Abstract
Introduction: Achilles tendinopathy (AT) is a chronic musculoskeletal pathology best evaluated by ultrasound imaging. This cross-sectional study aimed at better understanding the relationship between musculoskeletal ultrasound biomarkers (MUBs) of Achilles tendon and localized pain, ankle flexibility, ankle strength, and functional abilities.Method: Forty-one participants with unilateral midportion chronic AT had their tendon images analyzed bilaterally in the longitudinal and transverse planes. The Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and Lower Extremity Functional Scale (LEFS) assessed pain and function, respectively, during standing and walking-related activities. Ankle flexibility was evaluated by weight-bearing lunge tests, while ankle isometric peak strength was measured using an instrumented dynamometer. Achilles tendon ultrasonographic images were analyzed using geometric (thickness), composition (echogenicity), and texture (homogeneity) MUBs. Discriminative validity was evaluated using paired Student's t-tests to compare MUBs between symptomatic and asymptomatic sides. Predictive validity was evaluated by computing the Pearson product-moment correlations coefficient between MUBs and pain, ankle flexibility, ankle strength, and function.Results: Significant differences were found in MUBs between the symptomatic and asymptomatic sides, confirming the discriminative validity of the selected MUBs. On the symptomatic side, thickness was found 29.9% higher (p < 0.001), echogenicity 9.6% lower (p < 0.001), and homogeneity 3.8% higher (p = 0.001) when compared with the asymptomatic side. However, predictive validity was scarcely confirmed, as most of the correlation coefficients were found negligible for the associations investigated between MUBs with localized pain, ankle flexibility, strength, and function. Only 14 statistically significant low to moderate associations were found, with negative and positive correlations ranging between −0.31 and −0.55 and between 0.34 and 0.54, respectively.Discussion: Musculoskeletal ultrasound biomarkers have a clinical utility in visualizing in vivo tendon integrity and diagnosing AT. MUBs should be valued as part of a comprehensive neuro-musculoskeletal assessment as they complement pain, flexibility, strength, and function measures. Altogether, they may inform the development and monitoring of a personalized rehabilitation treatment plan.
Highlights
Achilles tendinopathy (AT) is a chronic musculoskeletal pathology best evaluated by ultrasound imaging
In agreement with the first hypothesis, significant differences were found in musculoskeletal ultrasound biomarkers (MUBs) between the symptomatic and asymptomatic Achilles tendons among individuals with chronic symptomatic unilateral AT, confirming the capacity of the selected MUBs to discriminate a symptomatic tendon from an asymptomatic one
The findings of this study address a concern raised by Matthews et al [62] who confirmed the relevance of texturerelated MUBs in characterizing tendon matrix changes, they are typically lacking in the literature
Summary
Achilles tendinopathy (AT) is a chronic musculoskeletal pathology best evaluated by ultrasound imaging. The precise etiology of AT remains uncertain, the risk of injury is mainly associated with a maladaptive response to overstimulation caused by repetitive plantarflexion and high forces transmitted through the tendon during functional activities involving plantarflexion [5]. Other factors such as the presence of common chronic diseases (i.e., diabetes, rheumatoid arthritis, or hypercholesterolaemia), training errors, cold environments, or the use of specific medications (i.e., corticosteroids, fluoroquinolone, statins) may increase the risk of AT [4, 6, 7]. These symptoms and impairments typically lead to functional limitations when walking, running, using stairs, and jumping, leading to decreased social participation and quality of life [4, 10, 11]
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