forward time was positively correlated with the SWVmean of the trapezius muscles on the affected and non-affected sides in patients with MPS (r = 0.635, p < 0.001; r = 0.576, p = 0.008). CONCLUSION SWE can quantitatively evaluate stiffness of trapezius muscles in patients with trapezius MPS. The stiffness of both affected and non-affected trapezius muscles increased in patients with trapezius MPS, and the degree of increase positively correlated with the time of cervical forward leaning.
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Affiliation(s)
- Chang-Juan Hao
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Wen-Li Xiao
- Department of Ultrasound, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
| | - Quan-Bin Zhang
- Department of Ultrasound, Sixth Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Mei Tan
- Device management and maintenance center, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Shanxi Tongji Hospital, Taiyuan, China
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19
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Guerri G, Palozzo A, Straticò P, Varasano V, Celani G, Di Francesco P, Vignoli M, Petrizzi L. 2D-SWE of the Metacarpophalangeal Joint Capsule in Horses. Vet Sci 2022; 9:vetsci9090478. [PMID: 36136694 PMCID: PMC9501397 DOI: 10.3390/vetsci9090478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Two-dimensional shear wave elastography (2D-SWE) employs an ultrasound impulse to produce transversely oriented shear waves, which travel through the surrounding tissue according to the stiffness of the tissue itself. The study aimed to assess the reliability of 2D-SWE for evaluating the elastosonographic appearance of the distal attachment of the fetlock joint capsule (DJC) in sound horses and in horses with osteoarthritis (OA) (2). According to a thorough evaluation of metacarpophalangeal joint (MCPJ), adult horses were divided in a sound Group (H) and in OA Group (P). Thereafter, a 2D-SWE of MCPJs was performed. Shear wave velocity (m/sec) and Young’s modulus (kPa) were calculated independently by two operators at each selected ROI. Statistical analysis was performed with R software. (3) Results: 2D-SWE had good–excellent inter-CC and intra-CC in both groups. Differences in m/s and kPa between Groups H and P were found in transverse scans with lower values in Group P. No correlation with age or DJC thickness was found. (4) Conclusions: 2D-SWE was repeatable and reproducible. In Group H, DJC was statistically stiffer than in Group P only in transverse scan. The technique showed poor sensitivity and specificity in differentiating fetlocks affected by OA.
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Affiliation(s)
- Giulia Guerri
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Adriana Palozzo
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Paola Straticò
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
- Correspondence:
| | - Vincenzo Varasano
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Gianluca Celani
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | | | - Massimo Vignoli
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Lucio Petrizzi
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
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20
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Ozbalci AB, Piskin A. Clinical Significance of Shear Wave Ultrasound Elastography in Patients With Idiopathic Adhesive Capsulitis: Can It Be Used Instead of Magnetic Resonance Imaging as an Early Indicator? Ultrasound Q 2022; 38:250-256. [PMID: 35394993 DOI: 10.1097/ruq.0000000000000603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The aim of this study was to evaluate the elasticity of the supraspinatus (SSp) and infraspinatus (ISp) tendons and coracohumeral ligament (CHL), as well as the thickness of CHL in patients diagnosed with adhesive capsulitis (AC) using ultrasound (US) and 2D shear wave elastography (2D-SWE), determining their contributions to diagnosis and stage differentiation.This prospective case-control study was conducted between January 2020 and May 2021. In all cases, the ultrasound examinations were performed using the virtual touch quantification and expressed as shear wave velocity (SWV) in meters per second. After US examinations, magnetic resonance imaging (MRI) was planned for all cases.The measurements made in US and MRI revealed that CHL thicknesses and SWV values of CHL and SSp and ISp tendons were statistically substantially higher in the patient group. The diagnostic performance of 2D-SWE in predicting AC was evaluated using receiver operating characteristics curve analysis. When the cutoff value of the mean SWE for CHL was taken as 4.67 m/s, the sensitivity of SWE was found to be 90.2% and the specificity 85.7%.Our study results suggest that CHL thickness on B-mode US, as well as SWV values of CHL and SSp and ISp tendons in 2D-SWE examination, can be used as a useful tool for AC diagnosis without the need for MRI, a costly and time-consuming examination.
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Affiliation(s)
| | - Ahmet Piskin
- Department of Orthopedics and Traumatology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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21
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Takaba K, Takenaga T, Tsuchiya A, Takeuchi S, Fukuyoshi M, Nakagawa H, Futamura H, Futamura R, Sugimoto K, Murakami H, Yoshida M. Elasticity of the Scalene Muscles in Collegiate Baseball Pitchers Using Shear Wave Elastography. Orthop J Sports Med 2022; 10:23259671221114930. [PMID: 36003968 PMCID: PMC9393373 DOI: 10.1177/23259671221114930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Thoracic outlet syndrome is more common in overhead athletes. The anterior and middle scalene muscles have been associated with thoracic outlet syndrome; however, the relationship between the elastic moduli of the scalene muscles and the overhead-throwing position has not been evaluated. Purpose: To investigate the elastic moduli of the anterior and middle scalene muscles in simulated throwing positions using shear wave elastography. Study Design: Descriptive laboratory study. Methods: We enrolled collegiate baseball players who underwent preseason medical checkups in January and February 2020. The anterior and middle scalene muscles were visualized in the short-axis view using ultrasound. In this view, the elastic moduli of the anterior and middle scalene muscles were measured using shear wave elastography in the following arm and neck positions: (1) adduction and neutral rotation of the shoulder (neutral), (2) 90° of abduction and external rotation of the shoulder (ABER), and (3) ABER with neck rotation toward the nonthrowing side (ABER+NR). Repeated-measures analysis of variance and a paired t test were used to compare the elastic modulus values among the 3 positions and between the 2 muscles, respectively. Results: Overall, 30 baseball players were included. In both scalene muscles, the elastic moduli were significantly greater in the ABER versus neutral position (anterior scalene: 14.4 ± 3.8 vs 9.4 ± 2.0 kPa, respectively [P < .001]; middle scalene: 15.8 ± 5.0 vs 10.9 ± 3.4 kPa, respectively [P < .001]). In the neutral position, the elastic modulus was significantly greater in the middle scalene than the anterior scalene (10.9 ± 3.4 vs 9.4 ± 2.0 kPa, respectively; P = .03). In the ABER+NR position, the elastic modulus was significantly greater in the anterior scalene than the middle scalene (18.1 ± 4.6 vs 15.8 ± 2.6 kPa, respectively; P = .03). Conclusion: Because the ABER position was a simulation of the throwing position, these results indicate that this position could be associated with high elastic moduli of the scalene muscles, and both the anterior and middle scalene muscles may be involved.
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Affiliation(s)
- Keishi Takaba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuya Takenaga
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Tsuchiya
- Arthroscopy and Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan
| | - Satoshi Takeuchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | | | | | | | | | | | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahito Yoshida
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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22
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Saha D, Prakash M, Sinha A, Singh T, Dogra S, Sharma A. Role of Shear-Wave Elastography in Achilles Tendon in Psoriatic Arthritis and Its Correlation with Disease Severity Score, Psoriasis Area and Severity Index. Indian J Radiol Imaging 2022; 32:159-165. [PMID: 35924126 PMCID: PMC9340198 DOI: 10.1055/s-0042-1743116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose
The aim of this study was to compare accuracy of shear-wave elastography (SWE) with gray scale (GS) ultrasound and power Doppler (pD) for diagnosing Achilles tendinopathy in psoriatic patients with and without arthritis and correlation with achillodynia and disease severity score, psoriasis area and severity index (PASI).
Methods
A total of 100 Achilles tendons were evaluated where 56% were cases of psoriatic arthritis with achillodynia; 44% were controls of psoriasis without arthritis in this prospective study. Evaluation was done with GS, pD, SWE at proximal, mid, and distal third of the tendon. Qualitative (color maps) and quantitative data, elastic modulus, kilopascal (kPa), were generated. Pearson's correlation was done to see association between kPa, PASI and clinical symptoms, achillodynia, scored using visual analog scale (VAS).
Results
Significant negative correlation was seen between duration of arthritis, VAS and PASI with SWE values with
r
= −0.34, −0.47, and −0.41, respectively. SWE could identify abnormal tendons in 71/100 (71%) in the overall study, 53/56 (94.6%) in cases, and 18/44 (40.9%) in control. The statistical significance was set at
p
≤ 0.05. In comparison, conventional ultrasound, GS, and pD together could identify 13/56 (23.21%) in cases and no abnormal tendon was identified in the control group.
Conclusion
SWE is a reliable, noninvasive, and valuable tool to detect early tendinopathy and monitor progression of disease.
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Affiliation(s)
- Debajyoti Saha
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anindita Sinha
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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The Achilles Tendon: Imaging Diagnoses and Image-Guided Interventions- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219:355-368. [PMID: 35506554 DOI: 10.2214/ajr.22.27632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Achilles tendon is commonly affected by both chronic repetitive overuse and traumatic injuries. Achilles tendon injuries can potentially affect any individual but have a particularly high incidence in professional athletes. Appropriate imaging evaluation and diagnosis are paramount to guiding appropriate management. In this AJR Expert Panel Narrative Review, we discuss the role of various imaging modalities (particularly ultrasound and MRI) in the assessment of Achilles tendon pathology, focusing on modalities' relative advantages and technical considerations. We describe the most common diagnoses affecting the Achilles tendon and adjacent structures, highlighting key imaging findings and providing representative examples. Various image-guided interventions that may be employed in the management of Achilles tendon pathology are also reviewed, including high-volume injection, tendon fenestration, prolotherapy, and corticosteroid injection. The limited evidence supporting such interventions are summarized, noting an overall paucity of large-scale studies showing benefit. Finally, a series of consensus statements by the panel on imaging and image-guided intervention for Achilles tendon pathology are provided.
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Khair RM, Stenroth L, Cronin NJ, Reito A, Paloneva J, Finni T. Muscle-tendon morphomechanical properties of non-surgically treated Achilles tendon 1-year post-rupture. Clin Biomech (Bristol, Avon) 2022; 92:105568. [PMID: 35066440 DOI: 10.1016/j.clinbiomech.2021.105568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/12/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Achilles tendon rupture appears to alter stiffness and length of the tendon. These alterations may affect the function of tendon in force transmission and in energy storage and recovery. We studied the mechanical properties of the Achilles' tendon post-rupture and their association with function. METHODS Twenty-four (20 males, 4 females) participants (mean age: 43 y, 176 cm, 81 kg) were recruited. Ultrasonography and dynamometry were used to assess the muscle-tendon unit morphological and mechanical properties of non-surgically treated patients 1-year post rupture. FINDINGS Injured tendons were longer with difference of 1.8 cm (95%CI: 0.5-1.9 cm; P < 0.001), and thicker by 0.2 mm (0.2-0.3 mm; P < 0.01). Medial gastrocnemius cross-sectional area was 1.0 cm2 smaller (0.8-1.1 cm2; P < 0.001), fascicles were 0.6 cm shorter (0.5-0.7 cm; P < 0.001) and pennation angle was 2.5° higher (1.3-3.6°; P < 0.001) when compared to the uninjured limb. We found no differences between injured and uninjured tendon stiffness 1-year post-rupture (mean difference: 29.8 N/mm, -7.7-67.3 N/mm; P = 0.170). The injured tendon showed 1.8 mm (1.2-2.4 mm; P < 0.01) lower elongation during maximal voluntary isometric contractions. Patient-reported functional outcome was related to the tendon resting length (β = 0.68, r(10) = 4.079, P = 0.002). Inter-limb differences in the medial gastrocnemius fascicle length were related to inter-limb differences in maximum contractions (β = 1.17, r(14) = 2.808, P = 0.014). INTERPRETATION Longer Achilles tendon resting length was associated with poorer self-evaluated functional outcome. Although the stiffness of non-surgically treated and uninjured tendons was similar 1-year post rupture, plantar flexion strength deficit was still present, possibly due to shorter medial gastrocnemius fascicle length.
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Affiliation(s)
- Ra'ad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland; School of Sport & Exercise, University of Gloucestershire, UK
| | | | - Juha Paloneva
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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Kuervers EJ, Firminger CR, Edwards WB. Effect of Knee Angle and Quadriceps Muscle Force on Shear-Wave Elastography Measurements at the Patellar Tendon. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2167-2175. [PMID: 34001405 DOI: 10.1016/j.ultrasmedbio.2021.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 06/12/2023]
Abstract
Shear-wave elastography (SWE) is a non-invasive imaging technique that provides estimates of tissue stiffness via shear-wave speed measurements. No standardized protocol currently exists for SWE of the patellar tendon, which may be influenced by knee angle and quadriceps muscle force. In this study, the reliability of SWE in cadaveric patellar tendons was examined at three knee angles (0°, 30° and 60°) and three quadriceps muscle forces (0, 50 and 100 N). Shear-wave speed was significantly higher at a knee angle of 60° than at 0° or 30° (increases of 7% and 9%, respectively), and when the quadriceps muscle force was greater than or equal to 50 N (increase of 15%). SWE of the patellar tendon displayed excellent repeatability regardless of knee angle as long as no quadriceps force was generated (intra-class correlation coefficient ≥0.91). This research illustrates the importance of controlling knee angle and quadriceps force for consistency and comparison of SWE results.
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Affiliation(s)
- Emily J Kuervers
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Colin R Firminger
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada.
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Zellers JA, Baxter JR, Silbernagel KG. Functional Ankle Range of Motion but Not Peak Achilles Tendon Force Diminished With Heel-Rise and Jumping Tasks After Achilles Tendon Repair. Am J Sports Med 2021; 49:2439-2446. [PMID: 34115525 PMCID: PMC8282709 DOI: 10.1177/03635465211019436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Deficits in sporting performance after Achilles tendon repair may be due to changes in musculotendinous unit structure, including tendon elongation and muscle fascicle shortening. PURPOSE/HYPOTHESIS The purpose was to discern whether Achilles tendon rupture reduces triceps surae muscle force generation, alters functional ankle range of motion, or both during sports-related tasks. We hypothesized that individuals who have undergone Achilles tendon repair lack the functional ankle range of motion needed to complete sports-related tasks. STUDY DESIGN Descriptive laboratory study. METHODS The study included individuals 1 to 3 years after treatment of Achilles tendon rupture with open repair. Participants (n = 11) completed a heel-rise task and 3 jumping tasks. Lower extremity biomechanics were analyzed using motion capture. Between-limb differences were tested using paired t test. RESULTS Pelvic vertical displacement was reduced during the heel-rise (mean difference, -12.8%; P = .026) but not during the jumping task (P > .1). In the concentric phase of all tasks, peak ankle plantarflexion angle (range of mean difference, -19.2% to -48.8%; P < .05) and total plantar flexor work (defined as the area under the plantar flexor torque - ankle angle curve) (range of mean difference, -9.5% to -25.7%; P < .05) were lower on the repaired side relative to the uninjured side. No significant differences were seen in peak Achilles tendon load or impulse with any of the tasks. There were no differences in plantar flexor work or Achilles tendon load parameters during eccentric phases. CONCLUSION Impaired task performance or increased demands on proximal joints were observed on the repaired side in tasks isolating ankle function. Tasks that did not isolate ankle function appeared to be well recovered, although functional ankle range of motion was reduced with rupture. Reduced plantar flexor muscle-tendon unit work supports previous reports that an elongated tendon and shorter muscle fascicles caused by Achilles tendon rupture constrain functional capacity. Achilles tendon peak load and impulse were not decreased, suggesting that reduced and shifted functional ankle range of motion (favoring dorsiflexion) underlies performance deficits. CLINICAL RELEVANCE These findings point to the need to reduce tendon elongation and restore muscle length of the triceps surae after Achilles tendon rupture in order to address musculature that is short but not necessarily weak for improved performance with sports-related activities.
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Affiliation(s)
- Jennifer A. Zellers
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Josh R. Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
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27
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Gimber LH, Daniel Latt L, Caruso C, Nuncio Zuniga AA, Krupinski EA, Klauser AS, Taljanovic MS. Ultrasound shear wave elastography of the anterior talofibular and calcaneofibular ligaments in healthy subjects. J Ultrason 2021; 21:e86-e94. [PMID: 34258033 PMCID: PMC8264467 DOI: 10.15557/jou.2021.0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/26/2021] [Indexed: 12/26/2022] Open
Abstract
Aim of study Most sprained lateral ankle ligaments heal uneventfully, but in some cases the ligament’s elastic function is not restored, leading to chronic ankle instability. Ultrasound shear wave elastography can be used to quantify the elasticity of musculoskeletal soft tissues; it may serve as a test of ankle ligament function during healing to potentially help differentiate normal from ineffective healing. The purpose of this study was to determine baseline shear wave velocity values for the lateral ankle ligaments in healthy male subjects, and to assess inter-observer reliability. Material and methods Forty-six ankles in 23 healthy male subjects aged 20–40 years underwent shear wave elastography of the lateral ankle ligaments performed by two musculoskeletal radiologists. Each ligament was evaluated three times with the ankle relaxed by both examiners, and under stress by a single examiner. Mean shear wave velocity values were compared for each ligament by each examiner. Inter-observer agreement was evaluated. Results The mean shear wave velocity at rest for the anterior talofibular ligament was 2.09 ± 0.3 (range 1.41–3.17); and for the calcaneofibular ligament 1.99 ± 0.36 (range 1.29–2.88). Good inter-observer agreement was found for the anterior talofibular ligament and calcaneofibular ligament shear wave velocity measurements with the ankle in resting position. There was a significant difference in mean shear wave velocities between rest and stressed conditions for both anterior talofibular ligament (2.09 m/s vs 3.21 m/s; p <0.001) and calcaneofibular ligament (1.99 m/s vs 3.42 m/s; p <0.0001). Conclusion Shear wave elastography shows promise as a reproducible method to quantify ankle ligament stiffness. This study reveals that shear waves velocities of the normal lateral ankle ligaments increased with applied stress compared to the resting state.
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Affiliation(s)
- Lana H Gimber
- Department of VA - Menlo Park Campus, Uniformed Services University, National Teleradiology Program, United States
| | - L Daniel Latt
- Department of Orthopaedic Surgery, The University of Arizona College of Medicine Banner-University Medical Center, United States
| | - Chelsea Caruso
- Department of Medical Imaging, The University of Arizona College of Medicine Banner-University Medical Center, United States
| | | | | | | | - Mihra S Taljanovic
- Department of Medical Imaging, The University of Arizona College of Medicine Banner-University Medical Center, United States
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Yang Y, Wu Y, Zhou K, Wu D, Yao X, Heng BC, Zhou J, Liu H, Ouyang H. Interplay of Forces and the Immune Response for Functional Tendon Regeneration. Front Cell Dev Biol 2021; 9:657621. [PMID: 34150755 PMCID: PMC8213345 DOI: 10.3389/fcell.2021.657621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023] Open
Abstract
Tendon injury commonly occurs during sports activity, which may cause interruption or rapid decline in athletic career. Tensile strength, as one aspect of tendon biomechanical properties, is the main parameter of tendon function. Tendon injury will induce an immune response and cause the loss of tensile strength. Regulation of mechanical forces during tendon healing also changes immune response to improve regeneration. Here, the effects of internal/external forces and immune response on tendon regeneration are reviewed. The interaction between immune response and internal/external forces during tendon regeneration is critically examined and compared, in relation to other tissues. In conclusion, it is essential to maintain a fine balance between internal/external forces and immune response, to optimize tendon functional regeneration.
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Affiliation(s)
- Yuwei Yang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yicong Wu
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Ke Zhou
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongmei Wu
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xudong Yao
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Boon Chin Heng
- Central Laboratories, School of Stomatology, Peking University, Beijing, China
| | - Jing Zhou
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hua Liu
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongwei Ouyang
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, and Department of Orthopedic Surgery of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, and Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
- Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China
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29
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Sarto F, Spörri J, Fitze DP, Quinlan JI, Narici MV, Franchi MV. Implementing Ultrasound Imaging for the Assessment of Muscle and Tendon Properties in Elite Sports: Practical Aspects, Methodological Considerations and Future Directions. Sports Med 2021; 51:1151-1170. [PMID: 33683628 PMCID: PMC8124062 DOI: 10.1007/s40279-021-01436-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2021] [Indexed: 12/16/2022]
Abstract
Ultrasound (US) imaging has been widely used in both research and clinical settings to evaluate the morphological and mechanical properties of muscle and tendon. In elite sports scenarios, a regular assessment of such properties has great potential, namely for testing the response to training, detecting athletes at higher risks of injury, screening athletes for structural abnormalities related to current or future musculoskeletal complaints, and monitoring their return to sport after a musculoskeletal injury. However, several practical and methodological aspects of US techniques should be considered when applying this technology in the elite sports context. Therefore, this narrative review aims to (1) present the principal US measures and field of applications in the context of elite sports; (2) to discuss, from a methodological perspective, the strengths and shortcomings of US imaging for the assessment of muscle and tendon properties; and (3) to provide future directions for research and application.
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Affiliation(s)
- Fabio Sarto
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Daniel P Fitze
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonathan I Quinlan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health Research, Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Marco V Narici
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- CIR-MYO Myology Centre, University of Padova, Padova, Italy
| | - Martino V Franchi
- Department of Biomedical Sciences, University of Padova, Padova, Italy.
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30
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Schneebeli A, Folli A, Falla D, Barbero M. Reliability of Sonoelastography Measurements of Lower Limb Tendon Properties: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1131-1150. [PMID: 33516588 DOI: 10.1016/j.ultrasmedbio.2020.12.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
This study investigated the reliability of sonoelastography techniques in quantifying lower limb tendon elasticity. A literature search was conducted using PubMed, Web of Science and CINAHL. The quality of the selected papers was evaluated using the Guidelines for Reporting Reliability and Agreement Studies and the Quality Appraisal Tool for Studies of Diagnostic Reliability checklist. Reliability values were extracted and synthesized. Twenty-four studies were included and were divided by the two main technologies used: strain and shear-wave elastography. The overall methodological quality was questionable; all studies were at risk of bias. Highly variable results ranging from poor to excellent reliability were found for both technologies and for all tendons considered. Intra-rater reliability of strain elastography on the Achilles tendon and shear-wave elastography on the patellar and quadriceps tendon was adequate. Inter-rater, inter-session and inter-machine reliability was insufficient. Caution should be used when interpreting results from sonoelastography studies measuring lower limb tendon elasticity.
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Affiliation(s)
- Alessandro Schneebeli
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland.
| | - Anna Folli
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
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The Value of Real-Time Shear Wave Elastography before and after Rehabilitation of Upper Limb Spasm in Stroke Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2020:6472456. [PMID: 32923483 PMCID: PMC7453236 DOI: 10.1155/2020/6472456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/10/2020] [Indexed: 12/30/2022]
Abstract
Objective Our goal was to evaluate the efficacy of muscle spasm before and after rehabilitation by comparing shear wave propagation velocity (SWV) and Young's modulus (YM) in the normal and spastic biceps brachii in stroke patients. Methods A study of 60 stroke patients with upper limb spasm was performed; these patients were admitted from April 2018 to September 2019. The modified Ashworth scale (MAS) scores of the spastic biceps brachii before and after rehabilitation treatment were compared. SWV and YM on the spastic and normal biceps brachii before rehabilitation treatment, SWV and YM on the spastic and normal biceps brachii after rehabilitation treatment, and SWV and YM on the spastic biceps brachii before and after rehabilitation treatment were compared. Whether SWV and YM on the spastic biceps brachii are related to MAS was compared. Results There was a statistically significant difference in SWV and YM between the normal and spastic biceps brachii before (P < 0.01) and after (P < 0.05) the rehabilitation treatment. There was no statistically significant difference in SWV and YM in the normal biceps brachii before and after the rehabilitation treatment (P > 0.05). There was a statistically significant difference in SWV and YM in the spastic biceps brachii before and after the rehabilitation treatment (P < 0.01). SWV and FM of the spastic biceps brachii are correlated with MAS before and after rehabilitation treatment, and the correlation coefficient for SWV was 0.563 and 0.605 for YM (P < 0.05). Conclusion SWE can be used as a means of assessment before and after rehabilitation treatment.
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Quarato CMI, Venuti M, Dimitri L, Lacedonia D, Simeone A, Mirijello A, Cosmo SD, Maiello E, Taurchini M, Scioscia G, Barbaro MPF, Copetti M, Sperandeo M. Transthoracic ultrasound shear wave elastography for the study of subpleural lung lesions. Ultrasonography 2021; 41:93-105. [PMID: 34218607 PMCID: PMC8696150 DOI: 10.14366/usg.21021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/15/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The aim of this study was to assess whether new-generation shear wave elastography (SWE) is suitable for the characterization of lung subpleural lesions. METHODS In total, 190 consecutive patients with subpleural lung lesions received ultrasonography and SWE. Patients with suspected malignancy underwent ultrasound-guided transthoracic needle biopsy. Final diagnoses were made on the basis of patients' clinical course, microbiological studies, and histological results. SWE was also performed in 25 healthy volunteers. RESULTS We found no statistically significant differences in stiffness between lung carcinomas, lung metastases, and pneumonia (P=0.296) or between different histological types of lung cancer (P=0.393). Necrosis was associated with reduced stiffness in pneumonia. Excluding necrotic lesions, pneumonia showed higher stiffness than lung carcinomas (2.95±0.68 m/s vs. 2.60±0.54 m/s, P=0.006). Chronic pneumonia showed increased stiffness (3.03±0.63 m/s), probably due to the presence of fibrotic tissue on histology. Pleural effusion was associated with a statistically significant reduction in stiffness, both in lung carcinomas (P=0.004) and lung metastases (P=0.002). The presence of air in healthy lung tissue may lead to incorrect speed estimates due to shear wave reflection (very high values, 14.64±2.19 m/s). CONCLUSION Transthoracic SWE could not distinguish lung malignancy from pneumonia, or between different histological types of lung carcinomas. In particular, SWE seems unable to resolve the clinical dilemma of chronic subpleural consolidations.
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Affiliation(s)
- Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Mariapia Venuti
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Lucia Dimitri
- Unit of Pathology, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Anna Simeone
- Department of Radiology, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Mirijello
- Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Salvatore De Cosmo
- Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Evaristo Maiello
- Unit of Oncology, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Marco Taurchini
- Unit of Thoracic Surgery, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, Policlinico Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound, Department of Internal Medicine, IRCCS Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
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Mutlu S, Erdem Toslak I, Inci A, Cekic B, Yavuz A. Evaluation of the Achilles Tendon Using B-Mode Ultrasound and Strain Elastography in Patients With Chronic Kidney Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:771-778. [PMID: 32856750 DOI: 10.1002/jum.15453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the B-mode ultrasound (US) features and elasticity of the Achilles tendon in patients with chronic kidney disease (CKD) using US elastography and to compare them with those of healthy individuals. METHODS From March 2019 through May 2019, 30 consecutive patients with variable stages of CKD and 30 healthy individuals were prospectively included in this study. Ultrasound and strain elastographic examinations were performed on both Achilles tendons of all individuals. Degrees of tendinopathy, if existed, were classified as defined by Archambault et al (J Clin Ultrasound 1998; 26:335-339), and thicknesses were documented with US. Strain ratios (SRs) were calculated by measuring the strain values from the Achilles tendon and Kager fat pad. Statistical differences in the SRs of Achilles tendons between the control group and patients with CKD were calculated. RESULTS The 30 patients with CKD ranged in age from 24 to 73 years, and the 30 healthy individuals ranged in age from 25 to 78 years. Both distal and left middle thirds of the Achilles tendons were thicker in patients with CKD than in healthy individuals (P < .05). The mean SRs ± SDs in the patient group (4.71 ± 0.95 and 4.85 ± 1.47 on the right and left, respectively) were significantly higher (P < .05) than in healthy individuals (2.31 ± 0.42 and 2.65 ± 0.55 on the right and left), which indicated an increased stiffness of Achilles tendons in the patient group. CONCLUSIONS As a semiquantitative and noninvasive imaging modality, strain elastography has the potential to detect the morphologic and elasticity changes of Achilles tendons in patients with CKD, which may give an opportunity to help physicians predict possible leading partial or complete tears.
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Affiliation(s)
- Samet Mutlu
- Department of Radiology, University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Iclal Erdem Toslak
- Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Ayca Inci
- Department of Internal Medicine Division of Nephrology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Bulent Cekic
- Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
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TURNAOĞLU H, ALTAY F, KURAL RAHATLI F, BOZKUŞ Y, TURHAN İYİDİR Ö, HABERAL KM. Acoustic radiation force impulse elastography findings of achilles tendon in patients with hypothyroidism. TURKISH JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.46310/tjim.869648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Laubach M, Hellmann JT, Dirrichs T, Gatz M, Quack V, Tingart M, Betsch M. Anterior knee pain after total knee arthroplasty: A multifactorial analysis. J Orthop Surg (Hong Kong) 2021; 28:2309499020918947. [PMID: 32338135 DOI: 10.1177/2309499020918947] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Dissatisfaction and an impaired quality of life after total knee arthroplasty (TKA) is often associated with postsurgical anterior knee pain (AKP). The underlying pathological mechanisms are not yet fully understood. Therefore, a multifactorial approach encompassing clinical and radiological parameters seemed reasonable and promising to investigate postsurgical AKP. METHODS In this cross-sectional study, 25 patients without and 25 patients with postsurgical AKP after unilateral TKA were randomly recruited from a larger cohort of patients. Multiple clinical and radiological parameters-including real-time shear wave elastography (SWE) to measure the patellar and quadriceps tendon elasticity-were acquired and subsequently associated with AKP. For statistical analysis, SPSS (IBM, version 25) was used. RESULTS In total 50 participants (58.0% men, mean age 63.42 years, mean body mass index 29.75 kg/m2), having different prosthetic designs implanted, were included. Independently of key covariates, the strength of the quadriceps muscle (p = 0.021), a thinner inlay (p = 0.041), and a lower position of the patella (p = 0.041) were associated with AKP. Although no correlation with AKP was found (p = 0.346, resp. p = 0.154), we observed significantly decreased Young's modulus of the patellar and quadriceps tendons for the involved knee compared to the uninvolved knee (p < 0.001). CONCLUSION In conclusion, quadriceps muscle strength, inlay thickness, and the patella position might be of particular relevance in avoiding postsurgical AKP. Future studies with larger sample sizes are needed to clarify the impact of quadriceps muscle strength and the postoperative patella position as well as the role of SWE as a personalized modifiable prediction marker.
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Affiliation(s)
- Markus Laubach
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Julian Tr Hellmann
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Matthias Gatz
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopaedics, RWTH Aachen University Hospital, Aachen, Germany
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Bang JY, Hahn S, Yi J, Lim YJ, Jung HK. Clinical applicability of shear wave elastography for the evaluation of medial epicondylitis. Eur Radiol 2021; 31:6726-6735. [PMID: 33634322 DOI: 10.1007/s00330-021-07791-3] [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: 08/05/2020] [Revised: 01/26/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the ability of shear wave elastography (SWE) in diagnosing medial epicondylitis and to compare the diagnostic performance of SWE with that of grey-scale ultrasound (GSU) and strain elastography (SE). METHODS GSU, SE, and SWE were performed on 61 elbows of 54 patients from March 2018 to April 2019. An experienced radiologist evaluated the GSU findings (swelling, cortical irregularity, hypoechogenicity, calcification, and tear), colour Doppler findings (hyperaemia), SE findings (strain ratio [SR]), and SWE findings (stiffness and shear wave velocity [SWV]). Participants were divided in two groups: patients with clinically diagnosed medial epicondylitis and patients without medial elbow pain. Findings from the two groups were compared, and the receiver operating characteristic (ROC) curves were calculated for significant features. RESULTS Of the 54 patients, 25 patients with 28 imaged elbows were clinically diagnosed with medial epicondylitis and 29 patients with 33 imaged elbows had no medial elbow pain. Cortical irregularity, hypoechogenicity, calcification, hyperaemia, SR, stiffness, and SWV were significantly different between the two groups. The areas under the ROC curves were 0.838 for hypoechogenicity, 0.948 for SR, 0.999 for stiffness, and 0.999 for SWV. The diagnostic performances of SR, stiffness, and SWV were significantly superior compared to that of hypoechogenicity. However, there were no significant differences among SR, stiffness, and SWV. CONCLUSIONS SWE can obtain both stiffness and SWV, which are valuable diagnostic tools in the diagnosis of medial epicondylitis. The diagnostic performance of SWE and SE is similar in detecting medial epicondylitis. KEY POINTS • Shear wave elastography providing stiffness and shear wave velocity showed excellent performance in the diagnosis of medial epicondylitis. • There was no significant difference in the ability of SE and SWE for diagnosing medial epicondylitis.
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Affiliation(s)
- Jin-Young Bang
- Department of Orthopaedic Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Seok Hahn
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea.
| | - Jisook Yi
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Yun-Jung Lim
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
| | - Hyun Kyung Jung
- Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 48108, Republic of Korea
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Material Properties of the Medial Elbow During Passive Valgus and Self-Initiated Varus Torques. J Appl Biomech 2021; 37:52-58. [DOI: 10.1123/jab.2020-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/17/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022]
Abstract
Shear wave elastography imaging of the ulnar collateral ligament (UCL) is used to help understand changes in material properties of the ligament. Ensuring that the wrist flexors are relaxed is essential as muscle contractions can alter the alignment of the medial elbow. The purpose of this study was to determine how the structural and material properties of the medial elbow respond to various elbow torques. The medial elbows of 20 healthy adults, free from upper extremity disorders, were imaged in 3 of the following torque conditions: (1) neutral relaxed, (2) passive valgus, and (3) active varus. Structural properties (ulnohumeral gap and UCL length) using B-mode and material properties (UCL and flexor muscle stiffness) using shear wave were measured. Passive valgus torque opened the ulnohumeral gap (P < .001), and increased UCL (P < .001) and wrist flexor stiffness (P = .001), compared with the neutral condition. Under an active varus contraction, the gap returned back to the neutral position, but UCL (P < .008) and wrist flexor stiffness (P < .004) remained elevated compared with neutral, meaning low-intensity torques can influence structural and material properties of the medial elbow. Therefore, effort should be taken to minimize muscle activation during imaging in order to accurately measure medial elbow properties.
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Bai X, Liu Z, Wang B. Shear Wave Elastography (SWE) Evaluation of Asymptomatic Flexor Pollicis Longus Tendon Condition After Volar Plate Fixation for Distal Radius Fracture. Int J Gen Med 2021; 14:187-193. [PMID: 33500654 PMCID: PMC7822231 DOI: 10.2147/ijgm.s290017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to evaluate asymptomatic flexor pollicis longus (FPL) tendon condition after volar plate fixation for distal radius fracture using shear wave elastography (SWE). Methods We evaluated 36 distal radius fractures with shear wave elastography to evaluate the FPL tendon after volar plate fixation. Ultrasonography was used to measure the FPL distance to the volar plate in the involved wrists, and the thickness of the FPL tendon in the involved wrists was measured on SWE sonograms taken 12 months postoperatively. Measurements of the involved wrists were compared with those of the intact wrists. The radiographic parameters and Soong grade were collected to analyze the correlation between these indicators and the value of the Young’s modulus and asymptomatic tendon injury. Results The mean values of the Young’s modulus for involved wrist were lower than for intact wrist tendons. The values of the Young’s modulus were correlated with the FPL distance, radial inclination, and Soong grade. FPL tendons of involved wrists exhibited in the majority a yellow (intermediate) SWE signal, compared to intact wrist tendons, which exhibited a red (hard) signal in the vast majority, and there were significant differences between the involved and intact wrist. Conclusion FPL tendon may develop asymptomatically changes after volar locking plate fixation of distal radius fractures, which can be detected by SWE effectively. FPL distance, radial accretion, and Soong grade may be the main causes of asymptomatic FPL tendon erosion.
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Affiliation(s)
- Xiaodong Bai
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Zhenyu Liu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
| | - Baojun Wang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, People's Republic of China
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Abstract
OBJECTIVE. The purpose of this article is to cover technical advances in musculo-skeletal ultrasound from the viewpoint of the radiologist. CONCLUSION. Among the advances in musculoskeletal ultrasound that we highlight the use of ultrahigh-frequency transducers to visualize ever-finer anatomic detail, the expanding practical clinical applications for microvascular imaging, and the use of elastography to predict function and, possibly, healing potential.
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Laurent D, Walsh L, Muaremi A, Beckmann N, Weber E, Chaperon F, Haber H, Goldhahn J, Klauser AS, Blauth M, Schieker M. Relationship between tendon structure, stiffness, gait patterns and patient reported outcomes during the early stages of recovery after an Achilles tendon rupture. Sci Rep 2020; 10:20757. [PMID: 33247156 PMCID: PMC7695820 DOI: 10.1038/s41598-020-77691-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 11/05/2020] [Indexed: 11/09/2022] Open
Abstract
After an Achilles tendon (AT) injury, the decision to return to full weightbearing for the practice of sports or strenuous activities is based on clinical features only. In this study, tendon stiffness and foot plantar pressure, as objective quantitative measures that could potentially inform clinical decision making, were repeatedly measured in 15 patients until 3 months after the AT rupture by using shear wave elastography (SWE) and wearable insoles, respectively. Meanwhile, patient reported outcomes assessing the impact on physical activity were evaluated using the Achilles Tendon Total Rupture Score (ATRS). At week-2 post-injury, stiffness of the injured tendon varied from 6.00 ± 1.62 m/s (mean ± SD) close to the rupture to 8.91 ± 2.29 m/s when measured more distally. While near complete recovery was observed in distal and middle regions at week-8, the shear wave velocity in the proximal region recovered to only 65% of the contralateral value at week-12. In a parallel pre-clinical study, the tendon stiffness measured in vivo by SWE in a rat model was found to be strongly correlated with ex vivo values of the Young’s modulus, which attests to the adequacy of SWE for these measures. The insole derived assessment of the plantar pressure distribution during walking showed slight sub-optimal function of the affected foot at week-12, while the ATRS score recovered to a level of 59 ± 16. Significant correlations found between tendon stiffness, insole variables and distinct ATRS activities, suggest clinical relevance of tendon stiffness and foot plantar pressure measurements. These results illustrate how an alteration of the AT structure can impact daily activities of affected patients and show how digital biomarkers can track recovery in function over time.
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Affiliation(s)
- Didier Laurent
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland.
| | - Lorcan Walsh
- Novartis Ireland Ltd., Elm Park, Merrion Road, Dublin 4, Ireland
| | - Amir Muaremi
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland
| | - Nicolau Beckmann
- Musculoskeletal Diseases Area, Novartis Institutes for Biomedical Research, 4002, Basel, Switzerland
| | - Eckhard Weber
- Musculoskeletal Diseases Area, Novartis Institutes for Biomedical Research, 4002, Basel, Switzerland
| | - Frederique Chaperon
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland
| | - Harry Haber
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland
| | - Joerg Goldhahn
- Institute for Translational Medicine, ETH Zürich, HCP H 15.3, Leopold-Ruzicka-Weg 4, 8093, Zürich, Switzerland
| | - Andrea Sabine Klauser
- Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Michael Blauth
- Department of Trauma Surgery, Center Operative Medicine, University Hospital, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Matthias Schieker
- Translational Medicine Department, Novartis Institute for BioMedical Research, Fabrikstrasse 10-3.40.4, 4002, Basel, Switzerland
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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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Otter S, Payne C, Jones AM, Webborn N, Watt P. Differences in Achilles tendon stiffness in people with gout: a pilot study. BMC Musculoskelet Disord 2020; 21:658. [PMID: 33028270 PMCID: PMC7542740 DOI: 10.1186/s12891-020-03598-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background Gout has been associated with weaker foot/leg muscles and altered gait patterns. There is also evidence of on-going foot pain and an increased risk of tendinopathy, with the Achilles and patella tendons most frequently affected in gout. Additionally, the inflammation associated with gout may change tissue elasticity. Ultrasound imaging utilising shear wave elastography (SWE) offers a non-invasive method of quantifying changes in tendon stiffness. SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with gout compared to controls (non-gout). Methods A cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated, and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along the centre of a longitudinal section of the mid-portion of each Achilles tendon. Prior to data collection, intra-observer error was good (>0.69). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI). Results A small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04 m/s (95% CI (0.38 to 1.7) p = 0.003 and left Achilles mdiff = 0.7 m/s (95% CI 0.09 to 1.32) p = 0.025. No relationship between the presence of tophi and SWE values were detected. Conclusion Subjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.
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Affiliation(s)
- Simon Otter
- School of Health Sciences, University of Brighton, 49 Darley Rd, Eastbourne, BN20 7UR, UK. .,Centre for Regenerative Medicine and Devices, University of Brighton, Lewes Road, Brighton, BN2 4AT, UK.
| | - Catherine Payne
- School of Sport and Service Management, University of Brighton, Hillbrow, Denton Road, Eastbourne, BN20 7SR, UK
| | - Anna-Marie Jones
- Research and Development, Sussex Partnership NHS Foundation Trust, Swandean, Arundel Road, Worthing, BN13 3EP, UK
| | - Nick Webborn
- Centre for Regenerative Medicine and Devices, University of Brighton, Lewes Road, Brighton, BN2 4AT, UK
| | - Peter Watt
- Centre for Regenerative Medicine and Devices, University of Brighton, Lewes Road, Brighton, BN2 4AT, UK.,School of Sport and Service Management, University of Brighton, Hillbrow, Denton Road, Eastbourne, BN20 7SR, UK
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Evaluation of patellar tendon with shear wave elastography after anterior cruciate ligament reconstruction using hamstring tendons. Jt Dis Relat Surg 2020; 31:137-42. [PMID: 32160507 PMCID: PMC7489118 DOI: 10.5606/ehc.2020.71745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives
This study aims to evaluate the characteristics of patellar tendons (PTs) of patients who underwent anterior cruciate ligament reconstruction (ACLR) with hamstring tendon autograft using shear wave elastography (SWE). Patients and methods
This prospective study was conducted between August 2017 and February 2018. We performed brightness mode (B-mode) ultrasound and SWE on 21 patients (20 males, 1 female; mean age 32 years; range, 19 to 42 years) who underwent ACLR with a single-bundle transtibial technique using quadruple hamstring autografts and 14 healthy controls (13 males, 1 female; mean age 35 years; range, 25 to 47 years). Length and thickness of the PT were evaluated with B-mode ultrasound, while elasticity values were evaluated with SWE in the patient and control groups. Results
The mean SWE value of the patient group on the operated side was 25.30 (min-max=16.60-46.20) and on the non-operated side 23.20 (min-max=12.40-44). There were no statistically significant differences regarding PT elasticity, thickness, or length between the groups (p>0.05). Conclusion There were no differences regarding elasticity, length, or thickness between the operated and healthy knees detected with SWE. Upcoming research should focus on tendon biopsy and biochemical analyses for the identification of possible intrastructural changes of the tendon due to collagen synthesis after ACLR with hamstring autograft.
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Importance of shear-wave elastography in prediction of Achilles tendon rupture. INTERNATIONAL ORTHOPAEDICS 2020; 45:1043-1047. [PMID: 32613301 DOI: 10.1007/s00264-020-04670-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE It was demonstrated that about 6% of patients with a ruptured Achilles tendon experience the rupture of contralateral tendon in the future; the aim of this study was to estimate the risk for rupture of contralateral tendon in patients who underwent surgical reconstruction of ruptured Achilles tendon by using subjective questionnaires and shear-wave elastography. METHODS Twenty-four patients who underwent surgical repair of the ruptured Achilles tendon and twelve age-matched healthy controls were examined with ultrasound SWE. Functional outcomes were assessed with American Orthopedic Foot and Ankle Society (AOFAS) scoring system and subjective rating system which we introduced and validated. RESULTS The elasticity of injured tendon was markedly decreased (by 42%) compared to the contralateral tendon of the patient, as expected. Both AOFAS score and our novel subjective assessment scale positively correlate with ultrasound SWE values in ruptured Achilles tendons. The elasticity of contralateral Achilles tendons in patients was 23% lower than among healthy individuals. CONCLUSION Irrespective of the lack of difference in the subjective feeling assessed by AOFAS, the contralateral tendon in the patients with reconstructed Achilles tendon has significantly lower stiffness than healthy individuals. Therefore, contralateral tendons in patients who suffered from rupture are more prone to future ruptures.
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45
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Quack V, Betsch M, Hellmann J, Eschweiler J, Schrading S, Gatz M, Rath B, Tingart M, Laubach M, Kuhl CK, Dirrichs T. Evaluation of Postoperative Changes in Patellar and Quadriceps Tendons after Total Knee Arthroplasty-A Comprehensive Analysis by Shear Wave Elastography, Power Doppler and B-mode Ultrasound. Acad Radiol 2020; 27:e148-e157. [PMID: 31526688 DOI: 10.1016/j.acra.2019.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES Up to now, the diagnosis of tendinopathies is based on conventional B-mode-ultrasound (B-US), Power Doppler-ultrasound (PD-US), and magnetic resonance imaging. In the past decade, Shear Wave Elastography (SWE) has been introduced in tendon imaging, for example in athletes or patients suffering from tendinopathy. SWE allows real-time quantification of tissue stiffness, and, by this, the assessment of the mechanical properties of a tendon and its changes during acute disease and tendon healing. So far there are no ultrasound-based studies that have evaluated postoperative tendon changes, anatomical and mechanical properties and tendon healing of the patellar, and quadriceps tendon following Total Knee Arthroplasty (TKA). The purpose of this prospective study was two-fold: first to analyze morphologic, vascular, and mechanical properties of patellar and quadriceps tendons in patients following TKA; and, second to evaluate possible changes thereof and their visibility in the course of time. MATERIALS AND METHODS Observational cross-sectional, IRB-approved study in 63 postoperative patients with a total of 76 total knee arthroplasties (50 unilateral, 13 bilateral) and 50 nonoperated knees for comparison, resulting in 152 postoperative patellar- and quadriceps and 100 nonoperated patellar- and quadriceps-tendons for comparative analysis. For further examination, we divided the 63 patients into two groups according to the duration since surgery (group A < 24 months; group B > 24 months). All patients completed a standardized questionnaire, furthermore the Knee Society score and the Knee Society function score. The amount of experienced pain was assessed using the ordinal numeric rating scale and the presence of anterior knee pain was examined. Subsequently every participant underwent a standardized multimodal ultrasound protocol consisting of B-US, PD-US, and SWE of the left and right patellar and quadriceps tendons. RESULTS Using the different US-modalities, operated patellar, and quadriceps tendons (n = 152) were significantly more frequent classified as pathological (B-US) (p < 0.001), the mean Ohberg score was significantly higher (PD-US) (p < 0.001), and the tendons were significantly softer (SWE) than their nonoperated counterparts (n = 100). Mean SWE-value of postoperative patellar tendons was 45.66 ± 14.84 kPa versus 60.08 ± 19.13 kPa in nonoperated knees (p < 0.001). Mean SWE-value of postoperative quadriceps tendons was 35.73 ± 15.66 kPa versus 52.69 ± 16.20 kPa in nonoperated knees (p < 0.001). Comparing the two postoperative groups (group A and B), we recognized a significant decrease of pathologically classified patellar and quadriceps tendons (B-US and PD-US) in group B. The early postoperatively reduced SWE values slightly increased during the course of time. CONCLUSION After TKA, patellar, and quadriceps tendons show significant measurable alterations in B-US, PD-US, and SWE. Especially a significant decrease of tendon stiffness in operated knees, as assessed by SWE, might be a surrogate marker for changed mechanical properties. These alterations improve, the longer ago the surgery was. The quantitative information obtained by SWE could be of particular interest in follow-up and therapy monitoring after TKA. Knowledge about tendon stiffness and it's varieties in different population groups (e.g. athletes, elderly, postoperative patients) is crucial to sonographically rate a tendon as "healthy" or "diseased."
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Affiliation(s)
- Valentin Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Julian Hellmann
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Björn Rath
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Laubach
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
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Changes of Material Elastic Properties during Healing of Ruptured Achilles Tendons Measured with Shear Wave Elastography: A Pilot Study. Int J Mol Sci 2020; 21:ijms21103427. [PMID: 32408704 PMCID: PMC7279368 DOI: 10.3390/ijms21103427] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022] Open
Abstract
Therapy options for ruptured Achilles tendons need to take into account the right balance of timing, amount and intensity of loading to ensure a sufficient biomechanical resilience of the healing tendon on the one hand, and to enable an adequate tensile stimulus on the other hand. However, biomechanical data of human Achilles tendons after rupture during the separate healing stages are unknown. Shear wave elastography is an ultrasound technique that measures material elastic properties non-invasively, and was proven to have a very good correlation to biomechanical studies. Taking advantage of this technology, 12 patients who suffered from an acute Achilles tendon rupture were acquired and monitored through the course of one year after rupture. Nine of these patients were treated non-operatively and were included for the analysis of biomechanical behaviour. A significant increase of material elastic properties was observed within the first six weeks after trauma (up to 80% of baseline value), where it reached a plateau phase. A second significant increase occurred three to six months after injury. This pilot study suggests a time correlation of biomechanical properties with the biological healing phases of tendon tissue. In the reparative phase, a substantial amount of biomechanical resilience is restored already, but the final stage of biomechanical stability is reached in the maturation phase. These findings can potentially be implemented into treatment and aftercare protocols.
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47
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Diagnosing Muscle Atrophy by Use of a Comprehensive Method of Assessing the Elastic Properties of Muscle During Passive Stretching. AJR Am J Roentgenol 2020; 214:862-870. [PMID: 31887095 DOI: 10.2214/ajr.19.21174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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48
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Hsiao YY, Yang TH, Chen PY, Hsu HY, Kuo LC, Su FC, Huang CC. Characterization of the extensor digitorum communis tendon using high-frequency ultrasound shear wave elastography. Med Phys 2020; 47:1609-1618. [PMID: 32020648 DOI: 10.1002/mp.14061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/13/2019] [Accepted: 01/20/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Hand tendon injuries caused by various accidents are common in emergency departments. The assessment of tendon properties is crucial for evaluating the effectiveness of therapy or rehabilitation during recovery after hand injuries. Many recent studies have indicated that the shear wave velocity (SWV) of tendons is related to their stiffness. However, measurement of SWV of hand tendon is still a challenge because the small size of tendon and the limitation of existing ultrasound systems for detecting fast SWV. METHODS We propose a high-frequency ultrasound (HFUS) elastography system using an external vibrator to measure the SWV of the extensor digitorum communis (EDC) tendon. First, animal studies were performed by measuring the SWV and stress of porcine tendons using the proposed HFUS elastography and materials testing systems respectively. In the human experiment, SWVs were measured during hand extension and flexion. The applied stress from a finger during the movements was recorded synchronously by using a load cell. RESULTS The experimental results reveal that a favorable linear correction (R2 of 0.96) was obtained between tendon SWV and stress in animal studies. In the human (hand) EDC tendon experiments, the SWV increased with the extension and flexion of the hand. The SWV of the EDC tendon was in the range of 20 to 135 m/s as the applied force from the finger of a healthy human increased to 50% maximal voluntary contraction. CONCLUSIONS All the experimental results show that the proposed HFUS elastography system can be used to characterize the EDC tendon and has potential use for evaluating tendon stiffness during recovery after hand injures.
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Affiliation(s)
- Yan-Yi Hsiao
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 701, Taiwan
| | - Tai-Hua Yang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 701, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan City, 701, Taiwan.,Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, 704, Taiwan
| | - Pei-Yu Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 701, Taiwan
| | - Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan City, 704, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University, Tainan City, 701, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 701, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan City, 701, Taiwan
| | - Chih-Chung Huang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 701, Taiwan.,Medical Device Innovation Center, National Cheng Kung University, Tainan City, 701, Taiwan
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Hackett L, Aveledo R, Lam PH, Murrell GAC. Reliability of shear wave elastography ultrasound to assess the supraspinatus tendon: An intra and inter-rater in vivo study. Shoulder Elbow 2020; 12:18-23. [PMID: 32010229 PMCID: PMC6974886 DOI: 10.1177/1758573218819828] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/07/2018] [Accepted: 11/23/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Shear wave elastography ultrasound is a relatively new technique that evaluates the tissue elasticity by applying an acoustic radiation force impulse. It is undetermined how reliable this modality is in assessing rotator cuff tendons. The aim of this study, therefore, was to evaluate the reliability of shear wave elastography ultrasound to assess the stiffness of normal and tendinopathic supraspinatus tendons. METHODS An inter- and intra-rater reliability trial was carried out using shear wave elastography to assess the supraspinatus tendon at its distal insertion, by measuring shear wave velocity and elasticity. Twenty participants with a mean age of 37 (21-69) years old were evaluated. Ten subjects with normal supraspinatus tendon and 10 subjects with tendinopathic tendon were selected. The Virtual Touch Imaging Quantification program was used to generate the acoustic radiation force impulse and to obtain the elastography data. Three raters with different experience in conventional ultrasound were used for the inter-rater trial in normal tendons and the most experienced rater examined all subjects for the intra-rater reliability evaluation. Each rater obtained three readings in three different examinations per subject over a one-week period. RESULTS The mean (±SEM) shear wave velocity for the normal supraspinatus tendon was 9.96 ± 0.02 m/s (=297 kPa), while in the tendinopathic supraspinatus tendon was 8.3 ± 0.2 m/s (=207 kPa) (p < 0.001). The intra-rater trial agreement was excellent, with an intraclass correlation coefficient = 0.96. In the inter-rater testing, the mean shear wave velocity in normal tendons was 9.90 ± 0.07 m/s (=294 kPa), with intraclass correlation coefficient = 0.45. CONCLUSION Shear wave elastography ultrasound was able to show that tendinopathic tendons were less stiff than normal tendons. It was a reliable imaging technique to assess the supraspinatus tendon, especially when used by a single experienced musculoskeletal sonographer.
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Affiliation(s)
| | | | | | - George AC Murrell
- George Murrell, Orthopaedic Research
Institute, St George Hospital, Level 2, 4-10 South Street, Sydney, New South
Wales 2217, Australia.
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50
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Yoo SJ, Lee S, Song Y, Kim CK, Lee BG, Bae J. Elasticity of torn supraspinatus tendons measured by shear wave elastography: a potential surrogate marker of chronicity? Ultrasonography 2020; 39:144-151. [PMID: 32106664 PMCID: PMC7065989 DOI: 10.14366/usg.19035] [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: 06/18/2019] [Accepted: 01/02/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This study investigated whether shear wave elastography (SWE) could be used to estimate the chronicity of supraspinatus tendon (SST) tears. METHODS A retrospective study was performed. From November 2015 to July 2016, 113 patients (52 men, 61 women; age range, 21 to 79 years) with persistent shoulder pain underwent 119 rotator cuff tendon examinations by routine B-mode ultrasonography, while SST elasticity was measured using SWE. Following the exclusion of eight suboptimal examinations, four examinations with missing SST measurements, and 27 examinations of patients with other conditions, 80 examinations were analyzed. A torn SST was found in 54 examinations (27 with a partial-thickness tear and 27 with a full-thickness tear). Elasticity values were compared in multiple ways. The results were analyzed using the Mann-Whitney U test or Kruskal-Wallis test. RESULTS No statistically significant difference in elasticity values (in kPa) was found between normal (median, 94.65; interquartile range [IQR], 87.43 to 105.47) and torn SSTs (median, 96.79; IQR, 86.71 to 108.56) or between full-thickness tears (median, 93.80; IQR, 82.50 to 108.33) and partial-thickness tears (median, 96.83; IQR, 90.60 to 112.20). However, there was a statistically significant difference in elasticity according to whether the duration of symptoms was 1 year or less (median, 92.20; IQR, 84.01 to 104.38) or longer than 1 year (median, 105.10; IQR, 100.41 to 116.03; P=0.032). CONCLUSION Elasticity values were significantly higher in torn SSTs in patients with chronic shoulder pain that had persisted for more than 1 year. Further studies with larger samples seem warranted to determine whether elasticity values measured by SWE can be used preoperatively as a surrogate marker of the chronicity of a rotator cuff tendon tear.
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Affiliation(s)
- Seung-Jin Yoo
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Yoonah Song
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Chun Ki Kim
- Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Bong Gun Lee
- Department of Orthopedic Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jiyoon Bae
- Department of Pathology, National Police Hospital, Seoul, Korea
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