Evaluation of Current Symptoms in Postoperative Achilles Tendons: A Multimodal Ultrasound Study

Priscila Nunes,Timm Dirrichs,Matthias Gatz,Marcel Betsch,Bernhard Fuss,Valentin Quack,Markus Tingart

doi:10.3390/healthcare9030288

Abstract

(1) Background: It is unknown which imaging parameters are associated with clinical persistent symptoms in postoperative Achilles tendons. This study used B-Mode, Power Doppler (PD-US), Ultrasound Tissue Characterization (UTC) and Shear Wave Elastography (SWE) to investigate which imaging parameters are associated with persistent symptoms in postoperative Achilles tendon tissue. (2) Methods: Retrospective, cross-sectional, multimodal imaging study. Based on the VISA-A score, postoperative tendons were assigned to two groups: 1. asymptomatic (VISA-A ≥ 90, n = 18); 2. symptomatic (VISA-A < 90, n = 10). The following imaging parameters were analyzed: UTC (echo type I, II, III, IV), B-Mode (diameter, cross sectional area, calcification, fiber irregularity), PD-US (Öhberg score) and SWE (SWE 3 mm, SWE area) using a t-test and a Mann–Whitney U test. (3) Results: SWE and PD-US showed significantly reduced elasticity and increased neovascularization in symptomatic tendons (SWE 3 mm p = 0.031, SWE area p = 0.046, Öhberg score p < 0.001). The only significant correlation between imaging parameters and the VISA-A score was assessed for SWE 3 mm (r = 0.378; p = 0.047) and the Öhberg score (r = −0.737; p < 0.001). Conclusions: Symptomatic postoperative Achilles tendons showed increased neovascularization and lower SWE values than asymptomatic ones. Future studies should examine the diagnostic accuracy of PD-US and SWE in detecting current symptoms in postoperative Achilles tendons.

Highlights

Achilles tendon ruptures and open surgical procedures such as tendon detachment/ reattachment procedures for Achilles tendinopathies may cause high tissue damage within the Achilles tendon
An ANCOVA demonstrated that the imaging parameters were significantly influenced by the VISA-A score value, but there was no influence of BMI, age, postoperative time, underlying etiology and operation technique on imaging parameters
Shear Wave Elastography (SWE) was able to depict a significant higher tendon elasticity in asymptomatic tendons compared to symptomatic tendons (p = 0.031, p = 0.046)

Summary

Introduction

Achilles tendon ruptures and open surgical procedures such as tendon detachment/ reattachment procedures for Achilles tendinopathies may cause high tissue damage within the Achilles tendon. Even after surgical management of Achilles tendon tears and tendinopathies, persistent pathological ultrasound findings such as areas of hypoechogenicity, fiber irregularity and tendon thickening can be found in asymptomatic patients [1,2,3]. It is unclear which imaging findings correlate with persistent symptoms in postoperatively altered tendon tissue [4]. Most current studies focus on the evaluation of the tendon structure in correlation to the postoperative timing, without considering current clinical symptoms The purpose of this diagnostic imaging study was to investigate whether UTC and SWE have further value in the evaluation of postsurgical and post-traumatic Achilles tendons. We hypothesized that UTC and SWE are able to distinguish between symptomatic and asymptomatic postsurgical Achilles tendons

Methods

Results

Discussion

Conclusion