Musculoskeletal Ultrasound Research Articles

A Case of Chronic Deep Infrapatellar Bursitis Complicated by Patellar Tendinopathy and its Evaluation With Musculoskeletal Ultrasound

Knee pain is a very common complaint in routine physiatry and orthopedic practice. While bursitis is a well-known and common cause of knee pain, deep infrapatellar bursa (DIPB) involvement is relatively less common. Inflammation of DIPB occurs commonly due to either direct trauma or overuse, but other rare causes have also been reported in the literature including infection, juvenile idiopathic arthritis, gout, and juvenile ankylosing spondylitis. We report a case of chronic inflammation of DIPB caused by direct trauma and associated with patellar tendinopathy. Additionally, we describe the characteristic findings on musculoskeletal ultrasonography (MSK-USG). For ultrasound evaluation, the patient should lie supine with the knee slightly flexed. Deep infrapatellar bursitis can be seen as an anechoic fluid-filled structure immediately posterior to the distal patellar tendon and anterior to the tibial tuberosity. While MRI can confirm the diagnosis of bursitis, MSK-USG can be quick, highly sensitive, and is able to confirm the diagnosis as well as to detect dynamic changes in the patellar tendon and adjacent structures. USG can also help in the treatment by guiding corticosteroid injection into the bursa. Activity modification and eccentric exercises play an important role in the rehabilitation program in these cases.

Aging and entheses: An ultrasonographic probing of degenerative enthesopathy in a cohort of 147 healthy subjects.

To investigate the prevalence and features of degenerative enthesopathic changes in a large cohort of healthy individuals by musculoskeletal ultrasound (MSUS) and their relation to age and other demographic features. In this cross-sectional study, 147 healthy subjects (1470 entheses) were examined by MSUS according to the Outcome Measures in Rheumatology guidelines: Achilles tendon, plantar fascia, patellar, and quadriceps insertions of both lower limbs. The mean age (±SD) of the participants was 43.68 (±14.53) years and 57.1% were female. Enthesopathy has been detected in at least 1 area in 113 subjects (76.87%). Thickening (21.6%) and hypoechogenicity (15.3%) were the most frequent inflammatory findings while enthesophyte (10.13%) was the most prevalent structural one. Age and male gender were significantly correlating with inflammatory (rs =.341, P=.001/r=.310, P=.001), structural (rs =.354, P=.001/r=.166, P=.04) and total scores (rs =.406, P=.001/r=.302, P=.001). More inflammatory changes were noticed in the age group 36-55years. Body mass index had a positive correlation with inflammatory (rs =.290, P=.001) and total scores (rs =0.298, P=.001) but not with structural lesions (rs =.154, P=.062). Thickening, hypoechogenicity, cortical irregularities, and enthesophytes are frequent degenerative features of enthesopathy. These findings need to be redefined to be more specific for spondyloarthritides. Enthesopathy should be interpreted with caution in the light of the clinical picture, especially in elderly and obese male patients.

A Patient with Symmetrical Polyarthritis. The Value of Conventional Radiography for a Correct Diagnosis.

Purpose of ReviewAmong the imaging modalities for the investigation of articular damage of patients with peripheral inflammatory arthropathies, conventional radiography (CR) is the mostly used. Other imaging modalities such as the musculoskeletal ultrasonography, magnetic resonance imaging, and dual-energy computed tomography scans are often used depending on a patient’s clinical needs.Recent FindingsWith the publication of new classification criteria for rheumatoid arthritis (RA), spondyloarthropathies, polymyalgia rheumatica, and others, many physicians are not using any of the above imaging techniques because they believe that by relying only on the classification criteria of a disease the diagnosis can be an easy task.SummaryWe present a patient with peripheral symmetrical polyarthritis involving the small joints of the hands, diagnosed and treated as RA and we discuss the role of imaging, especially the use of CR as an initial screening tool for the evaluation of the articular manifestations and joint damage, and its further usefulness in order to reach a definitive correct diagnosis.

Immediate Effects of Long-Axis Talocrural Thrust Manipulation on the Length of the Anterior Talofibular and Calcaneofibular Ligaments Measured With Musculoskeletal Ultrasound Imaging

ObjectiveThe aim of the present study was to measure the immediate effect of a thrust manipulation on the length of the anterior talofibular and calcaneofibular ligaments in healthy patients. MethodsA convenience sample of 47 healthy patients were recruited for this quasi-experimental study. The patients had an age range from 22 to 54 years, with a mean age of 30.36 years. There were 23 female patients and 24 male patients. Musculoskeletal ultrasound imaging was used to measure the length of the anterior talofibular and calcaneofibular ligaments before and immediately after a high-velocity long-axis thrust manipulation of the talocrural joint during various validated test positions. ResultsA single long-axis thrust manipulation did not result in a significant change in the length of the anterior talofibular ligament (P = .325). Additionally, there was no significant difference in calcaneofibular length after a long-axis thrust manipulation (P = .26). ConclusionThe results indicate that the length of the anterior talofibular and calcaneofibular ligament did not significantly change after a single long-axis thrust manipulation of the talocrural joint in healthy patients. It appears that the joint capsule of the talocrural joint reached end-range during the manipulation before the ligament undergoes plastic length changes; thus, the increase in joint range of motion after a thrust manipulation was probably not due to increased plastic length changes of the anterior talofibular and calcaneofibular ligaments.

Ultrasound Features across Subtypes of Juvenile Idiopathic Arthritis

Objective: The aim of this study was to evaluate musculoskeletal ultrasound (MSUS) features across categories of juvenile idiopathic arthritis (JIA). Methods: In this cross-sectional study, all patients were subjected to full history taking, clinical examination including disease assessment parameters and laboratory investigations. In addition, all children were examined by both grayscale (GS) and power Doppler (PD) MSUS images. Results: By MSUS, the number of joints with synovial effusion was 697 of a total 2400 examined joints (29%) and joints with synovial thickening counted 673 (28%). The number of joints with positive PD signals was 446 (18.6%). There was a significant difference among JIA subtypes as regards different MSUS features. Moreover, there was a discrepancy regarding synovial effusion (p = 0.018), hypertrophy scores (p = 0.013), and the total US severity score (p = 0.026). This divergence was attributed to the significant difference between systemic juvenile idiopathic arthritis (SJIA) and other categories. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MSUS in JIA and its subtypes were calculated. Conclusion: MSUS is a highly sensitive method for detecting synovitis, tenosynovitis, and erosive bone disease, and it helps to make proper therapeutic decisions. There was a significant difference among JIA subtypes regarding MSUS features.

Clinical Value of Musculoskeletal Ultrasound in Rehabilitation After Flexor Tendon Rupture Repair of the Hand

Objective: To explore the application effect and clinical value of musculoskeletal ultrasound in the rehabilitation of hand function after flexor tendon rupture repair. Method: In this study, 72 patients were selected from among patients who underwent flexor tendon rupture repair of the hand in Yancheng Third People’s Hospital from May 2018 to May 2020; the patients were randomly divided into the control group (routine hand rehabilitation training) and the experimental group (musculoskeletal ultrasound and targeted hand rehabilitation training based on examination results) by die roll, with 34 cases in each group; the hand rehabilitation of the two groups were compared. Results: The excellent and good rate of the total active motion (TAM) of the experimental group (94.44%) was significantly higher than that of the control group (69.44%) (P < 0.05); before treatment, there was no significant difference in the diameter and degree of stenosis of the artery in the finger between the two groups (P > 0.05); after treatment, the degree of stenosis and the diameter of the artery of the experimental group were significantly better than those of the control group (P < 0.05). Conclusion: For patients treated with flexor tendon rupture repair of the hand, the use of musculoskeletal ultrasound in the rehabilitation process can significantly improve the functional recovery of the hand; therefore, it is worthy of in-depth research, promotion, and application in clinical rehabilitation.

Importance of baseline musculoskeletal ultrasound findings in the prognosis of rheumatoid arthritis.

To investigate the prognostic value of baseline musculoskeletal ultrasound (MSUS) findings for rheumatoid arthritis (RA). We retrospectively analyzed 138 patients with RA. Patients' first MSUS record was considered as the baseline expression. The subsequent MSUS changes that showed alleviation or progression were regarded as the cutoff point. Grayscale ultrasound (GSUS) synovitis, power Doppler ultrasound (PDUS) synovitis, PDUS tenosynovitis (TS), and bone erosion were scored using a semi-quantitative scale. According to the ultrasound (US) results of the cutoff point, patients were divided into the alleviation group and the progression group. Laboratory results (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], rheumatoid factor [RF], anticyclic citrullinated peptide [anti-CCP] antibody, and anti-keratin antibody [AKA]), disease activity score in 28 joints (DAS28)-ESR, and US scores were compared between the two groups to analyze the prognostic value of US findings in RA. The alleviation group had higher levels of CRP, synovitis, TS, GSUS synovitis, PDUS synovitis, PDUS TS, and US total scores at baseline than the progression group (p < 0.05). The alleviation group received more aggressive treatment in their initial approach than the progression group (p < 0.05). The frequency of US examinations in the alleviation group was more than that in the progression group at follow-up (p < 0.05). Presence of baseline synovitis (OR 0.248, p = 0.006) and a higher GSUS synovitis score (OR 0.521, p = 0.006) were negatively correlated with RA progression. Presence of baseline synovitis and higher GSUS synovitis score do not always indicate worse prognosis of RA, which can be improved with aggressive treatment. Regular MSUS follow-up may have positive influences on prognosis. Key Points • The presence of synovitis at baseline and higher GSUS synovitis score do not necessarily imply poor prognosis of RA. • Prompt and powerful therapy and regular ultrasound follow-up can slow down the progression of RA and improve its prognosis. • Patients with slight and less arthritis at baseline might be ignored and get worse prognosis due to mild treatment strategies and irregular MSUS examination.

Musculoskeletal ultrasound as a screening-tool for rheumatoid arthritis: results of the \u201cRheuma-Truck\u201d screening and awareness initiative

ObjectiveTo evaluate musculoskeletal ultrasound (MSUS) as a screening tool for rheumatoid arthritis (RA) and osteoarthritis (OA) patients in a rheumatology-screening program.Patients and methodsTo raise awareness for rheumatic diseases, a mobile rheumatology office was deployed in different cities of Germany (“Rheuma-Truck”). Standardized questionnaire assessment, testing for rheumatoid factor and citrullinated peptide antibodies and medical student driven MSUS of the clinically dominant hand/foot including wrist, MCP-II, -III, -V, PIP-II, -III, MTP-II and -V were offered free of charge to the population. In case of suspicious results, a rheumatologist was consulted.ResultsIn MSUS, 192 of 560 selected volunteers (aged 18–89, mean 52.7 years; 72.9% female) had suspicious findings including synovitis or erosions primarily affecting the MTP-II (11.8%), dorsal wrist (8.9%), and MCP-II (7%). 354 of the 560 volunteers further visited a rheumatologist of whom 76 were diagnosed with RA. According to the ‘US7 Score’, a sum scores ≥ 5 was significantly predictive for RA (odds ratio (OR) 5.06; confidence interval (CI) 0.83–35.32). 313 volunteers displayed signs of OA including osteophytes, while MCP-II (36.2%), MCP-III (14.8%), and the wrist (10.5%) were mostly affected. Diagnosis of RA was favoured over OA if the wrist (OR 4.2; CI 1.28–13.95), MTP-II (OR 1.62; CI 1.0–2.6), and MCP-V (OR 2.0; CI 1.0–3.8) were involved.ConclusionMedical student driven MSUS by the ‘US7 Score’ can facilitate diagnosis of RA in rheumatology-screening programs due to the level of the score and the affected joints. A high rate of unknown OA signs was detected by MSUS. A mobile rheumatology office displays an opportunity to screen patients for RA and OA.

Evaluation of a Musculoskeletal Ultrasound Workshop in the Family Medicine Clerkship

The family medicine (FM) clerkship is appropriate for incorporating musculoskeletal ultrasound (MSKUS) education, as many outpatient visits in primary care occur for musculoskeletal (MSK) concerns. Despite rising popularity of point-of-care imaging in primary care, ultrasound (US) training in medical education is limited due to lack of resources and time. The purpose of this study is to evaluate the effects of an MSKUS workshop in the FM clerkship through student self-evaluations. Seventy-five medical students enrolled in the FM clerkship during the 2019-2020 academic year participated in hands-on MSKUS workshops staffed by faculty, residents, and a fellow. Workshops coincided with FM residency didactic teaching, allowing for protected time to host US training. Of workshop participants, 98.6% completed both pre- and postworkshop evaluations assessing confidence and acceptability of the workshop (rated on a 0-10 Likert scale, where higher scores represent more confidence or greater benefit, respectively). Students noted increased confidence with use of ultrasound, recognition of MSK structures, and performance of landmark-guided procedures (preworkshop 2.6±1.6; postworkshop 7.4±1.1). Students endorsed high levels of agreement in the benefit of the workshop to their education (9.4±1.3) and MSK understanding (9.4±1.2). This study demonstrates the benefit of an MSKUS workshop as part of the FM clerkship and addresses previously identified challenges to providing US education. Results suggest a short-term benefit from an MSKUS workshop in confidence in MSKUS knowledge and satisfaction with the curriculum.

Changes in ultrasound imaging of joints, entheses, bursae and tendons 24 and 48 h after adjusted weight training.

Background:Joint effusion and enthesitis are common ultrasound findings in rheumatic diseases such as rheumatoid arthritis or spondyloarthritis. However, changes of joints and entheses were not only observed in patients but also in physically active individuals and athletes.Objectives:The purpose of this study was to evaluate joint, entheseal, bursal and tendon musculoskeletal ultrasound (MSUS) findings in large and medium joints of young healthy individuals after completing a standardised weight training.Design:This is a prospective cohort study.Methods:MSUS examinations of large- and medium-sized joints, and related entheseal sites, bursae and tendons were performed on young healthy individuals (ages 18–30 years). Before, 24 and 48 h after completing 1 h of standardised weight exercise, the subjects were evaluated by MSUS. The development of the MSUS findings and associated effects were examined using generalised linear mixed effects models.Results:In total, 51 healthy individuals (52.9% female) with a mean age of 23.7 (±2.5) years were enrolled. The results showed an increase in the number of individuals with at least one joint effusion from 37 (72.5%) before the weight training to 48 (94.1%) after 48 h. Entheses with pathologies were observed in 14 participants (27.5%) at baseline, increasing to 29 participants (56.9%) 48 h after the weight training. Biceps tendon sheath effusion was detected in 9 individuals (17.6%) prior to training, rising to 22 individuals (43.1%) after 48 h. A significant increase in the number of joints with effusion and abnormal entheses within 48 h after the weight training was indicated by the generalised linear mixed effects models.Conclusion:Within 48 h after the weight training session, a significant increase in the prevalence of joint effusion in large and medium joints and the prevalence of abnormal entheses was observed. As a result, when performing and interpreting an MSUS examination, the patient’s physical activities should be taken into account.

A glimpse into the future of systemic lupus erythematosus.

This viewpoint article on a forecast of clinically meaningful changes in the management of systemic lupus erythematosus (SLE) in the next 10 years is based on a review of the current state of the art. The groundwork has been laid by a robust series of classification criteria and treatment recommendations that have all been published since 2019. Building on this strong foundation, SLE management predictably will take significant steps forward. Assessment for lupus arthritis will presumably include musculoskeletal sonography. Large-scale polyomics studies are likely to unravel more of the central immune mechanisms of the disease. Biomarkers predictive of therapeutic success may enter the field; the type I interferon signature, as a companion for use of anifrolumab, an antibody against the common type I interferon receptor, is one serious candidate. Besides anifrolumab for nonrenal SLE and the new calcineurin inhibitor voclosporin in lupus nephritis, both of which are already approved in the United States and likely to become available in the European Union in 2022, several other approaches are in advanced clinical trials. These include advanced B cell depletion, inhibition of costimulation via CD40 and CD40 ligand (CD40L), and Janus kinase 1 (Jak1) and Tyrosine kinase 2 (Tyk2) inhibition. At the same time, essentially all of our conventional therapeutic armamentarium will continue to be used. The ability of patients to have successful SLE pregnancies, which has become much better in the last decades, should further improve, with approaches including tumor necrosis factor blockade and self-monitoring of fetal heart rates. While we hope that the COVID-19 pandemic will soon be controlled, it has highlighted the risk of severe viral infections in SLE, with increased risk tied to certain therapies. Although there are some data that a cure might be achievable, this likely will remain a challenge beyond 10 years from now.

Fascinated by Cartilage: Basics of Paediatric Musculoskeletal Ultrasound

Fascinated by Cartilage: Basics of Paediatric Musculoskeletal Ultrasound

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Elbow.

In this dynamic protocol, ultrasound examination of the elbow using different maneuvers is described for several/relevant elbow problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide-prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine])-will help musculoskeletal physicians perform a better and uniform/standard approach.

Role of musculoskeletal ultrasound, magnetic resonance imaging, and serum chemokine C-X-C motif ligand 10 in early detection of arthritis in patients with psoriasis

Aim of the workTo assess the role of musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) and the following laboratory biomarkers; C-reactive protein (CRP), serum uric acid (SUA) and chemokine C-X-C motif ligand 10 (CXCL-10) in early detection of psoriatic arthritis (PsA) among patients with skin psoriasis (PsO). Patients and methodsA cross-sectional study was performed over 40 psoriatic patients with arthralgia and another 40 without arthralgia. All underwent MSUS of the peripheral joints, entheses, and MRI of sacroiliac joints. Madrid Sonographic Enthesitis Index (MASEI) scores were calculated. Each patient was tested for CRP, SUA, and CXCL-10. ResultsThe 80 patients median age was 46.5 (25) years (19–66 years) and were 44 females and 36 males (F: M 1.2:1) and disease duration of PsO was 4 (10.38) years (0.08–30 years). The CXCL-10 level in all the patients was 552.5 (535) pg/mL (300–1000 pg/mL). 24 (30%) of the patients had early PsA as they had active enthesitis, synovitis or sacroiliitis. 14 (17.5%) had enthesopathy without positive power Doppler (PD) signals. CXCL-10 significantly correlated with tender joint count (p < 0.001), entheseal count (p < 0.001), MASEI inflammatory score (p = 0.02) and inversely with damage score (p = 0.048). It was significantly associated with PsA development. Unlike CRP and SUA, CXCL-10 was highly sensitive (100%) for detecting PsA using a cut-off point of 552.5 pg/mL (p < 0.001). ConclusionsImaging detected PsA and subclinical enthesopathy are common among psoriatic patients. CXCL-10 is associated with abnormal PD findings. It may be a future predictive biomarker for PsA in those patients.

A roadmap for better management for synovitis in haemophilia.

A roadmap for better management for synovitis in haemophilia.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Shoulder.

In this dynamic protocol, ultrasound examination of the shoulder using different maneuvers is described for several/relevant shoulder problems. Scanning videos are coupled with real-time patient examination videos for better understanding. The authors believe that this practical guide prepared by an international consensus of several experts (EURO-MUSCULUS: European Musculoskeletal Ultrasound Study Group and USPRM: Ultrasound Study Group of ISPRM [International Society of Physical and Rehabilitation Medicine]) will help musculoskeletal physicians perform a better and uniform/standard approach.

Ultrasonographic features of arthritis in patients with primary Sjögren's syndrome and its clinical significance

ObjectiveTo observe the ultrasonographic features of arthritis in patients with primary Sjögren's syndrome (pSS) and to analyze its correlation with clinical manifestations and disease activity. MethodsUltrasound (US) examinations were performed in a total of 1200 joints of 40 patients with pSS. A semi-quantitative grading method (0–3) for scoring synovial hyperplasia, PD synovitis, bone erosion, tenosynovitis was used. The clinical and laboratory data were collected, disease activity was assessed. The correlation between US lesions and disease activity assessment and clinical manifestations was analyzed. ResultsUS findings of musculoskeletal in patients with pSS mainly involved the small joints of the hands and wrists and the lesions were mild. The semi-quantitative score of musculoskeletal US was positively correlated with ESSPRI. The occurrence of musculoskeletal US lesions is associated with immunological abnormalities and inflammatory markers, and patients with high IgG, RF, and inflammatory markers are prone to abnormal US findings. ConclusionThe incidence of arthritis in patients with pSS is high, and musculoskeletal US has its characteristics. The musculoskeletal US semi-quantitative method can effectively evaluate arthritis in patients with pSS, and the US score of arthritis has a certain correlation with the overall disease activity. US can provide a reference for the diagnosis of arthritis and disease activity assessment in patients with pSS.

Hemophilia: The Past, the Present, and the Future.

Hemophilia: The Past, the Present, and the Future.

High patient global assessment scores in patients with rheumatoid arthritis otherwise in remission do not reflect subclinical inflammation.

To assess whether high patient global assessment (PGA) scores by patients with rheumatoid arthritis (RA) otherwise in remission reflect subclinical inflammation. Cross-sectional, single-center study, including consecutive RA patients. Remission states were defined based on the ACR/EULAR Boolean definition: 4V-remission (tender and swollen 28-joint counts (TJC28/SJC28), C-reactive protein (CRP), and PGA all≤1), PGA-near-remission (the same, except PGA>1), and non-remission (any of TJC28, SJC28, CRP>1). A blinded expert musculoskeletal ultrasonographer scanned 44 joints, 38 tendon sheaths, 4 bursae on the same day of the clinical evaluation. Each structure was assessed for the presence of Grey Scale synovial hypertrophy (GS) and Power Doppler (PD), both scored using a semi-quantitative scale (0-3 points). The Global OMERACT-EULAR Synovitis Score (GLOESS, 0-132, primary outcome), and a global tenosynovitis/bursitis score (GTBS) were compared between remission states, using non-parametric tests. Different sensitivity analyses comparing GS and PD subscores were performed. In total, 130 patients (mean age 63 years, 86% female, average disease duration 14 years) were included 40 being in 4V-remission, 40 in PGA-near-remission, 50 in non-remission. 4v-remission and PGA-near-remission presented similar median (IQR) GLOESS, [6 (5-11) and 4 (1-7), P>0.05, respectively] and GTBS [0 (0-1) and 0 (0-2), P>0.05, respectively]. The same was observed in GS, PD scores, and in global synovitis score considering only the 16 joints not included in 28-joint counts. These observations were confirmed in patients with≤5 years disease duration. Subclinical inflammation is not present among persons with elevated PGA who are otherwise in remission. PGA-near-remission patients would be exposed to the risk of overtreatment if current treatment recommendations were strictly followed. This study supports the need to reconsider the role of PGA in definitions used to target immunosuppressive therapy and to provide a separate and enhanced focus to the patient's experience of the disease.

Application Value of Musculoskeletal Ultrasound in DAA-THA with Conjoined Tendon Repair

Objective: To observe the ultrasonographic characteristics of conjoined tendon repair in direct anterior approach for total hip arthroplasty (DAA-THA), and to evaluate the efficacy of musculoskeletal ultrasound in determining the healing after joint tendon repair. Methods: A total of 60 patients who required primary total hip arthroplasty in Yulin Orthopedic Hospital of Chinese and Western Medicine from July 2020 to July 2021 were selected; the patients were divided into two groups, an observation group, group A (n = 30), and a control group, group B (n = 30), according to different intraoperative methods. There was no significant difference in gender, age, and diagnosis between the two groups. Direct anterior approach was used for both the groups. For group A, the joint capsule and conjoined tendon (superior gemellus, obturator internus, and inferior gemellus) were repaired in situ, whereas for group B, only the joint capsule was repaired in situ, while the conjoined tendon was not repaired. The healing of the tendon was observed. Results: (1) in terms of diagnosis, after conjoined tendon repair, 26 cases in group A showed good tendon continuity, good tension, and a small amount of effusion echo around, three cases showed partial interruption of tendon echo, low echo, or no echo inside with insufficient structural clarity, and a case showed complete interruption; in group B, all 30 cases had continuous interruption, poor tension, tendon retraction, and thickening; the healing rate of group A’s conjoined tendon repair was 96.67%; (2) in terms of prognostic assessment, one month after the surgery, the Harris score of group A was significantly higher than that of group B (P &lt; 0.05); however, there was no significant difference in the terms of the Harris score between the two groups 3-6 months after surgery (P &gt; 0.05); the effective tension of conjoined tendon and the effective muscle strength of group A were significantly higher than those of group B (P &lt; 0.05). Conclusion: Musculoskeletal ultrasound has high diagnostic value in the healing of conjoined tendon and provides dynamic clinical observation after conjoined tendon repair in DAA-THA; it is proven that DAA-THA with conjoined tendon repair on the premise of reconstructing the joint capsule can well restore its tension, enhance its muscle strength, significantly improve early joint stability and joint function, as well as facilitate the rapid recovery of patients.