Name: Författare i fokus: Utforska komplexiteten i akillessenskador - forskning och framtida riktningar
Uploaded: 2023-10-27T15:00:00
Description: Watch this Scientific Journal Video about Measurement of Healthy and Injured Triceps Surae Morphology at JoVE.com

Författarna vill tacka tidigare och nuvarande medlemmar av Delaware Tendon Research Group som har hjälpt till med datainsamling med hjälp av detta protokoll. Forskning som rapporteras i denna publikation stöddes av National Institute of Arthritis and Musculoskeletal and Skin Diseases vid National Institutes of Health under tilldelningsnummer R01AR072034, R01AR078898, F31AR081663, R21AR067390, och av Eunice Kennedy Shriver National Institute of Child Health and Human Development vid National Institutes of Health under tilldelningsnummer T32HD007490. Innehållet är helt och hållet författarnas ansvar och representerar inte nödvändigtvis de officiella åsikterna från National Institutes of Health. Forskning som redovisas i denna publikation har också finansierats av Forskningsrådet för idrottsvetenskap, Stockholms läns landsting (ALF-projektet) och Vetenskapsrådet. Detta arbete stöddes också delvis av ett stipendium för främjande av doktorandstudier från Stiftelsen för Sjukgymnastikforskning och av Reumatologiska forskningsstiftelsen för läkar- och doktorandhandledning.

Följande protokoll följer de riktlinjer som fastställts av och har godkänts av University Institutional Review Board för att säkerställa säker och etisk forskning på människor. Alla försökspersoner gav informerat samtycke till deltagande i forskningsstudier och spridning av data. Det fullständiga protokollet tar cirka 20 minuter att utföra av en utbildad sonograf. Individuella mätningar kan dock göras per bedömningsbehov.
1. Märkning av huden
<ol><li>Be deltagaren att sitta...

Ultraljudsutvärdering av akillessenans morfologi

<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>

Kritiska steg i protokollet för att säkerställa metodernas giltighet och tillförlitlighet inkluderar användningen av hudmarkeringar på deltagarna för att vägleda ultraljudsundersökningen och den nödvändiga utbildningen av personer som utför de mätningar som används i forskningsstudier. Hudmarkeringar på specifika dokumenterade platser hjälper till att bedöma variabler av intresse konsekvent och korrekt på samma platser hos samma individ över tid. Att applicera hudmarkeringar på olika individer på sam...

Hälsenan har sitt ursprung vid de myoendinösa korsningarna mellan gastrocnemius- och soleusmusklerna och sätter in på den bakre calcaneus. Hälsenan består främst av tätt packad, organiserad kollagenvävnad arrangerad på ett hierarkiskt sätt för att maximera draghållfastheten1. Trots sin förmåga att motstå tunga krafter är akillessenan känslig för flera typer av skador under hela livet. Dessa skador, såsom akillestendinopati och akillessenrupturer, åtföljs ofta av förändringar i strukturen hos triceps surae och omgivande vävnader. Vid akillestendinopati uppvisar patienter ofta förtjockning av fusiforma senor, tendinos, kollagendisorganisation och neovaskularisering, en process för proliferation av vaskulär och neural vävnad in i senan2. Dessutom inkluderar patologiska förändringar associerade med achilles tendinopati paratendinit, intratendinösa och/eller entesala förkalkningar och bursit 2,3. Efter hälsenerupturer är strukturella förändringar vanliga, oavsett behandling, och inkluderar förtjockning av akillessenan och ökad senlängd 4,5. Dessutom är muskelförändringar, såsom triceps surae muskelatrofi, också ofta förknippade med akillessenskador 5,6.
Förmågan att bedöma triceps surae och omgivande vävnadsstrukturer ger värdefull insikt i strukturell integritet, vävnadskvalitet och storlek, som är kända för att relatera till symtom, funktion och prognos 4,7,8,9. Ultraljudsavbildning är ett tillförlitligt och giltigt bedömningsverktyg för dessa strukturer, inklusive, men inte begränsat till, akillessenans längd10, tjocklek10,11, tvärsnittsarea (CSA)12, gastrocnemius anatomisk CSA13 och neovaskularisering14,15. Bedömning av dessa mått ger värdefull insikt i förståelsen av frisk triceps surae-vävnad, samt kvantifiering av strukturella förändringar för att utvärdera skaderisk, svårighetsgrad och återhämtning, samt förståelse för friska vävnadskvaliteter16.
Trots den kliniska och forskningsmässiga nyttan av ultraljudsavbildning för att bedöma triceps surae-struktur, finns det ofta skillnader i avbildningstekniker och mätparametrar mellan kliniska studier och forskningsstudier17,18. Som ett resultat av detta är det svårt att göra jämförelser mellan studier. Därför är syftet med denna metodartikel att beskriva ett giltigt och tillförlitligt protokoll för effektiv utvärdering av triceps surae muskel- och senstruktur med hjälp av muskuloskeletal ultraljudsavbildning. Detta protokoll syftar till att visa att det är möjligt att införliva detta verktyg i forskning och kliniska miljöer, i sin helhet eller som specifika delar hos friska och skadade individer. Dessutom ges representativa värden för friska och skadade triceps surae.

<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

Skador på akillessenan uppstår under hela livslängden och kan påverka livskvaliteten och den allmänna hälsan negativt. Achilles tendinopati klassificeras i allmänhet som en överbelastningsskada i samband med förtjockning av fusiforma senor, neovaskularisering och interstitiell sendegeneration. Aktuell litteratur tyder på att dessa strukturella förändringar är förknippade med symtom och lägre fysiska aktivitetsnivåer, samt symtom och funktion i nedre extremiteterna på lång sikt. Kirurgiskt och icke-kirurgiskt behandlade hälsenerupturer resulterar i ökad sentvärsnittsarea (CSA) och en förlängd akillessena. Båda de strukturella utfallen har kliniska implikationer, eftersom större CSA predicerar funktion positivt, medan ökad senförlängning förutsäger minskad funktion efter hälseneruptur. Med tanke på sambandet mellan strukturella förändringar i samband med hälseneskador för både skadans svårighetsgrad och skadeåterhämtning, är det viktigt att kunna kvantifiera akillessenans struktur på ett tillförlitligt och korrekt sätt. Silbernagels grupp har etablerat en giltig och tillförlitlig metod för att effektivt utvärdera triceps surae muskel- och senstruktur. I detta protokoll används B-mode muskuloskeletal ultraljudsavbildning för att mäta triceps surae-strukturen, inklusive akillessenans tjocklek och CSA, soleustjocklek och förekomsten av ytterligare fynd (förkalkningar och bursit). B-mode utökat synfält används för att mäta längden på akillessenan och gastrocnemius anatomiska CSA. Slutligen används power Doppler för att identifiera intratendinös vaskularisering. Kvantifiering av triceps surae-strukturen gör det möjligt att jämföra extremiteter samt longitudinella förändringar som svar på träning och behandling för friska individer och de med akillessenskador. Detta protokoll har hittills använts i många forskningsstudier och visar sig vara värdefullt för att förstå sambandet mellan senstruktur och skadeutveckling, svårighetsgrad och återhämtning. I takt med att ultraljudsapparater blir allt billigare och mer portabla visar sig detta protokoll vara lovande som ett kliniskt verktyg, med tanke på dess snabba och effektiva metoder.

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.

Författare i fokus: Utforska komplexiteten i akillessenskador - forskning och framtida riktningar

Mätning av frisk och skadad Triceps surae-morfologi

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.

Åtgärderna i detta protokoll har visat sig vara tillförlitliga och giltiga10,20. Utmärkt tillförlitlighet har rapporterats för akillessenlängd till gastrocnemius med utökat synfält (interclass correlation coefficient (ICC): 0,944) och akillessenlängd till soleus (ICC: 0,898)10. Den minsta detekterbara förändringen på gruppnivå (MDC-gruppen) för längdmått på akillessenan är 0,43 cm för längd till gastrocnemiu...

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

Ultraljudsavbildning blir allt mer tillgänglig i kliniska miljöer och forskningsmiljöer, och ett konsekvent protokoll kommer att vara fördelaktigt för jämförelse mellan studier och för kliniska tolkningar. Detta protokoll för ultraljudsutvärdering är en giltig och tillförlitlig metod för att utvärdera akillessenans morfologi hos friska, tendinopatiska och rupturerade senor.

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

Vår forskning fokuserar på att försöka förstå komplexiteten i akillessenskador, specifikt akillessenopati och akillessenrupturer. Så vi utvärderar olika domäner av senhälsa, såsom smärta och symtomfunktion, senstruktur och psykologiska faktorer för att på ett heltäckande sätt identifiera individuella skillnader i skadad presentation och återhämtning. Det finns för närvarande en klyfta mellan de som bedömer struktur och de som bedömer andra mått på senhälsa, såsom symtom och funktion.Så med detta protokoll, i kombination med ytterligare utvärderingsmetoder för att bedöma andra senhälsodomäner, kommer vi att ge en värdefull inblick i förhållandet mellan struktur, funktion, symtom, återhämtning av struktur efter skada och strukturella egenskaper hos hälsoindivider och de med olika skador eller komorbiditeter. Resultaten från vårt laboratorium och användningen av ultraljudsavbildningsmetodik har verkligen banat väg för att känna igen effekterna av senförlängning, senans läkning längre efter en hälseneruptur och vikten av att minimera denna förlängning för att optimera återhämtningen. Dessutom har resultaten hjälpt oss att verkligen förstå nya vetenskapliga frågor om skillnaderna i återhämtning mellan patienter med akillestendinopati.

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.

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.

Ultraljudsundersökning av hälsenan för att studera morfologi

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.