Name: 저자 스포트라이트: 아킬레스건 손상의 복잡성 탐구 — 연구 및 향후 방향
Uploaded: 2023-10-27T15:00:00
Description: Watch this Scientific Journal Video about Measurement of Healthy and Injured Triceps Surae Morphology at JoVE.com

저자들은 이 프로토콜을 사용하여 데이터 수집을 지원한 Delaware Tendon Research Group의 전현직 구성원에게 감사를 표하고 싶습니다. 이 간행물에 보고된 연구는 미국 국립보건원(National Institutes of Health)의 국립관절염 및 근골격계 및 피부질환 연구소(National Institute of Arthritis and Musculoskeletal and Skin Diseases)의 지원을 받아 수상 번호 R01AR072034, R01AR078898, F31AR081663, R21AR067390로, 그리고 미국 국립보건원(National Institutes of Health)의 유니스 케네디 슈라이버 국립 아동 건강 및 인간 발달 연구소(National Institute of Child Health and Human Development)의 지원을 받았습니다(수상 번호 T32HD007490). 내용은 전적으로 저자의 책임이며 반드시 National Institutes of Health의 공식 견해를 나타내는 것은 아닙니다. 이 간행물에 보고된 연구는 스웨덴 스포츠 과학 연구 위원회, 스톡홀름 카운티 위원회(ALF 프로젝트) 및 스웨덴 연구 위원회에서 제공하는 보조금의 지원도 받았습니다. 이 연구는 또한 물리 치료 연구 재단 (Foundation for Physical Therapy Research)의 박사 과정 장학금 (Promotion of Doctoral Studies Scholarship)과 류마티스 연구 재단 (Rheumatology Research Foundation) 의료 및 대학원생 프리셉터십 (Medical and Graduate Student Preceptorship)의 지원을 받았습니다.

다음 프로토콜은 안전하고 윤리적인 인간 피험자 연구를 보장하기 위해 University Institutional Review Board에서 정한 지침을 따르고 승인되었습니다. 모든 피험자는 연구 참여 및 데이터 보급에 대해 정보에 입각한 동의를 제공했습니다. 전체 프로토콜은 숙련된 초음파 검사자가 수행하는 데 약 20분이 걸립니다. 그러나 평가 필요에 따라 개별 측정을 수행할 수 있습니다.
1. 피부의 마...

아킬레스건 형태의 초음파 평가

<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. 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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. 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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> 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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방법의 타당성과 신뢰성을 보장하기 위한 프로토콜의 중요한 단계에는 초음파 검사를 안내하기 위해 참가자의 피부 표시를 사용하고 연구 연구에 사용되는 측정을 수행하는 개인에 대한 필수 교육이 포함됩니다. 문서화된 특정 위치의 피부 표시는 시간이 지남에 따라 동일한 개인의 동일한 위치에서 관심 변수를 일관되고 정확하게 평가하는 데 도움이 됩니다. 또한, 동일한 체계적인 방식으로 ?...

아킬레스건은 비복근과 가자미근의 근건성 접합부에서 시작되어 종골 뒤쪽에 삽입됩니다. 아킬레스건은 주로 인장강도를 최대화하기 위해 계층적으로 배열된 조밀하고 조직화된 콜라겐 조직으로 구성되어 있다1. 강한 힘을 견딜 수 있는 능력에도 불구하고 아킬레스건은 일생 동안 여러 유형의 부상에 취약합니다. 아킬레스 건병증 및 아킬레스 건 파열과 같은 이러한 부상은 종종 삼두근 수와 주변 조직의 구조 변화를 동반합니다. 아킬레스 건병증에서 환자는 종종 방추형 힘줄이 두꺼워지고, 건증, 콜라겐 무질서화, 혈관 및 신경 조직이 힘줄로 증식하는 과정인 신생혈관형성(neovascularization)을 보인다2. 또한 아킬레스 건병증과 관련된 병리학적 변화에는 부건염, 건내 및/또는 내막 석회화 및 활액낭염 2,3이 포함됩니다. 아킬레스건 파열 후 치료와 관계없이 구조적 변화가 흔하게 발생하며, 아킬레스건이 두꺼워지고 힘줄 길이가 늘어나는 등의 증상이 나타난다 4,5. 또한, 삼두근 수라 근위축증(triceps surae muscular atrophy)과 같은 근육 변화도 일반적으로 아킬레스건 손상과 관련이 있다 5,6.
삼두근 및 주변 조직 구조를 평가할 수 있는 능력은 증상, 기능 및 예후와 관련된 것으로 알려진 구조적 무결성, 조직 품질 및 크기에 대한 귀중한 통찰력을 제공합니다 4,7,8,9. 초음파 영상은 아킬레스건 길이10, 두께 10,11, 단면적(CSA)12, 비복근 해부학적 CSA13 및 신생혈관 형성(14,15)을 포함하되 이에 국한되지 않는 이러한 구조에 대한 신뢰할 수 있고 유효한 평가 도구입니다. 이러한 측정에 대한 평가는 건강한 삼두근 조직에 대한 이해뿐만 아니라 부상 위험, 중증도 및 회복을 평가하기 위한 구조적 변화의 정량화뿐만 아니라 건강한 조직의 품질을 이해하는 데 귀중한 통찰력을 제공한다16.
삼두근 구조를 평가하는 데 있어 초음파 영상의 임상 및 연구 유용성에도 불구하고, 임상 및 연구 연구 간에 영상 기법과 측정 매개변수에 차이가 있는 경우가 많다17,18. 그 결과, 연구 간의 비교가 어렵습니다. 따라서 이 방법 논문의 목적은 근골격계 초음파 영상을 사용하여 삼두근 및 힘줄 구조를 효율적으로 평가하기 위한 유효하고 신뢰할 수 있는 프로토콜을 설명하는 것입니다. 이 프로토콜은 이 도구를 건강 및 부상당한 개인의 전체 또는 특정 부분으로 연구 및 임상 환경에 통합할 수 있는 가능성을 입증하는 것을 목표로 합니다. 또한, 건강한 삼두근과 부상당한 삼두근에 대한 대표 가치를 제공합니다.

<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

아킬레스건 손상은 일생 동안 발생하며 삶의 질과 전반적인 건강에 부정적인 영향을 미칠 수 있습니다. 아킬레스 건병증은 일반적으로 방추형 힘줄 비후화, 신생혈관 형성 및 간질 힘줄 변성과 관련된 과사용 부상으로 분류됩니다. 현재 문헌에 따르면 이러한 구조적 변화는 장기적으로 증상 및 하지 기능뿐만 아니라 증상 및 신체 활동 수준 저하와 관련이 있습니다. 수술 및 비수술적 관리로 관리되는 아킬레스건 파열은 힘줄 단면적(CSA)이 증가하고 아킬레스건이 길어집니다. CSA가 클수록 기능을 긍정적으로 예측하는 반면, 힘줄 연장이 증가하면 아킬레스건 파열 후 기능이 감소할 것으로 예측되기 때문에 두 구조적 결과 모두 임상적 의미가 있습니다. 아킬레스건 손상과 관련된 구조적 변화가 부상 중증도와 부상 회복 사이의 관계를 고려할 때, 아킬레스건 구조를 신뢰할 수 있고 정확하게 정량화할 수 있는 것이 중요합니다. Silbernagel의 그룹은 삼두근, 수라, 근육 및 힘줄 구조를 효율적으로 평가하기 위한 유효하고 신뢰할 수 있는 방법을 확립했습니다. 이 프로토콜에서는 B-모드 근골격계 초음파 영상을 사용하여 아킬레스건 두께 및 CSA, 가자미 두께, 추가 소견(석회화 및 활액낭염)의 존재를 포함한 삼두근 구조를 측정합니다. B 모드 확장 시야는 아킬레스 건 길이와 비복 해부학적 CSA를 측정하는 데 사용됩니다. 마지막으로, 파워 도플러는 건내 신생혈관 형성을 식별하는 데 사용됩니다. 삼두근 구조의 정량화는 건강한 개인과 아킬레스건 손상이 있는 사람들을 위한 운동 및 치료에 대한 종단 변화뿐만 아니라 팔다리 간의 비교를 가능하게 합니다. 이 프로토콜은 현재까지 많은 연구에서 사용되어 왔으며 힘줄 구조와 부상 발달, 중증도 및 회복 간의 관계를 이해하는 데 가치가 있음이 입증되었습니다. 초음파 장치가 점점 더 저렴하고 휴대가 간편해짐에 따라 이 프로토콜은 빠르고 효율적인 방법을 감안할 때 임상 도구로 유망한 것으로 입증되었습니다.

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.

저자 스포트라이트: 아킬레스건 손상의 복잡성 탐구 — 연구 및 향후 방향

건강한 삼두근과 부상당한 삼두근 수래 형태 측정

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.

이 프로토콜의 조치는 신뢰할 수 있고 유효한 것으로 입증되었습니다10,20. 확장된 시야에서 비복근까지의 아킬레스건 길이(ICC: 0.944) 및 아킬레스건에서 가자미까지의 길이(ICC: 0.898)에 대한 탁월한 신뢰성이 보고되었습니다10. 아킬레스건 길이 측정에 대한 그룹 수준(MDC그룹)에서 감지 가능한 최소 변화는 비복근까지의 길이에 ...

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

초음파 영상은 임상 및 연구 환경에서 점점 더 접근성이 높아지고 있으며, 일관된 프로토콜은 연구 간 비교 및 임상 해석에 도움이 될 것입니다. 초음파 평가를 위한 이 프로토콜은 건강한 건병증성 힘줄 및 파열된 힘줄에서 아킬레스건 형태를 평가하는 유효하고 신뢰할 수 있는 방법입니다.

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

우리의 연구는 아킬레스건 손상, 특히 아킬레스건 병증과 아킬레스건 파열의 복잡성을 이해하는 데 중점을 둡니다. 그래서 통증 및 증상 기능, 힘줄 구조, 심리적 요인 등 힘줄 건강의 다양한 영역을 평가하여 부상 증상 발현과 회복에 있어 개인차를 종합적으로 파악합니다. 현재 구조를 평가하는 사람들과 증상 및 기능과 같은 힘줄 건강의 다른 척도를 평가하는 사람들 사이에는 단절이 있습니다.따라서 이 프로토콜을 통해 다른 힘줄 건강 영역을 평가하기 위한 추가 평가 방법과 함께 구조, 기능, 증상, 부상 후 구조의 회복, 건강 개인과 다른 부상 또는 동반 질환을 가진 사람들의 구조적 특성 간의 관계에 대한 귀중한 통찰력을 제공할 것입니다. 우리 연구실의 결과와 초음파 영상 방법론의 사용은 힘줄 신장의 영향, 아킬레스건 파열 후 힘줄이 더 오래 치유되는 것, 회복을 최적화하기 위해 힘줄이 늘어나는 것을 최소화하는 것의 중요성을 인식하는 데 실제로 길을 열었습니다. 또한, 이 결과는 아킬레스 건병증 환자들 사이의 회복 차이에 대한 새로운 과학적 질문을 이해하는 데 도움이 되었습니다.

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.

연구

의학

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.

형태학을 연구하기 위한 아킬레스건의 초음파 영상

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.