Yoshida Keiichi, Itoigawa Yoshiaki, Morikawa Daichi, Maruyama Yuichiro, Ishijima Muneaki
Department of Orthopaedics, Juntendo University Urayasu Hospital, Chiba, Japan.
Department of Orthopaedics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Foot Ankle Int. 2023 Mar;44(3):243-250. doi: 10.1177/10711007221151083. Epub 2023 Feb 14.
Shear wave elastography (SWE) has been used to examine the elasticity of a ruptured Achilles tendon; however, the healing process of a ruptured tendon has not been studied yet. This study aimed to detail the change in mechanical properties of a healing Achilles tendon rupture managed conservatively or surgically using SWE.
Using a prospective cohort study design, we evaluated the patients treated conservatively (conservative group) and surgically (surgical group) with the "gift-box" technique for an isolated index acute Achilles tendon rupture during their healing process. SWE measurements were taken of both the injured and uninjured sides every 4 weeks up to 24, 36, and 48 weeks after treatment. Additionally, tendon thickness and power Doppler (PD) grade were measured at the same time points as SWE measurements. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot rating system score and Achilles tendon Total Rupture Score (ATRS) were compared at 24 and 48 weeks.
The ruptured Achilles tendon obtained an SWE value comparable with the unruptured side at 12 weeks in the conservative group and at 4 weeks with surgical group. The surgical group had significantly higher SWE values up to 24 weeks compared with the conservative group. Additionally, this group had a significantly larger increase in tendon thickness in nearly all periods. Both treatment groups were comparable regarding the PD grade, AOFAS score, and ATRS.
SWE is a convenient noninvasive method to determine the progress of the healing process after tendon injury. Our analysis using SWE has revealed the detailed chronologic changes in SWE values and related mechanical properties of a healing Achilles tendon rupture, which can be used for devising appropriate rehabilitation protocols.
Level II, prospective cohort study.
剪切波弹性成像（SWE）已被用于检查跟腱断裂后的弹性；然而，尚未对肌腱断裂的愈合过程进行研究。本研究旨在详细描述使用SWE保守或手术治疗的跟腱断裂愈合过程中力学性能的变化。
采用前瞻性队列研究设计，我们评估了采用“礼盒”技术保守治疗（保守组）和手术治疗（手术组）的孤立性急性跟腱断裂患者在愈合过程中的情况。在治疗后24、36和48周内，每4周对受伤侧和未受伤侧进行SWE测量。此外，在与SWE测量相同的时间点测量肌腱厚度和功率多普勒（PD）分级。比较24周和48周时美国矫形足踝协会（AOFAS）踝后足评分系统得分和跟腱完全断裂评分（ATRS）。
保守组在12周时，手术组在4周时，断裂的跟腱获得了与未断裂侧相当的SWE值。与保守组相比，手术组在24周时的SWE值显著更高。此外，该组在几乎所有时期的肌腱厚度增加也显著更大。两个治疗组在PD分级、AOFAS评分和ATRS方面相当。
SWE是一种方便的无创方法，可用于确定肌腱损伤后愈合过程的进展。我们使用SWE的分析揭示了跟腱断裂愈合过程中SWE值和相关力学性能随时间的详细变化，可用于制定适当的康复方案。
II级，前瞻性队列研究。
