How to diagnose plantaris tendon involvement in midportion Achilles tendinopathy - clinical and imaging findings.

Lorenzo Masci,Hans T M Van Schie,Håkan Alfredson,Christoph Spang

doi:10.1186/s12891-016-0955-5

Lorenzo Masci, Hans T M Van Schie + Show 2 more

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https://doi.org/10.1186/s12891-016-0955-5

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Abstract

BackgroundThe purpose of this investigation was to evaluate if clinical assessment, Ultrasound + Colour Doppler (US + CD) and Ultrasound Tissue Characterisation (UTC) can be useful in detecting plantaris tendon involvement in patients with midportion Achilles tendinopathy.MethodsTwenty-three tendons in 18 patients (14 men, mean age: 37 years and 4 women: 44 years) (5 patients with bilateral tendons) with midportion Achilles tendinopathy were surgically treated with a scraping procedure and plantaris tendon removal. For all tendons, clinical assessment, Ultrasound + Colour Doppler (US + CD) examination and Ultrasound Tissue Characterisation (UTC) were performed.ResultsAt surgery, all 23 cases had a plantaris tendon located close to the medial side of the Achilles tendon. There was vascularised fat tissue in the interface between the Achilles and plantaris tendons. Clinical assessment revealed localised medial activity-related pain in 20/23 tendons and focal medial tendon tenderness in 20/23 tendons. For US + CD, 20/23 tendons had a tendon-like structure interpreted to be the plantaris tendon and localised high blood flow in close relation to the medial side of the Achilles. For UTC, 19/23 tendons had disorganised (type 3 and 4) echopixels located only in the medial part of the Achilles tendon indicating possible plantaris tendon involvement.ConclusionsUS + CD directly, and clinical assessment indirectly, can detect a close by located plantaris tendon in a high proportion of patients with midportion Achilles tendinopathy. UTC could complement US + CD and clinical assessment by demonstrating disorganised focal medial Achilles tendon structure indicative of possible plantaris involvement.

Highlights

The purpose of this investigation was to evaluate if clinical assessment, Ultrasound + Colour Doppler (US + Colour + Doppler (CD)) and Ultrasound Tissue Characterisation (UTC) can be useful in detecting plantaris tendon involvement in patients with midportion Achilles tendinopathy
There is evidence that the plantaris tendon can be detected by ultrasound [13], there are, to the best of our knowledge, no studies on humans comparing macroscopic and ultrasound findings in patients with midportion Achilles tendinopathy and potential plantaris tendon involvements
There are no studies that have investigated the use of UTC in diagnosing plantaris tendon involvement in midportion Achilles tendinopathy

Summary

Introduction

The purpose of this investigation was to evaluate if clinical assessment, Ultrasound + Colour Doppler (US + CD) and Ultrasound Tissue Characterisation (UTC) can be useful in detecting plantaris tendon involvement in patients with midportion Achilles tendinopathy. There is evidence that the plantaris tendon can be detected by ultrasound [13], there are, to the best of our knowledge, no studies on humans comparing macroscopic and ultrasound findings in patients with midportion Achilles tendinopathy and potential plantaris tendon involvements. A novel imaging modality called Ultrasound Tissue Characterisation (UTC) has recently been introduced to visualise Achilles tendon structure and to quantify tendon matrix integrity [14, 15]. There are no studies that have investigated the use of UTC in diagnosing plantaris tendon involvement in midportion Achilles tendinopathy

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