Name: 作者聚焦：探索跟腱损伤的复杂性 — 研究和未来方向
Uploaded: 2023-10-27T15:00:00
Description: Watch this Scientific Journal Video about Measurement of Healthy and Injured Triceps Surae Morphology at JoVE.com

作者要感谢特拉华州肌腱研究小组的过去和现在的成员，他们协助使用该协议收集数据。本出版物中报告的研究得到了美国国立卫生研究院国家关节炎、肌肉骨骼和皮肤病研究所的支持，奖项编号为 R01AR072034、R01AR078898、F31AR081663、R21AR067390，并由美国国立卫生研究院的 Eunice Kennedy Shriver 国家儿童健康和人类发展研究所支持，奖项编号为 T32HD007490。内容完全由作者负责，并不一定代表美国国立卫生研究院的官方观点。本出版物中报告的研究还得到了瑞典体育科学研究委员会、斯德哥尔摩郡议会（ALF 项目）和瑞典研究委员会提供的资助。这项工作也得到了物理治疗研究基金会的博士研究促进奖学金和风湿病研究基金会医学和研究生导师的部分支持。

以下协议遵循大学机构审查委员会制定并已批准的指导方针，以确保安全和合乎道德的人体研究。所有受试者都对参与研究和数据传播提供了知情同意。训练有素的超声医师大约需要 20 分钟才能完成完整的方案。但是，可以根据评估需求进行单独测量。
1.皮肤标记
<ol><li>要求参与者坐在底座的末端，双腿悬在桌子上。</li>
	<li>在双侧触诊并标记胫骨内侧平台和内踝最远端。?...

跟腱形态的超声评估

<ol>
	<li>Millar, N. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tendinopathy.">Tendinopathy.</a> Nat Rev Dis Primers. 7 (1), 1 (2021).</li><li>Silbernagel, K. G., Hanlon, S., Sprague, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+clinical+concepts:+Conservative+management+of+Achilles+tendinopathy.">Current clinical concepts: Conservative management of Achilles tendinopathy.</a> J Athl Train. 55 (5), 438-447 (2020).</li><li>Chimenti, R. L., Cychosz, C. C., Hall, M. M., Phisitkul, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+concepts+review+update:+insertional+Achilles+tendinopathy.">Current concepts review update: insertional Achilles tendinopathy.</a> Foot Ankle Int. 38 (10), 1160-1169 (2017).</li><li>Zellers, J. A., Pohlig, R. T., Cortes, D. H., Gr&#228;vare Silbernagel, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Achilles+tendon+cross-sectional+area+at+12+weeks+post-rupture+relates+to+1-year+heel-rise+height.">Achilles tendon cross-sectional area at 12 weeks post-rupture relates to 1-year heel-rise height.</a> Knee Surg Sports Traumatol Arthrosc. 28 (1), 245-252 (2020).</li><li>Aufwerber, S., Edman, G., Gr&#228;vare Silbernagel, K., Ackermann, P. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Changes+in+tendon+elongation+and+muscle+atrophy+over+time+after+Achilles+tendon+rupture+repair:+a+prospective+cohort+study+on+the+effects+of+early+functional+mobilization.">Changes in tendon elongation and muscle atrophy over time after Achilles tendon rupture repair: a prospective cohort study on the effects of early functional mobilization.</a> Am J Sports Med. 48 (13), 3296-3305 (2020).</li><li>Heikkinen, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tendon+length,+calf+muscle+atrophy,+and+strength+deficit+after+acute+Achilles+tendon+rupture:+Long-term+follow-up+of+patients+in+a+previous+study.">Tendon length, calf muscle atrophy, and strength deficit after acute Achilles tendon rupture: Long-term follow-up of patients in a previous study.</a> J Bone Joint Surg Am. 99 (18), 1509-1515 (2017).</li><li>Corrigan, P., Cortes, D. H., Pohlig, R. T., Gr&#228;vare Silbernagel, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tendon+morphology+and+mechanical+properties+are+associated+with+the+recovery+of+symptoms+and+function+in+patients+with+Achilles+tendinopathy.">Tendon morphology and mechanical properties are associated with the recovery of symptoms and function in patients with Achilles tendinopathy.</a> Orthop J Sports Med. 8 (4), 2325967120917271 (2020).</li><li>De Jonge, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationship+between+neovascularization+and+clinical+severity+in+Achilles+tendinopathy+in+556+paired+measurements.">Relationship between neovascularization and clinical severity in Achilles tendinopathy in 556 paired measurements.</a> Scand J Med Sci Sports. 24 (5), 773-778 (2014).</li><li>De Jonge, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+tendon+structure+returns+to+asymptomatic+values+in+nonoperatively+treated+Achilles+tendinopathy+but+is+not+associated+with+symptoms:+A+prospective+study.">The tendon structure returns to asymptomatic values in nonoperatively treated Achilles tendinopathy but is not associated with symptoms: A prospective study.</a> Am J Sports Med. 43 (12), 2950-2958 (2015).</li><li>Silbernagel, K. G., Shelley, K., Powell, S., Varrecchia, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extended+field+of+view+ultrasound+imaging+to+evaluate+Achilles+tendon+length+and+thickness:+A+reliability+and+validity+study.">Extended field of view ultrasound imaging to evaluate Achilles tendon length and thickness: A reliability and validity study.</a> Muscles Ligaments Tendons J. 6 (1), 104-110 (2016).</li><li>Albano, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+and+ultrasound+in+Achilles+tendinopathy:+predictive+role+and+response+assessment+to+platelet-rich+plasma+and+adipose-derived+stromal+vascular+fraction+injection.">Magnetic resonance and ultrasound in Achilles tendinopathy: predictive role and response assessment to platelet-rich plasma and adipose-derived stromal vascular fraction injection.</a> Eur J Radiol. 95, 130-135 (2017).</li><li>Alghamdi, N. H., Killian, M., Aitha, B., Pohlig, R. T., Silbernagel, K. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantifying+the+dimensions+of+Achilles+tendon+insertional+area+using+ultrasound+imaging+a+validity+and+reliability+study.">Quantifying the dimensions of Achilles tendon insertional area using ultrasound imaging a validity and reliability study.</a> Muscles Ligaments Tendons J. 9 (4), 544-551 (2019).</li><li>Park, E. S., Sim, E., Rha, D. W., Jung, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Estimation+of+gastrocnemius+muscle+volume+using+ultrasonography+in+children+with+spastic+cerebral+palsy.">Estimation of gastrocnemius muscle volume using ultrasonography in children with spastic cerebral palsy.</a> Yonsei Med J. 55 (4), 1115-1122 (2014).</li><li>Risch, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+sonographic+assessment+of+intratendinous+blood+flow+in+achilles+tendinopathy+patients+reliable?:+Consistency+of+Doppler+ultrasound+modes+and+intra-+and+inter-observer+reliability.">Is sonographic assessment of intratendinous blood flow in achilles tendinopathy patients reliable?: Consistency of Doppler ultrasound modes and intra- and inter-observer reliability.</a> Ultrasound Int Open. 2 (1), E13-E18 (2016).</li><li>Risch, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+evaluating+Achilles+tendon+vascularization+assessed+with+Doppler+ultrasound+advanced+dynamic+flow.">Reliability of evaluating Achilles tendon vascularization assessed with Doppler ultrasound advanced dynamic flow.</a> J Ultrasound Med. 37 (3), 737-744 (2018).</li><li>Forney, M. C., Delzell, P. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Musculoskeletal+ultrasonography+basics.">Musculoskeletal ultrasonography basics.</a> Cleve Clin J Med. 85 (4), 283-300 (2018).</li><li>Dams, O. C., Reininga, I. H. F., Gielen, J. L., van den Akker-Scheek, I., Zwerver, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Imaging+modalities+in+the+diagnosis+and+monitoring+of+Achilles+tendon+ruptures:+A+systematic+review.">Imaging modalities in the diagnosis and monitoring of Achilles tendon ruptures: A systematic review.</a> Injury. 48 (11), 2383-2399 (2017).</li><li>Fredberg, U., Bolvig, L., Andersen, N. T., Stengaard-Pedersen, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonography+in+evaluation+of+Achilles+and+patella+tendon+thickness.">Ultrasonography in evaluation of Achilles and patella tendon thickness.</a> Ultraschall Med. 29 (1), 60-65 (2007).</li><li>Dudley-Javoroski, S., McMullen, T., Borgwardt, M. R., Peranich, L. M., Shields, R. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+and+responsiveness+of+musculoskeletal+ultrasound+in+subjects+with+and+without+spinal+cord+injury.">Reliability and responsiveness of musculoskeletal ultrasound in subjects with and without spinal cord injury.</a> Ultrasound Med Biol. 36 (10), 1594-1607 (2010).</li><li>Zellers, J. A., Cortes, D. H., Pohlig, R. T., Silbernagel, K. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tendon+morphology+and+mechanical+properties+assessed+by+ultrasound+show+change+early+in+recovery+and+potential+prognostic+ability+for+6-month+outcomes.">Tendon morphology and mechanical properties assessed by ultrasound show change early in recovery and potential prognostic ability for 6-month outcomes.</a> Knee Surg Sports Traumatol Arthrosc. 27 (9), 2831-2839 (2019).</li><li>Zellers, J. A., Bley, B. C., Pohlig, R. T., Alghamdi, N. H., Silbernagel, K. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Frequency+of+pathology+on+diagnostic+ultrasound+and+relationship+to+patient+demographics+in+individuals+with+insertional+Achilles+tendinopathy.">Frequency of pathology on diagnostic ultrasound and relationship to patient demographics in individuals with insertional Achilles tendinopathy.</a> Int J Sports Phys Ther. 14 (5), 761-769 (2019).</li><li>de Jonge, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+midportion+Achilles+tendinopathy+in+the+general+population.">Incidence of midportion Achilles tendinopathy in the general population.</a> Br J Sports Med. 45 (13), 1026-1028 (2011).</li><li>Lemme, N. J., Li, N. Y., DeFroda, S. F., Kleiner, J., Owens, B. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+Achilles+tendon+ruptures+in+the+United+States:+athletic+and+nonathletic+injuries+from+2012+to+2016.">Epidemiology of Achilles tendon ruptures in the United States: athletic and nonathletic injuries from 2012 to 2016.</a> Orthop J Sports Med. 6 (11), 2325967118808238 (2018).</li><li>Jackson, J. B., Chu, C. H., Williams, K. A., Bornemann, P. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+ultrasonographic+parameters+of+the+posterior+tibial,+peroneal,+and+Achilles+tendons.">Normal ultrasonographic parameters of the posterior tibial, peroneal, and Achilles tendons.</a> Foot Ankle Spec. 12 (5), 480-485 (2019).</li><li>Schmidt, W. A., Schmidt, H., Schicke, B., Gromnica-Ihle, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Standard+reference+values+for+musculoskeletal+ultrasonography.">Standard reference values for musculoskeletal ultrasonography.</a> Ann Rheum Dis. 63 (8), 988-994 (2004).</li><li>Ackermann, P. W., Hart, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Metabolic Influences on Risk for Tendon Disorders. , (2016).</li><li>Westh, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+habitual+exercise+on+the+structural+and+mechanical+properties+of+human+tendon,+in+vivo,+in+men+and+women.">Effect of habitual exercise on the structural and mechanical properties of human tendon, in vivo, in men and women.</a> Scand J Med Sci Sports. 18 (1), 23-30 (2008).</li><li>Cassel, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+of+Achilles+and+patellar+tendinopathy+and+their+association+to+intratendinous+changes+in+adolescent+athletes.">Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes.</a> Scand J Med Sci Sports. 25 (3), e310-e318 (2015).</li><li>Hirschm&#252;ller, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Achilles+tendon+power+Doppler+sonography+in+953+long+distance+runners+-+a+cross+sectional+study.">Achilles tendon power Doppler sonography in 953 long distance runners - a cross sectional study.</a> Ultraschall Med. 31 (4), 387-393 (2010).</li><li>Radovanovi&#263;, G., Bohm, S., Arampatzis, A., Legerlotz, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+Achilles+tendinopathy+the+symptomatic+tendon+differs+from+the+asymptomatic+tendon+while+exercise+therapy+has+little+effect+on+asymmetries-an+ancillary+analysis+of+data+from+a+controlled+clinical+trial.">In Achilles tendinopathy the symptomatic tendon differs from the asymptomatic tendon while exercise therapy has little effect on asymmetries-an ancillary analysis of data from a controlled clinical trial.</a> J Clin Med. 12 (3), 1102 (2023).</li><li>Corrigan, P., Cortes, D. 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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Fundamentals of Musculoskeletal Ultrasound 3rd Edition. , (2018).</li><li>Scanlan, K. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonographic+artifacts+and+their+origins.">Sonographic artifacts and their origins.</a> AJR Am J Roentgenol. 156 (6), 1267-1272 (1991).</li><li>Gimber, L. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Artifacts+at+musculoskeletal+US:+resident+and+fellow+education+feature.">Artifacts at musculoskeletal US: resident and fellow education feature.</a> Radiographics. 36 (2), 479-480 (2016).</li></ol>

协议中确保方法有效性和可靠性的关键步骤包括在参与者身上使用皮肤标记来指导超声检查，以及对执行研究中使用的测量的个体进行必要的培训。在特定记录位置的皮肤标记有助于随着时间的推移在同一个体的相同位置一致准确地评估感兴趣的变量。此外，以相同的系统方式将皮肤标记应用于不同的个体，可以比较个体之间的相同变量。所需的可靠性培训是该协议中的另一个关键步骤，允许在?...

跟腱起源于腓肠肌和比目鱼肌的肌腱连接处，并插入跟骨后部。跟腱主要由密集堆积、有组织的胶原组织组成，这些胶原组织以分层方式排列，以最大限度地提高抗拉强度1。尽管跟腱能够承受重力，但跟腱在整个人的一生中都容易受到多种类型的伤害。这些损伤，如跟腱病和跟腱断裂，通常伴有肱三头肌和周围组织结构的变化。在跟腱病中，患者常表现出梭状肌腱增厚、肌腱变性、胶原蛋白紊乱和新生血管形成，这是血管和神经组织增殖到肌腱的过程2。此外，与跟腱病相关的病理变化包括副腱炎、肌腱内和/或肌腱内钙化以及滑囊炎 2,3。跟腱断裂后，无论治疗如何，结构变化都很常见，包括跟腱增厚和肌腱长度增加 4,5。此外，肌肉变化，如肱三头肌、肱三头肌、肌肉萎缩，也通常与跟腱损伤有关 5,6。
评估肱三头肌和周围组织结构的能力为了解结构完整性、组织质量和大小提供了有价值的见解，已知这些与症状、功能和预后有关 4,7,8,9。超声成像是这些结构的可靠且有效的评估工具，包括但不限于跟腱长度10、厚度 10,11、横截面积 （CSA）12、腓肠肌解剖学 CSA13 和新生血管形成14,15。对这些措施的评估为理解健康的肱三头肌组织以及量化结构改变以评估损伤风险、严重程度和恢复以及理解健康组织质量提供了宝贵的见解16.
尽管超声成像在评估肱三头肌结构方面具有临床和研究效用，但临床和研究在成像技术和测量参数方面往往存在差异17,18。因此，研究之间的比较是困难的。因此，本方法论文的目的是描述一种有效且可靠的协议，用于使用肌肉骨骼超声成像有效评估肱三头肌、肱三头肌和肌腱结构。该协议旨在证明将该工具全部或作为健康和受伤个体的特定部分纳入研究和临床环境的可行性。此外，还提供了健康和受伤肱三头肌的代表性值。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Aquaflex Stand Off Pad</td>
			<td>Parker Laboratories&#160;</td>
			<td>E8317C</td>
			<td></td>
		</tr>
		<tr>
			<td>Aquasonic ultrasound Gel</td>
			<td>Parker Laboratories&#160;</td>
			<td>E8365AF</td>
			<td></td>
		</tr>
		<tr>
			<td>Linear Array Ultrasound Probe L4-12t-RS</td>
			<td>GE Healthcare</td>
			<td>5495987</td>
			<td></td>
		</tr>
		<tr>
			<td>LOGIC e Ultrasound</td>
			<td>GE Healthcare</td>
			<td>E8349PA</td>
			<td></td>
		</tr>
		<tr>
			<td>Osirix Dicom Viewer</td>
			<td>Pixmeo SARL</td>
			<td></td>
			<td>Software for measurements</td>
		</tr>
	</tbody>
</table>

measurement of healthy and injured triceps surae morphology

跟腱损伤会在整个生命周期中发生，会对生活质量和整体健康产生负面影响。跟腱病通常被归类为与梭状肌腱增厚、新生血管形成和间质肌腱变相关的过度使用性损伤。目前的文献表明，从长远来看，这些结构变化与症状和较低的身体活动水平以及症状和下肢功能有关。手术和非手术治疗的跟腱断裂会导致肌腱横截面积 （CSA） 增加和跟腱拉长。这两种结构性结局都具有临床意义，因为较大的 CSA 正向预测功能，而肌腱延长增加预示着跟腱断裂后功能减退。鉴于跟腱损伤相关的结构变化在损伤严重程度和损伤恢复方面的关系，能够可靠、准确地量化跟腱结构至关重要。Silbernagel的团队已经建立了一种有效且可靠的方法，可以有效地评估肱三头肌、腱部肌肉和肌腱结构。在该方案中，B 型肌肉骨骼超声成像用于测量肱三头肌结构，包括跟腱厚度和 CSA、比目鱼肌厚度以及是否存在其他发现（钙化和滑囊炎）。B 模式扩展视野用于测量跟腱长度和腓肠肌解剖学 CSA。最后，使用功率多普勒技术识别肌腱内新生血管形成。肱三头肌结构的量化可以比较四肢之间的比较，以及健康个体和跟腱损伤个体对运动和治疗的纵向变化。迄今为止，该方案已被用于许多研究，并被证明对于理解肌腱结构与损伤发展、严重程度和恢复之间的关系很有价值。随着超声设备变得越来越实惠和便携，鉴于其快速有效的方法，该协议被证明作为一种临床工具很有希望。

The Achilles tendon originates at the myotendinous junctions of the gastrocnemius and soleus muscles and inserts on the posterior calcaneus. The Achilles tendon consists primarily of densely packed, organized collagen tissue arranged in a hierarchical fashion to maximize tensile strength1. Despite its ability to withstand heavy forces, the Achilles tendon is susceptible to several types of injuries throughout one&#39;s lifespan. These injuries, such as Achilles tendinopathy and Achilles tendon ruptures, are often accompanied by changes in the structure of the triceps surae and surrounding tissues. In Achilles tendinopathy, patients often exhibit fusiform tendon thickening, tendinosis, collagen disorganization, and neovascularization, a process of proliferation of vascular and neural tissue into the tendon2. Additionally, pathological changes associated with Achilles tendinopathy include paratendinitis, intratendinous, and/or entheseal calcifications, and bursitis2,3. After Achilles tendon ruptures, structural changes are common occurrences, irrespective of treatment, and include Achilles tendon thickening and increased tendon length4,5. Furthermore, muscular changes, such as triceps surae muscular atrophy, are also commonly associated with Achilles tendon injuries5,6.
The ability to assess triceps surae and surrounding tissue structures provides valuable insight into structural integrity, tissue quality, and size, which are known to relate to symptoms, function, and prognosis4,7,8,9. Ultrasound imaging is a reliable and valid assessment tool of these structures, including, but not limited to, Achilles tendon length10, thickness10,11, cross-sectional area (CSA)12, gastrocnemius anatomical CSA13, and neovascularization14,15. Assessment of these measures provides valuable insight into the understanding of healthy triceps surae tissue, as well as quantification of structural alterations to evaluate injury risk, severity, and recovery, as well as understanding healthy tissue qualities16.
Despite the clinical and research utility of ultrasound imaging in assessing triceps surae structure, there are often differences in imaging techniques and measurement parameters among clinical and research studies17,18. As a result, comparisons between studies are difficult. Therefore, the purpose of this methods paper is to describe a valid and reliable protocol for efficiently evaluating triceps surae muscle and tendon structure using musculoskeletal ultrasound imaging. This protocol aims to demonstrate the feasibility of incorporating this tool into research and clinical settings through its entirety or as specific parts in healthy and injured individuals. In addition, representative values for healthy and injured triceps surae are provided.

作者聚焦：探索跟腱损伤的复杂性 — 研究和未来方向

健康和受伤的肱三头肌形态的测量

Our research focuses on trying to understand the complexities of Achilles tendon injuries, specifically Achilles tendinopathy and achilles tendon ruptures. So we evaluate various domains of tendon health, such as pain and symptoms function, tendon structure, and psychological factors to kind of comprehensively identify individual differences in injured presentation and recovery. There is a current disconnect between those assessing structure and those assessing other measure of tendon health, such as symptoms and function.So with this protocol, in conjunction with additional evaluation methods to assess other tendon health domains, we'll provide a valuable insight into relationship between structure, function, symptoms, recovery of structure of after injury, and structural characteristics of health individuals and those with different injuries or comorbidities. The results from our lab and the use of ultrasound imaging methodology has really paved the way in recognizing the impacts of tendon elongation, the tendon healing longer after an achilles tendon rupture, and the important of minimizing this lengthening to optimize recovery. Additionally, the results have helped us really understand new scientific questions in the differences in recovery amongst patients with Achilles tendinopathy.

该协议中的措施已被证明是可靠和有效的10,20。据报道，对于扩大视场的跟腱长度到腓肠肌（类间相关系数 （ICC）：0.944）和跟腱长度到比目鱼肌 （ICC： 0.898）10，具有出色的可靠性。跟腱长度测量值在组水平（MDC组）的最小可检测变化为腓肠肌长度为 0.43 厘米，腓肠肌长度为0.41 厘米，比目鱼肌长度为 0.41 厘米。个体水平的 M...

Watch this Scientific Journal Video about Measurement of Healthy and Injured Triceps Surae Morphology at JoVE.com

超声成像在临床和研究环境中变得越来越容易获得，一致的方案将有利于研究之间的比较和临床解释。该超声评估方案是评估健康、肌腱病和断裂肌腱中跟腱形态的有效且可靠的方法。

Achilles tendon injuries occur throughout the lifespan and can negatively affect quality of life and overall health. Achilles tendinopathy is generally ...

我们的研究重点是试图了解跟腱损伤的复杂性，特别是跟腱病和跟腱断裂。因此，我们评估了肌腱健康的各个领域，例如疼痛和症状功能、肌腱结构和心理因素，以全面识别受伤表现和恢复的个体差异。目前，评估结构的人和评估其他肌腱健康指标（如症状和功能）的人之间存在脱节。因此，通过该协议，结合其他评估方法来评估其他肌腱健康领域，我们将提供关于结构、功能、症状、损伤后结构恢复以及健康个体和具有不同损伤或合并症的人的结构特征之间关系的宝贵见解。我们实验室的结果和超声成像方法的使用确实为识别肌腱伸长的影响、跟腱断裂后肌腱愈合的时间更长，以及最小化这种延长以优化恢复的重要性铺平了道路。此外，这些结果帮助我们真正理解了跟腱病患者恢复差异的新科学问题。

measurement-of-healthy-and-injured-triceps-surae-morphology

Research

JoVE Journal

Medicine

Measurement of Healthy and Injured Triceps Surae Morphology

Achilles tendon injuries occur throughout the lifespan and can negatively affect quality of life and overall health. Achilles tendinopathy is generally classified as an overuse injury associated with fusiform tendon thickening, neovascularization, and interstitial tendon degeneration. Current literature suggests these structural changes are associated with&#160;symptoms and lower physical activity levels, as well as&#160;symptoms and lower extremity function in the long term. Surgically and non-surgically managed Achilles tendon ruptures result in increased tendon cross-sectional area (CSA) and a lengthened Achilles tendon. Both structural outcomes have clinical implications, as larger CSA positively predicts function, whereas increased tendon lengthening predicts reduced function after Achilles tendon rupture. Given the relationship between structural changes associated with Achilles tendon injuries for both injury severity and injury recovery, it is critical to be able to quantify Achilles tendon structure reliably and accurately. Silbernagel&#39;s group has established a valid and reliable method for efficiently evaluating triceps surae muscle and tendon structure. In this protocol, B-mode musculoskeletal ultrasound imaging is used to measure triceps surae structure, including Achilles tendon thickness and CSA, soleus thickness, and the presence of additional findings (calcifications and bursitis). B-mode extended field-of-view is used to measure Achilles tendon length and gastrocnemius anatomical CSA. Finally, power Doppler is used to identify intratendinous neovascularization. Quantification of triceps surae structure allows for comparison between limbs as well as longitudinal changes in response to exercise and treatment for healthy individuals and those with Achilles tendon injuries. This protocol has been used in many research studies to date and proves valuable in understanding the relationship between tendon structure and injury development, severity, and recovery. As ultrasound devices are becoming more affordable and portable, this protocol proves promising as a clinical tool, given its quick and efficient methods.

Ultrasound imaging is becoming more accessible in clinical and research settings, and a consistent protocol will be beneficial for comparison between studies and for clinical interpretations. This protocol for ultrasound evaluation is a valid and reliable method to evaluate Achilles tendon morphology in healthy, tendinopathic, and ruptured tendons.

科研

医学

Ultrasound Imaging of Achilles Tendon to Study Morphology

To begin, prepare for ultrasound imaging. Use B-mode ultrasound with a five centimeter linear array transducer. For a visualization of the tricep surae, set the frequency to 10 megahertz and the depth of the measurement to 3.5 centimeters.Adjust the foci between 0.75 and 1.75 centimeters with gain adjusted to 49 for optimal visualization of tissue. Place ultrasound gel on the posterior calcaneus. Holding the probe in the long axis, visualize the proximal calcaneal notch after aligning the notch with the midpoint of the ultrasound probe.Mark this location on the skin. To determine the position for measurement of Achilles tendon thickness in healthy individuals, measure two centimeters proximal from the proximal calcaneal notch and mark this location on the skin. For individuals with Achilles tendinopathy, visualize the thickest portion of the achilles tendon with the ultrasound probe on the long axis and mark this location on the skin.For individuals with Achilles tendinopathy without visible fusiform thickening, palpate the tendon and locate the position of most pain. Mark the skin at this location. For individuals with Achilles tendon rupture, visualize the location of rupture with the ultrasound probe in the long axis and mark this location on the skin.For the other limb, make the skin marking at the same distance from the proximal calcaneal notch as the involved limb. To measure gastrocnemius tendon length, hold the probe on the long axis. Using an extended field of view, begin the image at the calcaneus by visualizing the Achilles tendon insertion.Glide the probe proximally along the midline of the Achilles tendon towards the mark at the gastrocnemius midpoint until the myotendinous junction is seen. End the image here and take three images then measure the soleus tendon length using an extended field of view, beginning the image at the calcaneus by visualizing the Achilles tendon insertion. Glide the probe proximally along the midline of the Achilles tendon toward the mark at the soleus until the soleus myotendinous is junction is visualized.Take three images of the Achilles free tendon length. Next, to measure Achilles tendon thickness place the probe on the long axis on the skin marking. Use the B-mode view and take three images of Achilles tendon thickness.Measure Achilles tendon cross-sectional area. Place a gel standoff pad on the skin marking. Holding the probe on the short axis, take three images of the Achilles tendon cross section.Further, measure the soleus thickness by placing the probe on the long axis on the skin marking made for the soleus. Using B-mode view, visualize the anterior border of the soleus muscle and take three images for soleus thickness. To distinguish between the soleus and flexor hallucis longus, ask the participant to actively flex and extend the great toe.Observe the movement of the fibers of the flexor hallucis longus and no movement in the soleus fibers. To measure the gastrocnemius cross-sectional area, hold the ultrasound probe on the short axis and in line with the mark for the gastrocnemius. Visualize the medial border of the medial gastrocnemius and begin the image by gliding the probe from medial to lateral until the lateral border of the lateral gastrocnemius visualized.To capture the most medial aspect of the medial gastrocnemius, ask the participant to abduct their legs and internally rotate the hip slightly. Using the B-mode view, observe the calcifications within the achilles tendon. Calcifications are unattached from the calcaneus and appear as hypoechoic areas with a shadow below present in multiple planes of view.Next, determine the presence of bursitis visualized by a hypoechoic area deep to the Achilles tendon at the proximal calcaneus for retrocalcaneal bursitis. To assess neovascularization within the Achilles tendon, use the doppler setting on the ultrasound. Position the doppler box on the tendon and hold the ultrasound probe still, avoiding pressing or distending the tissue.Scan the length of the Achilles free tendon, being sure to assess each portion of the tendon without movement of the probe to prevent artifact. If there is vasculature visible within or in contact with the tendon, take three videos each for three seconds in the region with maximal blood flow.

跟腱超声成像研究形态学

Ultrasound Measurements of Achilles Tendon in Healthy and Injured Individuals

Begin by performing ultrasound recordings before measurement. To measure gastrocnemius tendon length, open the longer extended field of view tendon image. Measure from the most proximal point of the tendon insertion.That is, the proximal calcaneal notch to the gastrocnemius myotendinous junction. Next, open the shorter extended field of view tendon image to measure the soleus tendon length. Measure from the proximal calcaneal notch to the soleus myotendinous junction.Then, measure from the proximal calcaneal notch to two centimeters, with the end of the measurement on the deep border of the tendon. Measure from this point to the direct superficial aspect of the tendon to get the two centimeter tendon thickness. In the case of achilles tendinopathy, if the tendon is thickened at this two centimeter distance, locate a healthy area in the free tendon and take this measurement from the proximal calcaneal notch.Next, visually identify the borders of the achilles tendon and outline the circumference of the tendon to measure the tendon cross-sectional area. At the center of the image, measure the achilles tendon from the superficial border to the deep border of the tendon to get the tendon thickness. Also, measure from the superficial border to the deep border of the soleus muscle to get the soleus thickness.Further, to measure the gastrocnemius cross-sectional area, visualize the borders of both the medial and lateral heads of the gastrocnemius and outline them. Demographics of the dataset showed that the individuals post achilles tendon rupture had a lesser proportion of females, whereas the individuals with achilles tendinopathy had an even distribution of males and females. Further, the age of healthy participants was lesser than those with achilles tendinopathy and achilles tendon rupture.Healthy participants showed an achilles tendon mean thickness of 0.47 centimeters and CSA of 0.58 centimeter squared. There were no significant differences between the limbs and achilles tendon length measures for healthy individuals. However, for individuals with achilles tendinopathy, thicker tendons with larger CSA were observed compared to asymptomatic limbs.Also, individuals post achilles tendon rupture showed achilles tendon elongation and larger achilles tendon CSA in the involved limb compared to the uninvolved limb.