Name: Autor destacado: Explorando las complejidades de las lesiones del tendón de Aquiles: investigación y direcciones futuras
Uploaded: 2023-10-27T15:00:00
Description: Watch this Scientific Journal Video about Measurement of Healthy and Injured Triceps Surae Morphology at JoVE.com

Los autores desean agradecer a los miembros pasados y actuales del Grupo de Investigación de Tendones de Delaware que han ayudado en la recopilación de datos utilizando este protocolo. La investigación reportada en esta publicación fue apoyada por el Instituto Nacional de Artritis y Enfermedades Musculoesqueléticas y de la Piel de los Institutos Nacionales de Salud bajo los números de premio R01AR072034, R01AR078898, F31AR081663, R21AR067390, y por el Instituto Nacional de Salud Infantil y Desarrollo Humano Eunice Kennedy Shriver de los Institutos Nacionales de Salud bajo el premio número T32HD007490. El contenido es responsabilidad exclusiva de los autores y no representa necesariamente los puntos de vista oficiales de los Institutos Nacionales de Salud. La investigación reportada en esta publicación también fue apoyada por subvenciones proporcionadas por el Consejo Sueco de Investigación para la Ciencia del Deporte, el Consejo del Condado de Estocolmo (proyecto ALF) y el Consejo Sueco de Investigación. Este trabajo también fue apoyado en parte por una beca de promoción de estudios de doctorado de la Fundación para la Investigación en Fisioterapia y por la Preceptoría de Estudiantes Médicos y de Posgrado de la Fundación de Investigación en Reumatología.

El siguiente protocolo sigue las pautas establecidas y ha sido aprobado por la Junta de Revisión Institucional de la Universidad para garantizar una investigación segura y ética con sujetos humanos. Todos los sujetos dieron su consentimiento informado para participar en los estudios de investigación y la difusión de datos. El protocolo completo tarda aproximadamente 20 minutos en ser realizado por un ecografista capacitado. Sin embargo, se pueden tomar medidas individuales según la necesidad de evaluación.
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Evaluación ecográfica de la morfología del tendón de Aquiles

<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. H., Pontiggia, L., 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=The+degree+of+tendinosis+is+related+to+symptom+severity+and+physical+activity+levels+in+patients+with+midportion+Achilles+tendinopathy.">The degree of tendinosis is related to symptom severity and physical activity levels in patients with midportion Achilles tendinopathy.</a> Int J Sports Phys Ther. 13 (2), 196-207 (2018).</li><li>Enriquez, J. L., Wu, T. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+introduction+to+ultrasound+equipment+and+knobology.">An introduction to ultrasound equipment and knobology.</a> Crit Care Clin. 30 (1), 25-45 (2014).</li><li>Jacobson, J. 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>

Los pasos críticos en el protocolo para garantizar la validez y confiabilidad de los métodos incluyen el uso de marcas cutáneas en los participantes para guiar el examen de ultrasonido y la capacitación requerida de las personas que realizan las mediciones utilizadas en los estudios de investigación. Las marcas cutáneas en ubicaciones documentadas específicas ayudan a evaluar las variables de interés de manera consistente y precisa en las mismas ubicaciones en el mismo individuo a lo largo del tiempo. Además, la...

El tendón de Aquiles se origina en las uniones miotendinosas de los músculos gastrocnemio y sóleo y se inserta en el calcáneo posterior. El tendón de Aquiles consiste principalmente en tejido de colágeno densamente empaquetado y organizado, dispuesto de manera jerárquica paramaximizar la resistencia a la tracción. A pesar de su capacidad para soportar grandes fuerzas, el tendón de Aquiles es susceptible a varios tipos de lesiones a lo largo de la vida. Estas lesiones, como la tendinopatía de Aquiles y las roturas del tendón de Aquiles, suelen ir acompañadas de cambios en la estructura del tríceps sural y los tejidos circundantes. En la tendinopatía de Aquiles, los pacientes a menudo exhiben engrosamiento del tendón fusiforme, tendinosis, desorganización del colágeno y neovascularización, un proceso de proliferación de tejido vascular y neural en el tendón2. Además, los cambios patológicos asociados a la tendinopatía de Aquiles incluyen paratendinitis, calcificaciones intratendinosas y/o entesales y bursitis 2,3. Después de las roturas del tendón de Aquiles, los cambios estructurales son comunes, independientemente del tratamiento, e incluyen el engrosamiento del tendón de Aquiles y el aumento de la longitud del tendón 4,5. Además, los cambios musculares, como la atrofia muscular del tríceps sural, también se asocian comúnmente con lesiones del tendón de Aquiles 5,6.
La capacidad de evaluar el tríceps sural y las estructuras tisulares circundantes proporciona información valiosa sobre la integridad estructural, la calidad y el tamaño del tejido, que se sabe que se relacionan con los síntomas, la función y el pronóstico 4,7,8,9. La ecografía es una herramienta de evaluación fiable y válida de estas estructuras, que incluye, entre otras, la longitud del tendón de Aquiles10, el grosor10,11, el área de la sección transversal (CSA)12, el CSA anatómico gastrocnemio13 y la neovascularización14,15. La evaluación de estas medidas proporciona información valiosa sobre la comprensión del tejido sano del tríceps sural, así como la cuantificación de las alteraciones estructurales para evaluar el riesgo de lesión, la gravedad y la recuperación, así como la comprensión de las cualidades del tejido sano16.
A pesar de la utilidad clínica y de investigación de la ecografía en la evaluación de la estructura del tríceps sural, a menudo existen diferencias en las técnicas de imagen y los parámetros de medición entre los estudios clínicos y de investigación17,18. Como resultado, las comparaciones entre estudios son difíciles. Por lo tanto, el propósito de este artículo es describir un protocolo válido y confiable para evaluar de manera eficiente la estructura muscular y tendinosa del tríceps sural mediante imágenes de ultrasonido musculoesquelético. Este protocolo tiene como objetivo demostrar la viabilidad de incorporar esta herramienta en entornos clínicos y de investigación en su totalidad o como partes específicas en individuos sanos y lesionados. Además, se proporcionan valores representativos de tríceps surales sanos y lesionados.

<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

Las lesiones del tendón de Aquiles se producen a lo largo de la vida y pueden afectar negativamente a la calidad de vida y a la salud en general. La tendinopatía de Aquiles generalmente se clasifica como una lesión por uso excesivo asociada con engrosamiento del tendón fusiforme, neovascularización y degeneración del tendón intersticial. La literatura actual sugiere que estos cambios estructurales se asocian con síntomas y niveles más bajos de actividad física, así como con síntomas y función de las extremidades inferiores a largo plazo. Las rupturas del tendón de Aquiles tratadas quirúrgicamente y no quirúrgicamente dan como resultado un aumento del área de la sección transversal del tendón (CSA) y un tendón de Aquiles alargado. Ambos resultados estructurales tienen implicaciones clínicas, ya que una mayor ASC predice positivamente la función, mientras que un mayor alargamiento del tendón predice una reducción de la función después de la ruptura del tendón de Aquiles. Dada la relación entre los cambios estructurales asociados con las lesiones del tendón de Aquiles tanto para la gravedad de la lesión como para la recuperación de la lesión, es fundamental poder cuantificar la estructura del tendón de Aquiles de manera confiable y precisa. El grupo de Silbernagel ha establecido un método válido y confiable para evaluar eficientemente la estructura del músculo tríceps sural y del tendón. En este protocolo, se utiliza la ecografía musculoesquelética en modo B para medir la estructura del tríceps sural, incluido el grosor del tendón de Aquiles y el CSA, el grosor del sóleo y la presencia de hallazgos adicionales (calcificaciones y bursitis). El campo de visión extendido en modo B se utiliza para medir la longitud del tendón de Aquiles y el CSA anatómico del gastrocnemio. Por último, el Doppler de potencia se utiliza para identificar la neovascularización intratendinosa. La cuantificación de la estructura del tríceps sural permite la comparación entre las extremidades, así como los cambios longitudinales en respuesta al ejercicio y al tratamiento para individuos sanos y aquellos con lesiones del tendón de Aquiles. Este protocolo se ha utilizado en muchos estudios de investigación hasta la fecha y resulta valioso para comprender la relación entre la estructura del tendón y el desarrollo, la gravedad y la recuperación de las lesiones. A medida que los dispositivos de ultrasonido son cada vez más asequibles y portátiles, este protocolo resulta prometedor como herramienta clínica, dados sus métodos rápidos y eficientes.

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.

Autor destacado: Explorando las complejidades de las lesiones del tendón de Aquiles: investigación y direcciones futuras

Medición de la morfología del tríceps sura sano y lesionado

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.

Las medidas de este protocolo han demostrado ser fiables y válidas 10,20. Se ha descrito una excelente fiabilidad para la longitud del tendón de Aquiles ampliada entre el tendón de Aquiles y el gastrocnemio (coeficiente de correlación interclase (ICC): 0,944) y la longitud del tendón de Aquiles con el sóleo (ICC: 0,898)10. El cambio mínimo detectable a nivel de grupo (grupo MDC) para las medidas de longitud del tendón de...

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

Las imágenes ecográficas son cada vez más accesibles en entornos clínicos y de investigación, y un protocolo coherente será beneficioso para la comparación entre estudios y para las interpretaciones clínicas. Este protocolo para la evaluación ecográfica es un método válido y fiable para evaluar la morfología del tendón de Aquiles en tendones sanos, tendinopáticos y rotos.

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

Nuestra investigación se centra en tratar de comprender las complejidades de las lesiones del tendón de Aquiles, específicamente la tendinopatía de Aquiles y las roturas del tendón de Aquiles. Por lo tanto, evaluamos varios dominios de la salud del tendón, como la función del dolor y los síntomas, la estructura del tendón y los factores psicológicos para identificar de manera integral las diferencias individuales en la presentación y recuperación de la lesión. Existe una desconexión actual entre los que evalúan la estructura y los que evalúan otras medidas de la salud del tendón, como los síntomas y la función.Por lo tanto, con este protocolo, junto con métodos de evaluación adicionales para evaluar otros dominios de la salud del tendón, proporcionaremos una valiosa información sobre la relación entre la estructura, la función, los síntomas, la recuperación de la estructura después de la lesión y las características estructurales de los individuos sanos y aquellos con diferentes lesiones o comorbilidades. Los resultados de nuestro laboratorio y el uso de la metodología de imágenes de ultrasonido realmente han allanado el camino para reconocer los impactos del alargamiento del tendón, la curación del tendón después de una ruptura del tendón de Aquiles y la importancia de minimizar este alargamiento para optimizar la recuperación. Además, los resultados nos han ayudado a comprender realmente las nuevas preguntas científicas sobre las diferencias en la recuperación entre los pacientes con tendinopatía de Aquiles.

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.

Investigación

Medicina

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.

Ecografía del tendón de Aquiles para estudiar la morfología

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.