Mean Tendon Thickness Research Articles

Repair of gluteus medius tears with bioinductive collagen patch augmentation: initial evaluation of safety and imaging.

ABSTRACTThe purpose of this study was to perform an initial, prospective evaluation of imaging findings and outcomes after open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation. A prospective study was performed of patients with clinical and magnetic resonance imaging (MRI) evidence of symptomatic gluteus medius tears who underwent open, double-row suture anchor repair with bioinductive bovine collagen patch augmentation. Preoperative and 6-month postoperative MRIs were reviewed by a fellowship-trained musculoskeletal radiologist, and outcome scores were recorded preoperatively and 6 months postoperatively [Hip Outcome Score (HOS) Sport; HOS Activities of Daily Living (HOS ADL); Modified Harris Hip Score (mHHS) and International Hip Outcomes Tool (iHOT-33)]. Nine patients, four high-grade tears (≥50% tendon thickness) and five low-grade tears (<50% thickness) underwent surgical repair. At 6 months, 7/9 (77.8%) of tendons were qualitatively classified as completely healed on MRI, with no complications. Mean tendon thickness increased significantly: mediolateral dimension by 5.8 mm (P < 0.001), anteroposterior dimension by 4.1 mm (P = 0.02) and cross-sectional area (CSA) by 48.4 mm2 (P = 0.001). Gluteus medius and minimus CSA did not change significantly (P > 0.05). Patients demonstrated improvements in mean scores for HOS ADL, mHHS and iHOT that met defined minimum clinically important differences (P < 0.05). Open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation is safe and associated with increased tendon thickness on postoperative MRI. Early outcome scores are encouraging and should be evaluated after patients have completed postoperative rehabilitation to measure the whole effect of treatment.

Bioinductive collagen implants facilitate tendon regeneration in rotator cuff tears.

PurposeTo evaluate the clinical outcomes, MRI imaging and histological characteristics of biopsy samples of the tendon from patients in whom rotator cuff repair was previously performed with a bioinductive type I bovine collagen implants.MethodsProspective study of 30 patients with partial or complete rotator cuff tears who underwent arthroscopic repair and augmentation with a resorbable type I bovine collagen implant. Preoperatively and at 6 and 12 months after surgery, the VAS, ASES and Constant-Murley scores were evaluated and an MRI study was performed. At 6 months, biopsies of the resulting tissue were obtained and examined histologically.ResultsPatients experienced statistically significant and sustained improvement from baseline for all scores and the mean tendon thickness increased by 1.84 mm. Magnetic resonance imaging evidence of complete healing was found in 27 patients and a considerable reduction in defect size, greater than 50%, was shown in 3. In all samples obtained, the new tissue generated had the histological appearance of a tendon, and was indistinguishable from the native tendon. There was no evidence of any remaining collagen implant.ConclusionsBiopsies of tissue formed from bioinductive type I bovine collagen implants showed, six months after surgery, the generation of a neotendon indistinguishable from the native one. Histology and MRI imaging, revealed complete integration of the implant and absence of inflammatory or foreign body reactions. The clinical parameters, thickness and MRI signal of the tendon improved significantly at 6 months, regardless of the type and size of the tear, and remained unchanged until 12 months.Level of evidenceLevel IV, case series.

High volume distension injection (HVDI) for chronic mid-portion Achilles tendinopathy: A service evaluation of clinical outcomes

Purpose: High Volume Distension Injection (HVDI) is a treatment adjunct in chronic mid-portion Achilles tendinopathy. This study analysed whether HVDI is safe and effective in an outpatient clinic setting. Methods: Retrospective service evaluation of 18 participants over 18 months. Ultrasound-guided saline, corticosteroid and bupivacaine was injected to disrupt vasculo-neural ingrowth, with post-procedure eccentric exercises. Mean follow-up was 8 weeks. Outcomes used were Numeric rating Scale (NRS) of pain, tendon thickness and Modified Ohberg score (MOS) of neovascularisation measured on Ultrasound and Doppler imaging. Results: Mean reduction in NRS was 5.30 ± 2.53 ( P &lt; 0.001). Mean tendon thickness reduction was 0.21 ± 0.17 cm ( P &lt; 0.001). Median MOS improved from 2.00 ± 2.00 to 1.00 ± 3.00 ( P = 0.009). No complications occurred. 11 participants had successful primary HVDI, 3 responded to a second injection. Two non-responders were referred for surgery and two referred for alternative therapy by patient preference. Conclusion: Significant reduction in pain, tendon thickness and neovascularity was observed in 78% of patients. Recurrence in 39%. HVDI with eccentric training is safe and effective intervention in outpatient clinic setting.

Isolated bioinductive repair of partial-thickness rotator cuff tears using a resorbable bovine collagen implant: two-year radiologic and clinical outcomes from a prospective multicenter study.

Current surgical treatment options for partial-thickness tears (eg, takedown and repair, in situ repair) are limited by the degenerative nature of the underlying tendon and may require extensive intervention that can alter the anatomic footprint. The complexity of available techniques to address these issues led to the development of a resorbable collagen implant, which can be used to create a bioinductive repair of partial-thickness tears. We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12), or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. After arthroscopic subacromial decompression without a traditional rotator cuff repair, a bioinductive implant was secured over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores (CMS) preoperatively and at 3 months, 1 year, and 2 years postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site. At 2-year follow-up, mean ASES and CMS scores improved both clinically and statistically at 1 and 2 years, compared with baseline, for intermediate- and high-grade tears. There was magnetic resonance imaging evidence of new tissue fill-in within the original baseline tear in 100% of the intermediate-grade tears and 95% of the high-grade tears. In 90.9% of the intermediate-grade tears and 84.2% of the high-grade tears, this new tissue fill-in represented at least an additional 50% of the volume of the initial lesion. From baseline to 2-year follow-up, the mean tendon thickness increased by 1.2 mm (standard deviation, 1.3; P = .012) and 1.8 mm (standard deviation, 2.2; P = .003) in the intermediate- and high-grade tears, respectively. The analysis of tear grade and location revealed no statistically significant difference in the change in mean tendon thickness at any time point. One patient with a high-grade articular lesion demonstrated progression to a full-thickness tear; however, the patient was noncompliant and the injury occurred while shoveling snow 1 month after surgery. Neither tear location nor treatment of bicep pathology affected the ASES or CMS scores at any follow-up point. No serious adverse events related to the implant were reported. Final results from this 2-year prospective study indicate that the use of this resorbable bovine collagen implant for isolated bioinductive repair of intermediate- and high-grade partial-thickness rotator cuff tears of the supraspinatus is safe and effective, regardless of tear grade and location.

Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System

Background: Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines. Purpose: To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)–based classification system for partial patellar tendon injuries. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models. Results: Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without (P < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear >50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness >8.8 mm correlated with the presence of a partial tear, while tendon thickness >11.45 mm and tear thickness >55.7% predicted surgical management. Conclusion: Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness >8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness >11.5 mm and/or >50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.

Assessment of tendon involvement in chronic hemodialysis patients: an ultrasonographic study

Aim of the workThe aim of this study was to detect changes occurring in some tendons, for example, Achilles, quadriceps, and supraspinatus tendons, using musculoskeletal ultrasound (MSUS) imaging in patients with chronic kidney disease (CKD) on regular hemodialysis and to evaluate associations of these changes with patients’ clinical status, parathyroid hormone (PTH) level as well as other laboratory parameters.Patients and methodsThis study was carried out on 35 patients and a group of 25 age-matched and sex-matched apparently healthy participants as a control group. All patients underwent history taking; clinical examination; and shoulder, knee, and ankle plain radiography. Laboratory investigations including PTH level were done. MSUS was performed on the selected tendons for all patients and controls.ResultsThe ankle was the most clinically affected joint. US abnormalities most commonly affected the Achilles tendon (15.2%) having calcific deposits, abnormal peritendon tissue, increased thickness, and abnormal structure, followed by the quadriceps tendon (2.9%), whereas the supraspinatus tendon was the least affected (2.3%). There were highly statistically significant differences between patients with CKD and controls regarding mean tendon thickness, with the quadriceps tendon and supraspinatus tendons being thicker in the study group (P<0.001). Significant positive correlations of PTH level with age, the duration of dialysis, and PO4 level were observed.ConclusionThere were significant tendon involvements among patients with CKD with the Achilles tendon mostly involved having calcific deposits, abnormal peritendon tissue, increased thickness, and abnormal structure. Tendon abnormalities occurred mainly in older patients with longer durations of dialysis, hypercalcemia (Ca), hyperphosphatemia (PO4), and a higher Ca×PO4 product. MSUS is a simple, noninvasive, and a substantial tool in the diagnosis and follow-up of tendon involvement among patients with CKD.

Partial Patellar Tendon Tears in Athletes: When Is Surgery Required?

Objectives: Partial patellar tendon tears (PPTTs) can be a frustrating injury for athletes and physicians. Determining the location and size of the PPTT are fundamental in understanding prognosis and selecting the most effective treatment. With recent enhancements in MRI quality, the size and dimensions of the tear can be more easily and accurately estimated. While some PPTTs respond to therapy, medication, bracing, biologic injections, and/or ultrasound procedures, other PPTTs in do not respond and require surgical intervention. The goal of this study is to correlate PPTT size and location to clinical outcomes, in order to create a classification system to help guide treatment decisions for athletes with PPTT. Methods: 112 athletic patients (range: 15-45 y/o, mean 23.9+7.2 y/o) who underwent knee MRI were included in this study. 85 of those patients (mean 24.9+8.1 y/o) presented with history and physical examination concerning for recalcitrant patellar tendonitis or suspicion of a partial patellar tendon tear. The other 27 athletic patients (mean 25.6+6.3 y/o) underwent MRI for other pathology and were included as age-matched controls. MR scans were evaluated for patellar tendon tear size, thickness, and location with respect to the entire patellar tendon. Descriptive statistics were used to evaluate tendon size and tear distributions. Pearson correlation, univariate regressions, and logistic regression were performed to correlate tendon geometry and tear sizes. Tear geometry variables were compared to patient outcome measures (return to previous activity level, surgical treatment) using t-tests. Results: 56 out of 85 symptomatic patients had partial patellar tendon tears. 91% of PPTTs involved the posterior and posteromedial region of the proximal patellar tendon (Figure 1). On axial MRI imaging, patients with PPTT had mean tendon thickness of 10 mm compared to 5.9 mm for athletes with no PPTT, including healthy controls (p&lt;.0001). There was a significant correlation between patellar tendon thickness and PPTT size (R=0.85, p&lt;0.0001). Logistic regression analysis showed that athletes with patellar tendon thickness above 7.45 mm are likely to have PPTTs (100% sensitivity). Tear distributions according to MRI grading are shown in Table 1. 11 out of 56 patients underwent surgery for PPTT. All 11 of these patients had tear sizes on axial images &gt; 50% of tendon thickness (mean thickness of tear 6.3 mm). Logistic regression showed that patellar tendon thickness &gt; 8.8 mm, and/or tear size &gt; 55% correlated with surgical intervention. Five of the surgical patients did not make a return to sport at the same level. No patient in this series had surgery for tear thickness less than 4.5 mm. Basketball, track and field and soccer were the most common sports involved in the study. Conclusion: PPTTs are located posterior/posteromedially in the proximal patellar tendon. The most sensitive metric for PPTTs are patellar tendon thickness (anterior to posterior), where thickness more than 8.8 mm is strongly predictive of having a partial tear in the tendon. Athletes with greater than a 55% tear thickness on axial MRI imaging or with a tear measuring more than 4.5 mm on axial cuts are less likely to respond to non-operative treatment. Tracking thickness changes on axial views, specifically in the posterior/posteromedial region, may predict effectiveness of non-operative therapy. [Table: see text][Figure: see text]

Radiologic and clinical evaluation of a bioabsorbable collagen implant to treat partial-thickness tears: a prospective multicenter study

Treatment of partial-thickness cuff tears remains controversial. Although conservative therapy may treat symptoms, these defects do not spontaneously heal and conversion to a full-thickness lesion with subsequent repair may alter the tendon footprint. The ability to induce new tissue formation and limit tear progression in intermediate- and high-grade partial-thickness tears without surgical repair may represent a significant advancement in the treatment paradigm for these lesions. We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12) or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. Following arthroscopic subacromial decompression without repair, a bioinductive implant was attached over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons and Constant-Murley scores preoperatively and at 3 and 12 months postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site. At 1-year follow-up, clinical scores improved significantly (P <.0001) and the mean tendon thickness increased by 2.0 mm (P <.0001). Magnetic resonance imaging evidence of complete healing was found in 8 patients and a considerable reduction in defect size was shown in 23, whereas 1 lesion remained stable. In 1 noncompliant patient with a high-grade articular lesion, progression to a full-thickness tear occurred while shoveling snow 1 month after surgery. No serious adverse events related to the implant were reported. Arthroscopic implantation of a bioinductive collagen scaffold is a safe and effective treatment for intermediate- to high-grade partial-thickness rotator cuff tears of the supraspinatus tendon.

Anatomy of the Adductor Magnus Origin: Implications for Proximal Hamstring Injuries.

Background:The adductor magnus (AM) has historically been a potential source of confusion in patients with suspected proximal hamstring avulsion injuries.Purpose:To investigate the anatomic characteristics of the AM, including its osseous origin, anatomic dimensions, and relationship to the proximal hamstring tendons.Study Design:Descriptive laboratory study.Methods:Dissection of the AM origin was performed in 11 (8 cadavers) fresh-frozen hip-to-foot cadaveric hemipelvis specimens. The gross anatomy and architecture of the proximal hamstring and AM tendons were studied. After dissecting the hamstring tendons away from their origin, the dimension, shape, and orientation of the tendon footprints on the ischial tuberosity were determined.Results:The AM was identified in all cadaveric specimens. The mean tendon thickness (anterior to posterior [AP]) was 5.7 ± 2.9 mm. The mean tendon width (medial to lateral [ML]) was 7.1 ± 2.2 mm. The mean tendon length was 13.1 ± 8.7 cm. The mean footprint height (AP dimension) was 12.1 ± 2.9 mm, and mean footprint width (ML dimension) was 17.3 ± 7.1 mm. The mean distance between the AM footprint and the most medial aspect of the conjoint tendon footprint was 8.5 ± 4.2 mm. Tendon measurements demonstrated a considerable degree of both intra- and interspecimen variability.Conclusion:The AM tendon is consistently present just medial to the conjoint tendon at the ischial tuberosity, representing the lateral-most portion of the AM muscle. This study found wide variation in the dimensional characteristics of the AM tendon between specimens. Its shape and location can mimic the appearance of an intact hamstring (conjoint or semimembranosus) tendon intraoperatively or on diagnostic imaging, potentially misleading surgeons and radiologists. Therefore, detailed knowledge of the AM tendon anatomy, footprint anatomy, and its relationship to the hamstring muscle complex is paramount when planning surgical approach and technique.Clinical Relevance:The reported data may aid surgeons in more accurate recognition, diagnosis, and repair of proximal hamstring avulsion injuries.

Ultrasound and Doppler findings in the Achilles tendon among middle-aged recreational floor-ball players in direct relation to a match

ObjectiveIn this study, structure, blood flow and thickness in the Achilles tendon related to tendon-loading activity were investigated.DesignExamination by ultrasound (US) and colour Doppler (CD) immediately before and after 1...

Sonographically Guided Intratendinous Injection of Hyperosmolar Dextrose to Treat Chronic Tendinosis of the Achilles Tendon: A Pilot Study

Chronic tendinosis of the Achilles tendon is a common overuse injury that is difficult to manage. We report on a new injection treatment for this condition. Thirty-six consecutive patients (25 men, 11 women; mean age, 52.6 years) with symptoms for more than 3 months (mean, 28.6 months) underwent sonography-guided intratendinous injection of 25% hyperosmolar dextrose every 6 weeks until symptoms resolved or no improvement was shown. At baseline and before each injection, clinical assessment was performed using a visual analogue scale (VAS) for pain at rest (VAS1), pain during normal daily activity (VAS2), and pain during or after sporting or other physical activity (VAS3). Sonographic parameters including tendon thickness, echogenicity, and neovascularity were also recorded. Posttreatment clinical follow-up was performed via telephone interview. Thirty-three tendons in 32 patients were successfully treated. The mean number of treatment sessions was 4.0 (range, 2-11). There was a mean percentage reduction for VAS1 of 88.2% (p < 0.0001), for VAS2 of 84.0% (p < 0.0001), and for VAS3 of 78.1% (p < 0.0001). The mean tendon thickness decreased from 11.7 to 11.1 mm (p < 0.007). The number of tendons with anechoic clefts or foci was reduced by 78%. Echogenicity improved in six tendons (18%) but was unchanged in 27 tendons (82%). Neovascularity was unchanged in 11 tendons (33%) but decreased in 18 tendons (55%); no neovascularity was present before or after treatment in the four remaining tendons. Follow-up telephone interviews of the 30 available patients a mean of 12 months after treatment revealed that 20 patients were still asymptomatic, nine patients had only mild symptoms, and one patient had moderate symptoms. Intratendinous injections of hyperosmolar dextrose yielded a good clinical response--that is, a significant reduction in pain at rest and during tendon-loading activities--in patients with chronic tendinosis of the Achilles tendon.

Tendon Thickness and Depth from Skin for Supraspinatus, Common Wrist and Finger Extensors, Patellar and Achilles Tendons: Ultrasonography study of healthy subjects

Summary Objective To assess normal intervals for depth from skin surface to tendon and tendon thickness, and their variance by demographic factors. Methods A standardised ultrasound imaging procedure was performed by a trained physiotherapist. The procedure included bilateral assessment of tendon thickness and depth to tendons and a blinded analysis of reliability. Regression analysis was used to correlate demographic variables with tendon thickness and depth. Material A sample of 448 tendons including the supraspinatus, common extensor digitorum and carpi, distal patellar and Achilles tendons was examined. The material was stratified by sex, body mass index, age, manual/non-manual work and sports participation. Results Evaluation of tendon thickness and depth from skin surface could be performed with high intra-observer reliability in the test-retest situation. Depth measurements had a mean test-retest difference of 0.24 mm (95% limits of agreement ± 0.37 mm), while mean test-retest difference tendon thickness was 0.22 mm (95% limits of agreement ± 0.35 mm) using the method advocated by Bland and Altman (1986) . The average depth to the supraspinatus tendon was 9.6 mm, but depth increased with body mass index and was doubled in overweight white-collar workers. In the hand-in-back position, depth to the supraspinatus tendon was reduced by 1.1 mm to 8.5 mm. Other mean depth scores were 1.2, 1.6 and 3.1 mm for the common extensors, Achilles and patellar tendons respectively. Mean tendon thickness was 6.6 mm for the supraspinatus tendons, 1.5 mm for the common extensor tendons, 5.8 mm for the patellar tendons and 5.5 mm for the Achilles tendons. Conclusion Depth from skin surface to superficially located tendons does not seem to depend on demographic variables. For the supraspinatus tendon, body mass index is moderately correlated to depth. Tendon thickness varies with anatomic location and between subjects, but individual differences between sides are small.