Achilles Tendon Diameter Research Articles

Morphological and Functional Outcomes >13 Years After Achilles Tendon Rupture Treated Operatively and Non-operatively

Objectives:In patients >13yrs after treatment for acute Achilles tendon rupture (AATR), 1) investigate side-to-side differences in MRI-defined morphological changes in the Achilles tendon and surrounding calf musculature, 2) investigate side-to-side differences in single-limb functional tasks, and 3) compare patients who received operative vs non-operative treatment.Methods:28 patients (11 operative, 17 non-operative) from a previous randomized trial returned 15±1 years post-AATR for testing (age: 57±7 years; BMI: 30±5 kg/m2). Patients underwent bilateral 3T MRI (MAGNETOM Prisma, Siemens) including sagittal and axial T1 and T2-weighted turbo spin echo (TSE), axial T1-weighted inversion recovery, and sagittal T2-weighted 3D isotropic TSE sequences. The maximum anteroposterior Achilles tendon diameter (MAD) and cross-sectional area (CSA), distance from the MAD to the superior margin of the calcaneus, tendon length, gastrocnemius and soleus CSA, and calf circumference were measured using distance and area software tools (Figure 1; AGFA Healthcare). Functional measures included single-legged heel-rise repetitions and maximum vertical jump height. All outcomes were compared between limbs and between groups.Results:Overall, there were significant side-to-side differences in most MRI and functional measures, with the injured limb Achilles tendon typically wider and thicker (MAD often twice as large), calf musculature CSA smaller, number of heel raises lower, and vertical jump height lower (Table 1). The only differences between treatment groups was in MAD and the distance from the MAD to the superior margin of the calcaneus, with a greater side-to-side difference for patients treated operatively (Table 1).Conclusion:Substantial side-to-side differences in tendon diameter, thickness, muscle bulk and functional performance persist beyond a decade after treatment for AATR. There were no differences favoring operative treatment over non-operative treatment.

Percutaneous Tendon Achilles Lengthening

Category: Hindfoot Introduction/Purpose: Percutaneous Achilles tendon lengthening (TAL) is a common procedure used to address equinus contracture of the foot. A triple hemisection technique has become popular due to its ease and efficiency. Several studies evaluate the surgical outcomes of this procedure, but currently, descriptive anatomical studies are lacking. The objective of the study was to evaluate the accuracy of performing Achilles tendon percutaneous hemisections, the amount of tendon excursion in the tensile gaps of the cuts after forced dorsiflexion and the improvement in the range of motion for dorsiflexion of the ankle joint. Methods: Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of theAchilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Followingforced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper. Results: The overall relative width of the percutaneous cut was 51.3% ± 16.3% of the Achilles tendon diameter, 44.3%± 13.6% for the proximal cut, 50.3% ± 15.6% for the intermediate cut, and 59.3% ± 18.4% for the distal cut. Tendonexcursion averaged 13.0 ± 3.8 mm for the proximal cuts, 12.5 ± 4.7 mm for the intermediate cuts, and 8.2 ± 3.7 mm forthe distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion dataanalysis. The mean range of motion for ankle dorsiflexion was 8.1 ± 3.9 degrees preprocedure and 27.6 ± 5.3 degreespostprocedure. The dorsiflexion angle significantly increased (P < .0001) at an average of 19.5 ± 5.0 degrees following TAL. Conclusion: Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accuratetechnique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures arepossible complications. Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.

Anatomic Evaluation of Percutaneous Achilles Tendon Lengthening.

The objective of the study was to evaluate the accuracy of percutaneous Achilles tendon lengthening (TAL) using a triple hemisection technique and the improvement in ankle dorsiflexion. Ten fresh-frozen above-knee cadaveric specimens were used. A percutaneous triple hemisection of the Achilles tendon (proximal, intermediate, and distal) was performed. Maximum ankle dorsiflexion was evaluated pre- and postprocedure with a digital goniometer. After proper dissection, the relative width of the cuts was noted. Following forced ankle dorsiflexion, displacement in the tensile gaps was measured in all 3 cuts with a precision digital caliper. The overall relative width of the percutaneous cut was 51.3% ± 16.3% of the Achilles tendon diameter, 44.3% ± 13.6% for the proximal cut, 50.3% ± 15.6% for the intermediate cut, and 59.3% ± 18.4% for the distal cut. Tendon excursion averaged 13.0 ± 3.8 mm for the proximal cuts, 12.5 ± 4.7 mm for the intermediate cuts, and 8.2 ± 3.7 mm for the distal cuts. One cadaver had a complete rupture of the Achilles tendon and was excluded from the excursion data analysis. The mean range of motion for ankle dorsiflexion was 8.1 ± 3.9 degrees preprocedure and 27.6 ± 5.3 degrees postprocedure. The dorsiflexion angle significantly increased ( P < .0001) at an average of 19.5 ± 5.0 degrees following TAL. Our cadaveric study demonstrated that the percutaneous triple hemisection of the Achilles was an accurate technique that provided successful lengthening of the tendon and increased ankle dorsiflexion. Complete ruptures are possible complications. Our cadaveric study showed that in a clinical situation, triple hemisections of the Achilles tendon can be performed reliably, with significant improvement of the ankle dorsiflexion, mainly through increased tendon excursion at the proximal and intermediate cuts, and with low risk of complete ruptures.

Evaluation of MR Images of the Ankle and Foot in Response to Long-Distance Running: A Systematic Review

Background: It has remained controversial on whether excessive loadings imposed on the ankle and foot complex during long-distance running have a deleterious effect. The aim of this systematic review is to determine whether long-distance running causes any visible changes of the ankle and foot on magnetic resonance imaging (MRI). Methods: Scopus, Web of Science, Embase and Ovid Medline were searched using key terms in relation to MRI findings of the ankle and foot in response to long-distance running, published between 1990 and 2016. The final search was conducted on 19 September, 2016. Studies were identified using inclusion and exclusion criteria. Methodological quality was assessed using a modified Quality Index. Results: The database search initially produced 551 articles and it was screened based on inclusion and exclusion criteria, finally resulting in four articles. Edema was reported in the talus, tibia, calcaneus, navicular, cuboid and cuneiforms. A significant alteration in signal intensity and/or edema was appeared in the calcaneus at the Achilles insertion point, intraosseous and subcutaneous over long-distance running. The diameter of Achilles tendon was also significantly increased. However, when comparing between race finishers and non-finishers, the plantar aponeurosis and subcutaneous were only significantly different, reporting a high rate of edema in non-finishers. Additionally, one study adopted T2* mapping and found significant alteration in T2* values in tibiotalar cartilage, but the value was unexpectedly decreased in the middle of long-distance running. Conclusion: This is the first systematic review to determine the effect of long-distance running on the ankle and foot using MRI. It shows that long-distance running may cause subtle pathological and biochemical changes in the ankle and foot, including the talus, tibia, the distal and proximal group of tarsal bones, 5th metatarsals, soft tissues and the Achilles tendons. However, there is no evidence that these changes have clinical relevance.

Tears of the fascia cruris demonstrate characteristic sonographic features: a case series analysis.

fascia cruris (FC) tears have recently been recognised in the literature, although little is known about their characteristic ultrasound findings. The aim was to describe the echo-graphic features of FC tears in order to improve recognition and diagnosis. the ultrasound reports and images of >600 patients attending a specialist musculoskeletal clinic for Achilles tendon ultrasound scans between October 2010-May 2014 were reviewed. Any patient diagnosed with a FC tear had a structured data set extracted. All ultrasound images were performed by one consultant radiologist. Bilateral Achilles images were available for analysis. sixteen patients from >600 subjects were diagnosed with a FC tear. Fourteen subjects were male and two female (mean age 37.8; range 23-61), with seven elite level sports men. Nine tears were right sided and seven left, with eight situated laterally and seven medially. Seven of the tears were situated in the musculotendinous junction. Symptomatic Achilles tendinopathy co-existed in ten of sixteen subjects (average transverse diameter of Achilles tendon = 7.1±2.0 mm). FC tears should be considered in the differential diagnoses for Achillodynia, diagnosed using their characteristic ultrasound findings, with a hypoechoic area at the medial or lateral attachment to the Achilles tendon in the transverse plane.

Trainingsadaptation der Achillessehne beim Hochleistungssportler – sonografische Grenzwerte für Achillessehnen

Current theories and empirical results regarding the sonographic dimensions of the Achilles tendon as well as an alleged training adaptation of the tendon in competitive athletes are tested for the first time in a large in vivo sample. The pathological validity of a thickened tendon in competitive athletes is under scrutiny. In addition to 202 national squad athletes from the German track and field federation, 199 age-matched normal individuals were examined sonographically. The portable ultrasound scanner Just Vision was used to compare 404 Achilles tendons of athletes with 398 Achilles tendons of normal individuals as to tendon diameter. Furthermore, pathologies were assessed. Achilles tendon diameter at the calcanear insertion was 4.2 ± 0.72 mm on average. Athletes' tendons were thicker than normal tendons (p < 0.001) - athletes, however, also reported more clinical symptoms (p < 0.001). In athletes, increasing diameters were associated with more clinical problems as opposed to normal individuals. At the tendon waist, diameters above 6.0 mm were very likely to go along with pathologies. For the first time, valid data of Achilles tendon diameters in competitive athletes and normal individuals have been presented. The emerging pattern of results clearly contradicts the notion of a physiological training adaptation of the Achilles tendon.

Hormone therapy is associated with smaller Achilles tendon diameter in active post‐menopausal women

The effects of hormonal status and activity levels on Achilles tendon structure were examined in asymptomatic post-menopausal women. It was hypothesized that women using hormone replacement therapy (HRT) would have better tendon structure than those not using HRT and that active women would have poorer tendon structure than inactive women. Eighty-five women including 53 active women (regular golf players) and 32 controls (healthy but inactive women) recorded their HRT and menopausal history and underwent basic anthropometric measurements. Women were divided into two groups based on their hormonal status: those currently using HRT; and those who had never used HRT or ceased using HRT at least 12 months prior to the study. Achilles tendons were examined with ultrasound and categorized as normal or abnormal, and the diameter of each tendon (mm) was recorded. Active women had a greater prevalence of tendon abnormality (P=0.10) and thicker Achilles tendons than inactive women (P<0.05). Active women on HRT had less tendon abnormality (P=0.056) than active women not on HRT and significantly less tendon thickness (P<0.05). This study indicates that Achilles tendon diameter is greater in active post-menopausal women. Hormone replacement therapy appeared to ameliorate this effect in active women. A similar effect from HRT on the Achilles tendons of inactive women was not apparent.

Achilles Tendon and Paratendon Microcirculation in Midportion and Insertional Tendinopathy in Athletes

Background Neovascularisation can be detected qualitatively by Power Doppler in Achilles tendinopathy. Quantitative data regarding tendon microcirculation have not been established and may be substantial. Purpose To assess the microcirculation of the Achilles tendon and the paratendon in healthy volunteers as well as in athletes with either midportion or insertional tendinopathy. Study Design Cohort study; Level of evidence, 2. Methods In 66 physically active volunteers, parameters of Achilles tendon and paratendon microcirculation, such as tissue oxygen saturation, relative postcapillary venous filling pressures, and microcirculatory blood flow, were determined at rest at 2-mm and 8-mm tissue depths. Forty-one patients never had Achilles pain (25 men, 27 ± 8 years), 14 patients had insertional pain (7 men, 29 ± 8 years), and 11 patients had midportion tendinopathy (7 men, 38 ± 13 years, not significant). Results Achilles tendon diameter 2 cm and 6 cm proximal to the insertion was increased in symptomatic tendons. Compared with the uninvolved opposite tendon, deep microcirculatory blood flow was significantly elevated at insertional (160 ± 79 vs 132 ± 42, P<. 05) as well as in midportion tendinopathy (150 ± 74 vs 119 ± 34, P<. 05). The microcirculation in the uninvolved opposite tendon and the normal athlete controls were not significantly different from each other (132 ± 42 insertional asymptomatic vs 119 ± 34 mid-portion vs 120 ± 48 healthy tendon). Insertional paratendon deep microcirculatory flow was elevated in all groups, whereas tissue oxygen saturation and relative postcapillary venous filling pressures were not significantly different. Conclusion Microcirculatory blood flow is significantly elevated at the point of pain in insertional and midportion tendinopathy. Postcapillary venous filling pressures are increased at both the midportion Achilles tendon and the midportion paratendon, whereas tissue oxygen saturation is not different among the studied groups. We found no evidence of an abnormal microcirculation of the asymptomatic limb in Achilles tendinopathy.