Abstract
Elastography can be used to estimate the regional shear modulus of a tendon. This can advance our knowledge on the impact of patellar alignment and regional patellar tendon stiffness. This is important as patellar tendon abnormality is mainly found in the medial portion of the tendon in subjects with proximal patellar tendinopathy. This paper aims to assess the effect of patellar displacement on differential modulation on the shear modulus of the patellar tendon. Shear modulus is captured on the medial and lateral half of the patella tendon using the Axiplorer® ultrasound unit in conjunction with a 4–15 MHz, 50 mm linear transducer with the patellar being positioned in its resting, medio- and laterally displaced positions on 40 adults (19 females, 21 males). When the patellar is displaced laterally, the shear modulus is significantly increased at the medial half in both genders but decreased at the lateral half only in females. Conclusions: Elastography detects changes in regional tendon stiffness associated with alteration in patellar positions. The modulation on the shear modulus is gender and region specific.
Highlights
Supersonic shear imaging technology (SSI) is a relatively new technique to measure stiffness of soft tissue in real time [1,2]
Test-retest reliability of patellar tendon shear modulus indicated good reliability for the lateral half (ICC = 0.94; 95% CI = 0.75 − 0.99) and medial half (ICC = 0.81; 95% CI = 0.17 − 0.96)
A larger q angle was associated with a greater reduction in the tendon shear modulus on the lateral half; and a smaller increase in the shear modulus on the medial half of the patellar tendon
Summary
Supersonic shear imaging technology (SSI) is a relatively new technique to measure stiffness of soft tissue in real time [1,2]. The study had good intra- and inter-rater reliability [4]. This new technique thereby enabled a non-invasive, direct and reliable measurement of tendon stiffness to be performed on a selected region of a tendon, providing a quantitative value. Assessment of regional tendon stiffness enabled a better understanding of mechanical demand/stress on selected regions of a tendon. This was important in the patellar tendon. Proximal patellar tendinopathy, a common knee problem, was found to have localized pathological changes, and the pathological changes were mainly detected in the medial portion of the tendon [5,6], site-specific evaluation at the different regions of a tendon might have shed light on the regional changes in tissue elasticity
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