Busilacchi A, Olivieri M, Ulisse S, Gesuita R, Skrami E, Lording T, Fusini F, Gigante A
Clinical Orthopaedics - Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, Italy.
Department of Radiology, Azienda Ospedaliero -Universitaria "Ospedali Riuniti", Via Conca 71, 60126, Ancona, Italy.
Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2124-32. doi: 10.1007/s00167-014-3484-5. Epub 2014 Dec 25.
To evaluate the sonoelastographic features of Achilles tendon healing after percutaneous treatment using real-time sonoelastography, a new tool able to quantify deformation in biological tissues.
Patients with atraumatic Achilles tendon ruptures, treated with a percutaneous technique, were assessed. Sonoelastographic evaluations were performed at the myotendinous junction, tendon body/lesion site and osteotendinous junction, both for the operated and contralateral side, at 40 days, 6 months and 1 year after surgery. Using standard regions of interest, the "strain index" (SI) was calculated as an indicator of tendon elasticity. Clinical outcomes were assessed by the ATRS questionnaire at 6 months and 1 year post-operatively and correlated with sonoelastographic findings. Sixty healthy tendons from 30 volunteers were used to provide a healthy control range.
Twenty-five patients were recruited for this study. The SI in treated tendons showed progressive stiffening over time, especially at myotendinous junction and at the site of the sutured lesion, resulting in significantly higher stiffness than both the contralateral tendon and healthy volunteers. Peak thickness of treated tendons occurred at 6 months, with a tendency to reduce at 1 year, while never achieving a normal physiological state. Greatest remodelling was seen at the lesion site. The contralateral tendon showed significant thickening at the myotendinous and osteotendinous junctions. The SI of the contralateral tendon was found to be stiffer than physiological values found in the control group. ATRS score improved significantly between 6 months and 1 year, being negatively correlated with the SI (p < 0.001).
RTSE showed that operatively treated Achilles tendons become progressively stiffer during follow-up, while the ATRS score improved. From a biomechanical point of view, at 1 year after surgery Achilles tendons did not show a "restitutio ad integrum". Real-time sonoelastography provides more qualitative and quantitative details in the diagnostics and follow-up of Achilles tendon conditions as the post-operative evolution of the repairing tissue.
Diagnostic and therapeutic study, Level III.
使用实时超声弹性成像评估经皮治疗后跟腱愈合的超声弹性成像特征，实时超声弹性成像是一种能够量化生物组织变形的新工具。
对采用经皮技术治疗的非创伤性跟腱断裂患者进行评估。在术后40天、6个月和1年，对手术侧和对侧的肌腱-肌肉交界处、肌腱体/损伤部位以及肌腱-骨交界处进行超声弹性成像评估。使用标准感兴趣区域，计算“应变指数”（SI）作为肌腱弹性的指标。术后6个月和1年通过ATRS问卷评估临床结果，并与超声弹性成像结果相关联。使用来自30名志愿者的60条健康肌腱提供健康对照范围。
本研究招募了25名患者。治疗后肌腱的SI随时间逐渐变硬，尤其是在肌腱-肌肉交界处和缝合损伤部位，导致其硬度显著高于对侧肌腱和健康志愿者。治疗后肌腱的最大厚度出现在6个月时，1年时有减小趋势，但从未达到正常生理状态。在损伤部位观察到最大程度的重塑。对侧肌腱在肌腱-肌肉交界处和肌腱-骨交界处明显增厚。发现对侧肌腱的SI比对照组的生理值更硬。ATRS评分在6个月至1年之间显著改善，与SI呈负相关（p<0.001）。
实时超声弹性成像显示，手术治疗的跟腱在随访期间逐渐变硬，而ATRS评分有所改善。从生物力学角度来看，术后1年跟腱未显示“完全恢复正常”。实时超声弹性成像在跟腱疾病的诊断和随访中，作为修复组织的术后演变，提供了更多定性和定量的细节。
诊断和治疗研究，III级。
