Abstract
PurposeThis study aimed to examine the anatomic variations at the level of the distal soleus musculotendinous junction and the possible association between the length of the free tendon and the development of symptomatic Achilles tendinopathy.MethodsWe retrospectively assessed 72 ankle MRI studies with findings of Achilles tendinopathy (study group, 26 females/46 males, mean age 52.6 ± 10.5 years, 30 right/42 left) and 72 ankle MRI studies with normal Achilles tendon (control group, 32 females/40 males, mean age 35.7 ± 13.7 years, 42 right/30 left side). We measured the distance from the lowest outline of the soleus myotendinous junction to the proximal outline of the Achilles tendon insertion (length of the free tendon, diameter a) and to the distal outline of the insertion (distance B). We also measured the maximum thickness of the free tendon (diameter c) and the distance between the levels of maximum thickness to the proximal outline of the Achilles tendon insertion (distance D). All measurements were assessed twice. Statistical analysis was performed using independent t test.ResultsDistances A and B were significantly larger in tendinopathic tendons (59.7 and 83.4 mm, respectively) than normal Achilles tendons (38.5 and 60.8 mm, respectively) (p = 0.001). Mean distance C was larger in tendinopathic than normal tendons (11.2 versus 4.9 mm). Distances C and D were significantly larger in males than females. There was no significant difference in the measurements between sides.ConclusionThere is wide anatomical variation in the length of the free Achilles tendon. Tendinopathy may be associated with the thicker free part of the Achilles tendon. The anatomical variant of the high soleus musculotendinous junction resulting in a longer free Achilles tendon may be a predisposing factor to the development of tendinopathy.
Highlights
The Achilles tendon is the largest tendon in the body, formed by twisted subtendons from the triceps surae muscle complex [21, 26, 29]
Group 1: the tendinopathic Achilles tendon measurements and the comparison between gender and sides are shown in Tables 1, 2
A few papers are assessing the Achilles tendon morphometry in the literature, with a few published studies measuring the length of the free tendon using magnetic resonance imaging (MRI) [1, 2, 12, 25, 27], 3D ultrasound [4, 17, 18], and in cadavers [22]
Summary
The Achilles tendon is the largest tendon in the body, formed by twisted subtendons from the triceps surae muscle complex [21, 26, 29]. Modern magnetic resonance imaging (MRI) has given new insights into the anatomy and morphology of the Achilles tendon and its surrounding structures and has allowed the accurate diagnosis of tendinopathy, based on signal and morphological tendon changes [7, 23, 24, 26]. MRI is nowadays a highly accurate tool to research musculoskeletal anatomy [23] in the living, as it provides anatomic data highly comparable to traditional surgical or cadaveric techniques [24]
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