Area Of Achilles Tendon Research Articles

Efficacy of combining a medial superior malleolar perforator flap from the posterior tibial artery with a vacuum-assisted closure dressing for skin and soft tissue defects of the Achilles tendon area.

This randomized clinical trial aimed to investigate the clinical efficacy of combining a medial superior malleolar perforator flap from the posterior tibial artery (PTAPF) with a vacuum-assisted closure (VAC) dressing for skin and soft tissue defects in the Achilles tendon area. Twenty-eight patients were randomly divided into two equally sized groups: the control group received treatment with a medial superior malleolar perforator flap, while the experimental group was treated with a perforator flap from the posterior tibial artery in combination with a VAC dressing. Perioperative data, including average operative time, intraoperative blood loss, intraoperative complications, time to ambulation, and hospital stay after surgery, were recorded. Clinical outcomes were assessed based on the time to first weight-bearing walking, time to full weight-bearing activity, Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society hindfoot and ankle score, and the range of motion for ankle plantar flexion. The patients were monitored for 3-12 months (average, 8.5), and it was observed that the flaps remained stable without enlargement, and their texture and color were similar to the surrounding tissue. Significantly enhanced postoperative indices were noted in the experimental group compared to the control group (P<0.05). The medial superior malleolar perforator flap from the posterior tibial artery, especially when combined with a VAC dressing, proves to be an effective method for repairing medium-sized skin defects in the Achilles tendon area. This approach offers several benefits, including a reliable blood supply, simplicity of the procedure, decreased damage to the donor site, improved aesthetic outcomes, and fewer postoperative complications.

A modified perforator-based stepladder V-Y advancement flap in the Achilles tendon area for coverage of larger posterior heel defects

Posterior heel defect coverage is challenging because of the paucity of suitable flaps. The traditional local stepladder V-Y advancement flap is recommended only for small defects because of the lack of an axial pedicle. This study reports our experience of using the perforator-based stepladder V-Y advancement flaps in a larger posterior heel defect repair. Twenty-two patients with posterior heel defects were treated with modified perforator-based stepladder V-Y advancement flaps in the Achilles tendon area for 11 years. Sixteen males and six females aged 3-74 years underwent surgery. The defect size, perforator characteristics, flap size, flap movement, sural nerve, lesser saphenous vein, deep fascia, flap survival, and outcome quality were analyzed. The perforators were found to predominate within two 2-cm intervals: 0-2cm and 4-6cm proximal to the tip of the lateral malleolus. Twenty-one perforator-based flaps healed uneventfully, and only one developed tip necrosis on the lower edge, which healed by secondary intention. The maximum distance of distal movement was 5.0cm for the modified flap in contrast to 2.5cm for the traditional flap. All flaps allowed adequate and durable reconstruction to be achieved, with excellent contouring after 2-28 months of follow-up. The perforator-based stepladder V-Y advancement flap resulted in good outcomes for larger posterior heel defects compared with conventional transfer methods. The flap is a reliable, well-vascularized, sensate, and pliable local flap option that uses similar tissue from adjacent skin for defect repair and creates an internal gliding surface for the Achilles tendon.

ODP137 Achilles Tendon Size and Characteristics for Diagnosis of Familial Hypercholesterolemia Among Thai Patients

Abstract Background The presence of tendon xanthomas, defined as thickening or nodularities of tendons, is subjective and remains largely undetected in patients with familial hypercholesterolemia (FH) in clinical practice. This study aimed to determine Achilles tendon thickness cutoff values associated with the highest diagnostic accuracy for identifying FH among Thai patients. Methods 63 subjects with possible, probable or definite FH according to the Dutch Lipid Clinic Network criteria, 58 subjects with hypercholesterolemia not compatible with FH and 55 normolipidemia subjects were recruited. Achilles tendon thickness was measured on each side separately at the point of maximum thickness using Lange skinfold calipers, Slim Guide skinfold calipers, plain radiograph of lateral ankles and ultrasonography. Ultrasonographic characteristics of the tendons were also recorded. The diagnostic performance of the maximum Achilles tendon thickness (maximum value of either left or right Achilles tendon of each person) obtained by each method was determined by Receiver-Operating Characteristic curves and optimal cut-points determined by Youden's index. Spearman rank-order correlation coefficient assessed factors associated with Achilles tendon thickness. Results Of all subjects, the mean age was 47 (±13) years, and 45% were male. The study groups were comparable in baseline characteristics except for a higher LDL cholesterol burden, a longer duration of lipid lowering therapy and a higher percentage of subjects receiving high intensity statins and ezetimibe in the FH group. Both types of skinfold calipers demonstrated 61% accuracy for diagnosing FH. An anteroposterior (AP) diameter on plain radiographs ≥7.7 mm had an 80% accuracy with 75% sensitivity and 82% specificity, whereas ultrasonographic thickness ≥6.4 mm. showed a 76% accuracy with 46% sensitivity and 93% specificity. Tendon border irregularities, diffuse hypoechogenicity and calcification were reported in a higher percentage of patients with FH, compared with the other 2 groups. Factors showing a significant correlation with Achilles tendon thickness in the FH group were years since FH diagnosis, a higher Dutch Lipid Clinic Network score and a higher body mass index (BMI). In the overall cohort, factors showing a significant correlation were higher LDL cholesterol burden and higher BMI. Conclusion Achilles tendon thickness measured by calipers showed low accuracy for FH diagnosis. An AP diameter on plain radiographs demonstrated highest sensitivity, whereas ultrasonographic thickness and area of Achilles tendon showed high specificity. Tendon irregularities, diffuse hypoechogenicity and calcification might serve as supportive findings. Presentation: No date and time listed

Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial

ObjectiveTo investigate the imaging characteristics and clinically assess heel enthesitis in spondyloarthritis (SpA) by applying in a post hoc analysis the Heel Enthesitis Magnetic Resonance Imaging Scoring system (HEMRIS) in blinded and centrally-read MRI data from the ACHILLES trial (NCT02771210).MethodsACHILLES included patients (≥18 years) with active psoriatic arthritis or axial SpA with clinical and MRI-positive heel enthesitis refractory to standard treatment. Patients were randomized to receive subcutaneous secukinumab 150/300 mg or placebo. At week 24, patients on placebo were switched to secukinumab treatment. MRI-positive heel enthesitis was confirmed in all patients by local investigators. MRIs were performed at 3 timepoints: screening and weeks 24 and 52. In the present analysis, all MRIs were re-evaluated by 2 blinded central readers in a consensus read fashion for a priori defined MRI parameters based on HEMRIS.ResultsAt screening, 171/204 (83.8%) of patients presented with entheseal inflammation and/or structural damage, considering both the Achilles tendon and plantar fascia. Pathologies were more evident in the Achilles tendon area compared to the plantar aponeurosis. The most frequent pathologies were intra-tendon hypersignal and retrocalcaneal bursitis. The mean total entheseal inflammation score at screening in the Achilles tendon area was 2.99 (N=204) and the mean change (standard deviation [SD]) from screening to weeks 24 and 52 was − 0.91 (1.99) and − 0.83 (2.12) in the secukinumab group vs − 0.48 (1.86) and − 0.80 (1.98) in the placebo-secukinumab group, respectively. The mean total structural damage score at screening was 1.36 (N=204) and the mean change (SD) from screening to weeks 24 and 52 was 0.00 (0.65) and − 0.06 (0.56) in the secukinumab group vs 0.08 (0.48) and 0.04 (0.75) in the placebo-secukinumab group, respectively.ConclusionsBased on the newly developed HEMRIS, entheseal inflammation and/or structural damage was confirmed in 83.3% of ACHILLES patients. Pathologies were more evident in the Achilles tendon area compared to plantar fascia, with the inflammatory parameters being more responsive with secukinumab treatment compared to placebo. The present analysis, with detailed information on individual MRI parameters, contributes to the scientific debate on heel enthesitis.Trial registrationClinicalTrials.gov NCT02771210.

Diagnostic Accuracy of Ultrasonography for Detection of AT by Taking Surgical Findings as Gold Standard

Objective: To assess the diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy by taking surgical findings as gold standard. Design of the Study: It was a descriptive cross-sectional study. Study Settings: This study was carried out at Department Of Diagnostic Radiology And Diagnostic Imaging Combined Military Hospital, Lahore from 23rd December 2017 to 22nd June 2018. Material and Methods: A total of 70 patients of age 20-70 years, of either gender presenting with severe pain and swelling in area of Achilles tendon were included. Patients with heel pain having concurrent heel ulcer, eczematous changes or calcaneal fractures, muscular dystrophy and previous surgery were excluded. All the patients were then underwent ultrasonography and findings were noted for presence or absence of Achilles tendinopathy. Each Ultrasonographic finding were compared with surgical findings. Results of the Study: Mean age was 41.24 ± 10.34 years. Out of these 70 patients, 46 (65.71%) were male and 24 (34.29%) were females with male to female ratio of 1.9:1. In USG positive patients, 40 (True Positive) had Achilles tendinopathy and 04 (False Positive) had no Achilles tendinopathy on surgical findings. Among, 26 USG negative patients, 03 (False Negative) had Achilles tendinopathy on surgical findings whereas 23 (True Negative) had no Achilles tendinopathy on surgical findings. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy by taking surgical findings as gold standard was 93.02%, 85.19%, 90.91%, 88.46% and 90.0% respectively. Conclusion: This study concluded that diagnostic accuracy of ultrasonography for detection of Achilles tendinopathy is quite high. Keywords: Achilles tendinopathy, ultrasonography, sensitivity.

Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area

BackgroundAchilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways, and different treatment strategies are applied. The outcome is rarely investigated.MethodsThis study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics.ResultsThe VISA-A-G outcome scores improved significantly from preoperative to 6 months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18–73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10–73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups. A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836).ConclusionsIn Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups.Trial registrationDRKS, DRKS00014266. Registered 06 April 2018. ‘Retrospectively registered’, https://www.drks.de/drks_web/navigate.do?navigationId=results.

Der Einsatz des Neuro-Fasziokutanen Suralisinsellappens zur Defektdeckung im Bereich des Unterschenkels und des Fußes

BackgroundThe closure of soft tissue defects in areas of the distal third lower leg anterior, ankle, heel and foot dorsum especially with exposed bony or tendinous tissue, in case of infections or difficult healing tendency is still challenging. These defects need a stable and sufficient soft tissue cover.With the introduction of the Neuro-Fasciocutaneus suralis island flap (hereinafter called suralis flap) we do have a good alternative with stable results and less operation complexity. Material and methodsSince 2005 we are using this technique for the coverage of complicated defect wounds, especially for complete heel and extensive foot dorsum defects.The most frequent area was the lateral malleolus and the Achilles tendon area with and maximum dimension of 7cm by 11cm. Results2 suralis flaps get lost; in 6 cases we saw superficial skin necrosis.In most of the harvest areas we could directly close the defects, in 7 cases we had to close the defects with split skin grafts.Technically it is easy to learn the harvest of the suralis flap and none of ourpatient's complaint about the reduces sensitivity after necessitated cutting of the suralis nerve. ConclusionDefects in areas of the distal third lower leg anterior, ankle, heel and foot dorsum does need a stable and sufficient soft tissue cover, especially with exposed bony or tendinous tissue or in case of infections or difficult healing tendency.The suralis flap as an alternative to the commonly used free flaps and reduces the surgical effort.

AUtologous fat graft in foot calcaneal postsurgical chronic ulcer

IntroductionPost-traumatic injury of talus’s posterior area and ankle joint with consequent scar formation is often complicated by an unhealing trophic ulcer. Aim of this paper is to evaluate the autologous fat graft effectiveness in treating Achilles tendon area wounds. Material and MethodsFrom October 2011 to March 2014 we treated with fat graft a total of 7 patients with post-surgical painful chronic ulcer of calcaneal area. Mean age was 38.6 years (range 22–64 years). One patient was a professional football player who was presenting a post-injury ulcer not respondant to advanced dressings. ResultsWound rehepitelization was observed in all cases treated within one month and fat grafting resolved pain related to the wound. All patient returned to their daily normal activities. In all cases treated we observed an increased softness of perilesional post-surgical scars. Our professional football player came back able to perform an usual training 5 days post-operation obtaining complete rehepitelization within 3 weeks. DiscussionOur surgical approach showed a therapeutic effect that relies on biological properties of adipose tissue; those properties are clear in both procedures of chronic ulcer’s rehepitelization stimulation and perilesional tissue’s enhancement obtaining pain control. The procedure is safe, with low rate of complication.

CLINICO-ANATOMICAL FEATURES OF INTEGUMENTARY TISSUES IN THE ACHILLES TENDON FROM THE POINT OF VIEW OF PLASTIC SURGERY. THE ANALYSIS OF WAYS OF ELIMINATION OF CICATRICIAL DEFORMATIONS IN THE ACHILLES TENDON AREA: THEIR ADVANTAGES, DISADVANTAGES

The article deals with the features of integumentary tissues in the Achilles tendon region, which must be taken into account in the planning of reconstructive surgeries, the clinical features of this scar localization, as well as the advantages and disadvantages of existing methods of normal skin repair in the Achilles tendon area.

A cross-sectional study on the mechanical properties of the Achilles tendon with growth.

This study aimed to elucidate growth pattern of mechanical properties of the Achilles tendon and to examine if imbalance between growth of bone and muscle-tendon unit occurs during adolescence. Fourteen elementary school boys, 30 junior high school boys, 20 high school boys and 15 male adults participated in this study. Based on estimated age at peak height velocity (PHV), junior high school boys were separated into two groups (before or after PHV). An ultrasonography technique was used to determine the length, cross-sectional area, stiffness and Young's modulus of Achilles tendon. In addition, the maximum strain in "toe region" (strainTP) was determined to describe the balance between growth of bone and muscle-tendon unit. No group difference was observed in length, cross-sectional area and strainTP among the groups. However, stiffness and Young's modulus in after PHV groups were significantly higher than those of elementary school boys and before PHV groups(p ≤ 0.05). These results indicate that mechanical properties of Achilles tendon change dramatically at and/or around PHV to increased stiffness. The widely believed assumption that muscle-tendon unit is passively stretched due to rapid bone growth in adolescence is not supported.

An Investigation of the Immediate Effect of Static Stretching on the Morphology and Stiffness of Achilles Tendon in Dominant and Non-Dominant Legs.

AimsThis study was undertaken to investigate the immediate effect of static stretching on normal Achilles tendon morphology and stiffness, and the different effect on dominant and non-dominant legs; and to evaluate inter-operator and intra-operator reliability of using shear-wave elastography in measuring Achilles tendon stiffness.Methods20 healthy subjects (13 males, 7 females) were included in the study. Thickness, cross-sectional area and stiffness of Achilles tendons in both legs were measured before and after 5-min static stretching using grey-scale ultrasound and shear-wave elastography. Inter-operator and intra-operator reliability of tendon stiffness measurements of six operators were evaluated.ResultsResult showed that there was no significant change in the thickness and cross-sectional area of Achilles tendon after static stretching in both dominant and non-dominant legs (p > 0.05). Tendon stiffness showed a significant increase in non-dominant leg (p < 0.05) but not in dominant leg (p > 0.05). The inter-operator reliability of shear-wave elastography measurements was 0.749 and the intra-operator reliability ranged from 0.751 to 0.941.ConclusionShear-wave elastography is a useful and non-invasive imaging tool to assess the immediate stiffness change of Achilles tendon in response to static stretching with high intra-operator and inter-operator reliability.

Ultrasonographic evaluation of Achilles tendon in children with flatfoot: A case-control morphometric study.

The purpose of this study was to investigate whether any relationships exist between the presence of flatfoot and ultrasonographic morphometric findings of Achilles tendon in children. The study included 30 pediatric patients with a mean age of 11.96±2.44 (SD) years (range: 9-16 years) with flexible flatfoot and 29 healthy pediatric controls who were matched for age and served as a control group. Demographic data of both groups such as age, height and weight, and anthropometric measurements including leg length and, length and cross-sectional area of the Achilles tendon on ultrasonography were tabulated. Relationships between the cross-sectional area of Achilles tendon and flatfoot and the other parameters were searched for using backward multiple regression analysis. No associations between flatfoot and length and cross-sectional area of the Achilles tendon, age, height, leg and foot length were found. A negative correlation was found between the cross-sectional area of Achilles tendon and presence of flatfoot (Beta=-4.93, P=0.01) and age (Beta=-1.96, P=0.04). A positive correlation was found between the cross-sectional area of Achilles tendon and shoe size (Beta=2.13, P=0.007). Flatfoot, shoe size, age and weight must be kept in mind as a clue for a thinner Achilles tendon morphometry which can be a risk factor in lower limb pathologies.

Lateral calcaneal artery perforator-based skin flaps for coverage of lower-posterior heel defects

Perforator-based flaps have been explored across almost all of the lower leg except in the Achilles tendon area. This paper introduced a perforator flap sourced from this area with regard to its anatomic basis and clinical applications. Twenty-four adult cadaver legs were dissected to investigate the perforators emerging along the lateral edge of the Achilles tendon in terms of number and location relative to the tip of the lateral malleolus, and distribution. Based on the anatomic findings, perforator flaps, based on the perforator(s) of the lateral calcaneal artery (LCA) alone or in concert with the perforator of the peroneal artery (PA), were used for reconstruction of lower-posterior heel defects in eight cases. Postoperatively, subjective assessment and Semmes-Weinstein filament test were performed to evaluate the sensibility of the sural nerve-innerved area. The PA ended into the anterior perforating branch and LCA at the level of 6.0 ± 1.4 cm (range 3.3-9.4 cm) above the tip of the lateral malleolus. Both PA and LCA, especially the LCA, gave rise to perforators to contribute to the integument overlying the Achilles tendon. Of eight flaps, six were based on perforator(s) of the LCA and two were on perforators of the PA and LCA. Follow-up lasted for 6-28 months (mean 13.8 months), during which total flap loss and nerve injury were not found. Functional and esthetic outcomes were good in all patients. The integument overlying the Achilles tendon gets its blood supply through the perforators of the LCA primarily and that of through the PA secondarily. The LCA perforator(s)-based and the LCA plus PA perforators-based stepladder flap is a reliable, sensate flap, and should be thought of as a valuable procedure of choice for coverage of lower-posterior heel defects in selected patients.

Drug induced periarticular thenar erythema with onycholysis related to nano-albumin bound paclitaxel therapy

Abstract Introduction A rather rare hypersensitivity reaction, periarticular thenar erythema with onycholysis (PATEO) syndrome, has been associated with the taxane class. To date, only docetaxel and paclitaxel have been associated with PATEO. This current case is highly suggestive of an association of nab-paclitaxel with PATEO. Presentation of case A 48 year-old female receiving first-line systemic therapy using nanoparticle albumin-bound paclitaxel (nab-Paclitaxel) for metastatic breast cancer developed a dark erythema on the dorsal surface of both hands and excoriation of the skin of the palmar surfaces of both hands which worsened despite continuing daily topical triamcinolone 0.1% ointment. Skin tightness, along with significant pain, resulted in difficulty ambulating. The rash was diagnosed as PATEO by the Dermatology consult service. Hydrocortisone 2.5% cream applied twice daily and mupirocin 2% cream applied three times daily was prescribed and subsequently nab-paclitaxel was discontinued. Discussion PATEO is clinically distinct from traditional palmar-plantar erythrodysesthesia (hand foot syndrome) associated with anthracyclines, antimetabolites, or multikinase inhibitors with unique clinical manifestations. The erythema in PATEO appears on the dorsum of the hand as opposed to the palmar surface and around the metacarpal joints. In addition, the thenar eminence and periarticular area of the Achilles tendon are often involved with erythema and violaceous plaques which may blister. Nail changes including discoloration, paronychia, onycholysis and exudation are observed in more severe cases. Conclusion This case study suggests PATEO may also be induced by the taxane molecule in the protein bound formulation and may be a risk for all patients receiving taxane therapies.

Application of thermovision in assessment of superficial tissue temperature changes under the influence of 1 MHz and 3 MHz ultrasounds wave

Ultrasound wave is a physical method commonly used in the rehabilitation process. Biological effects of ultrasound wave are complex, and they have been subject of several studies for many years. It is assumed that ultrasound wave causes an increase in tissue temperature; however, some study results stay in opposition to this statement. Thermal imaging is a method that helps to determine, in a precise way, the temperature distribution of the tested body surface area, which allows us to verify whether ultrasound waves always have thermal effects. The aim of the study was to evaluate the differences in temperature distribution depicted by thermal imaging, after the use of ultrasonic waves with two different values of frequency (1 and 3 MHz) in the area of Achilles tendon. The study involved 50 healthy students group in which there were 28 women and 22 men. The average age in the group was 20.54 years (±1.09). All study participants underwent ultrasound treatment with two different values of frequency. Skin temperature of the tested area was recorded with the use of thermographic camera. Ultrasound wave was applied to the area of Achilles tendon. Each person had the procedure performed twice with a seven-day time interval. There were ultrasonic waves with a frequency of 1 MHz applied one time and then ultrasonic wave with a frequency of 3 MHz applied once for the second time. Paraffin oil was used as a coupling medium. The result of Student’s t test showed a statistically significant difference in mean temperature values measured immediately after treatment (3.3341) and 5 min after the treatment (2.6037) for a frequency of 3 and 1 MHz. A comparison of temperature values for both frequencies 10 min after the treatment and 15 min after the treatment was not statistically relevant. The results of the studies indicate that only ultrasonic treatment at a frequency of 3 MHz has influence on an increase of surface temperature.

AB1002 Do Foot Posture and the Age-Related Variations Led to Sonographic Abnormalities in the Paediatric Healthy Foot?

BackgroundAs ultrasonography has proven to be a helpfulness tool for detecting articular and periarticular foot disease in juvenile idiopathic arthritis, the interpretation of some findings such as effusion or power...

A Cross-Sectional Study of the Plantar Flexor Muscle and Tendon during Growth

The purpose of this study was to investigate growth changes in human plantar flexor muscle and tendons. In addition, we ascertained whether growth changes in muscle and tendon were more closely related to skeletal age than chronological age. 22 elementary school children (ESC), 19 junior high school students (JHS), and 23 young adults (ADT) men participated in this study. Maximal strain and hysteresis of tendon structures and cross-sectional area of Achilles tendon were measured using ultrasonography. In addition, skeletal age was assessed using Tanner-Whitehouse III method. Maximal strain of ESC was significantly greater than that of other groups, while no significant difference was observed between JHS and ADT. There was no difference in hysteresis among 3 groups. Relative cross-sectional area (to body mass(2/3)) of ADT was significantly smaller than that of other groups. For ESC and JHS, measured variables of muscle and tendon were significantly correlated to both chronological and skeletal ages. These results suggested that immature musculoskeletal system was protected by more extensible and larger tendon structures in ESC and only by larger tendon structures in JHS, respectively. Furthermore, there were no differences in correlation coefficient values between measured variables of muscle and tendon and chronological or skeletal ages.

Quantitative ultrasound method for assessing stress–strain properties and the cross-sectional area of Achilles tendon

The Achilles tendon is one of the most commonly observed tendons injured with a variety of causes, such as trauma, overuse and degeneration, in the human body. Rupture and tendinosis are relatively common for this strong tendon. Stress–strain properties and shape change are important biomechanical properties of the tendon to assess surgical repair or healing progress. Currently, there are rather limited non-invasive methods available for precisely quantifying the in vivo biomechanical properties of the tendons. The aim of this study was to apply quantitative ultrasound (QUS) methods, including ultrasonic attenuation and speed of sound (SOS), to investigate porcine tendons in different stress–strain conditions. In order to find a reliable method to evaluate the change of tendon shape, ultrasound measurement was also utilized for measuring tendon thickness and compared with the change in tendon cross-sectional area under different stress. A total of 15 porcine tendons of hind trotters were examined. The test results show that the attenuation and broadband ultrasound attenuation decreased and the SOS increased by a smaller magnitude as the uniaxial loading of the stress–strain upon tendons increased. Furthermore, the tendon thickness measured with the ultrasound method was significantly correlated with tendon cross-sectional area (Pearson coefficient = 0.86). These results also indicate that attenuation of QUS and ultrasonic thickness measurement are reliable and potential parameters for assessing biomechanical properties of tendons. Further investigations are needed to warrant the application of the proposed method in a clinical setting.

Mutations in SERPINB7, Encoding a Member of the Serine Protease Inhibitor Superfamily, Cause Nagashima-type Palmoplantar Keratosis

"Nagashima-type" palmoplantar keratosis (NPPK) is an autosomal recessive nonsyndromic diffuse palmoplantar keratosis characterized by well-demarcated diffuse hyperkeratosis with redness, expanding on to the dorsal surfaces of the palms and feet and the Achilles tendon area. Hyperkeratosis in NPPK is mild and nonprogressive, differentiating NPPK clinically from Mal de Meleda. We performed whole-exome and/or Sanger sequencing analyses of 13 unrelated NPPK individuals and identified biallelic putative loss-of-function mutations in SERPINB7, which encodes a cytoplasmic member of the serine protease inhibitor superfamily. We identified a major causative mutation of c.796C>T (p.Arg266(∗)) as a founder mutation in Japanese and Chinese populations. SERPINB7 was specifically present in the cytoplasm of the stratum granulosum and the stratum corneum (SC) of the epidermis. All of the identified mutants are predicted to cause premature termination upstream of the reactive site, which inhibits the proteases, suggesting a complete loss of the protease inhibitory activity of SERPINB7 in NPPK skin. On exposure of NPPK lesional skin to water, we observed a whitish spongy change in the SC, suggesting enhanced water permeation into the SC due to overactivation of proteases and a resultant loss of integrity of the SC structure. These findings provide an important framework for developing pathogenesis-based therapies for NPPK.

SAT0258 A Prospective Evaluation of the Diagnostic Value of Conventional Radiography, Ultrasound and MRI in Comparison to Clinical Examination for the Assessment of Heel and Knee Enthesitis in Patients With Spondyloarthritis and Controls

BackgroundSpondyloarthritides (SpA) are characterized by inflammatory and structural changes in the axial skeleton and in peripheral joints and entheses. Imaging has an essential role in the new classification criteria for...