Musculoskeletal Radiology Practice, Heraklion Crete, Greece.
Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Göteborgsvägen 31, 431 80, Gothenburg, Sweden.
Surg Radiol Anat. 2021 Oct;43(10):1681-1689. doi: 10.1007/s00276-021-02768-9. Epub 2021 May 25.
This study aimed to examine the anatomic variations at the level of the distal soleus musculotendinous junction and the possible association between the length of the free tendon and the development of symptomatic Achilles tendinopathy.
We retrospectively assessed 72 ankle MRI studies with findings of Achilles tendinopathy (study group, 26 females/46 males, mean age 52.6 ± 10.5 years, 30 right/42 left) and 72 ankle MRI studies with normal Achilles tendon (control group, 32 females/40 males, mean age 35.7 ± 13.7 years, 42 right/30 left side). We measured the distance from the lowest outline of the soleus myotendinous junction to the proximal outline of the Achilles tendon insertion (length of the free tendon, diameter a) and to the distal outline of the insertion (distance B). We also measured the maximum thickness of the free tendon (diameter c) and the distance between the levels of maximum thickness to the proximal outline of the Achilles tendon insertion (distance D). All measurements were assessed twice. Statistical analysis was performed using independent t test.
Distances A and B were significantly larger in tendinopathic tendons (59.7 and 83.4 mm, respectively) than normal Achilles tendons (38.5 and 60.8 mm, respectively) (p = 0.001). Mean distance C was larger in tendinopathic than normal tendons (11.2 versus 4.9 mm). Distances C and D were significantly larger in males than females. There was no significant difference in the measurements between sides.
There is wide anatomical variation in the length of the free Achilles tendon. Tendinopathy may be associated with the thicker free part of the Achilles tendon. The anatomical variant of the high soleus musculotendinous junction resulting in a longer free Achilles tendon may be a predisposing factor to the development of tendinopathy.
本研究旨在探讨跟腱止点远侧腓肠肌腱膜肌腹结合部的解剖学变异，以及游离肌腱长度与症状性跟腱腱病发展之间的可能关联。
我们回顾性评估了 72 例踝关节 MRI 检查结果为跟腱腱病的病例（研究组，26 名女性/46 名男性，平均年龄 52.6±10.5 岁，30 例右侧/42 例左侧）和 72 例踝关节 MRI 检查结果为正常跟腱的病例（对照组，32 名女性/40 名男性，平均年龄 35.7±13.7 岁，42 例右侧/30 例左侧）。我们测量了从腓肠肌腱膜肌腹结合部的最低点到跟腱止点近端（游离肌腱长度，直径 a）和止点远端（距离 B）的距离。我们还测量了游离肌腱的最大厚度（直径 c）以及最大厚度到跟腱止点近端的距离（距离 D）。所有测量均进行了两次评估。使用独立 t 检验进行了统计学分析。
跟腱腱病组的 A 距和 B 距（分别为 59.7 和 83.4mm）明显大于正常跟腱组（分别为 38.5 和 60.8mm）（p=0.001）。跟腱腱病组的 C 距大于正常跟腱组（分别为 11.2 和 4.9mm）。C 距和 D 距在男性中明显大于女性。两侧之间的测量值无显著差异。
游离跟腱的长度存在广泛的解剖学变异。腱病可能与较厚的游离跟腱部分有关。由于较高的腓肠肌腱膜肌腹结合部的解剖变异导致游离跟腱较长，可能是腱病发展的一个易感因素。
