Tendon morphology and mechanical properties assessed by ultrasound show change early in recovery and potential prognostic ability for 6-month outcomes.

Abstract

Optimizing tendon structural recovery during the first 12weeks after Achilles tendon rupture is a prime target to improve patient outcomes, but a comprehensive understanding of biomarkers is needed to track early healing. The purpose of this study was to observe healing of tendon structure over time using ultrasound-based, tendon-specific measures and to identify relationships between tendon structural characteristics and clinical measures of gait and strength. Twenty-seven participants (21 males, mean (SD) age 39 (11)years) were assessed at 4, 8, 12, and 24weeks after injury or surgery using ultrasound imaging techniques. Gait analysis and strength testing were added at the later time points. Ruptured tendons had significantly lower dynamic shear modulus (p < 0.001), greater tendon cross-sectional area (p < 0.001), and greater length (p < 0.001) than the uninjured side. Dynamic shear modulus, cross-sectional area, and length were found to increase over time (p < 0.01). Tendon structure at 4weeks post-injury [cross-sectional area symmetry (r = 0.737, p = 0.002) and dynamic shear modulus (r = 0.518, p = 0.040)] related to stance phase walking symmetry at 24weeks. Tendon structure assessed by ultrasound imaging changes over the first 24weeks of healing after Achilles tendon rupture, suggesting it could be used as a biomarker to track tendon healing early in recovery. Additionally, tendon structure within the first 12weeks relates to later walking gait and heel-rise symmetry, which may indicate that tendon structure could have prognostic value in the care of these patients. This study's clinical relevance is in its support for using ultrasound imaging to assess early patient healing and prognosticate later patient outcomes after Achilles tendon rupture. Level 2, prospective cohort prognostic study.