Abstract
The aim of the study was to check if the subtendons of the Achilles tendon can be identified in vivo on MRI in the midportion of the tendon. The relation of the plantaris tendon to the Achilles tendon was also examined. A retrospective study of 200 MRI of ankle joints including the Achilles tendon was conducted. Statistical analysis of the correlation between the possibility of identifying the subtendons and the side, gender, presence of the central soleus tendon and plantaris tendon variation was performed. The inter-observer agreement between two reviewers in their evaluation of the subtendons was assessed using kappa statistics. The subtendon from the lateral head of the gastrocnemius muscle was identified in 65% (k = 0.63) and was located in the anterior part of the Achilles tendon. The subtendon from the soleus muscle was recognized in 12% (k = 0.75) comprising anterior part of the tendon. In 6% the subtendon from the medial head of the gastrocnemius muscle was identified (k = 0.58). The central soleus tendon was identified in 85% of cases. Statistical analysis shows the weak correlation of the presence of the central soleus tendon and the possibility of identifying the subtendon from the soleus muscle. The plantaris tendon was directly related to the insertion of the Achilles tendon in 42.5%. Identification of the subtendons of the Achilles tendon on MRI is challenging, and most often it is only possible to find the subtendon of the lateral head of the gastrocnemius muscle.
Highlights
The Achilles tendon is composed of twisted subtendons corresponding to each part of the triceps surae muscle
The highest agreement between reviewers was in the case of the subtendon from the soleus muscle (S-Sol) (Table 2) while the lowest was seen in identification of the S-MGC
The distribution of the subtendons of the midportion the Achilles tendon found in our study is the following the S-Sol is located antero-medially, the S-LGC anteriorly while the S-MGC posteriorly
Summary
The Achilles tendon is composed of twisted subtendons corresponding to each part of the triceps surae muscle. The fascicular structure of the Achilles tendon is well known and documented on cadavers[4], there is no corresponding radiological work on large material in magnetic resonance imaging (MRI). Ultrasound is a routinely used imaging method of the pathology of the Achilles tendon[8], but due to the fact that our work applies to the use of MRI, we will not discuss ultrasound more broadly. The aim of the study was to evaluate the possibility of identifying subtendons in the midportion of the Achilles tendon in vivo on MRI, assessing the rotation of the subtendons and the relation of the plantaris tendon to the Achilles tendon
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