Sonography of chronic Achilles tendinopathy: a case-control study

Area of Science:

• Musculoskeletal Imaging
• Radiology
• Orthopedics

Background:

• Chronic Achilles tendinopathy is a common condition affecting athletes and the general population.
• Accurate diagnosis is crucial for effective treatment and management.
• Sonography offers a non-invasive method for evaluating tendon pathology.

Purpose of the Study:

• To define sonographic criteria for diagnosing Achilles tendinopathy.
• To compare the ultrasound appearance of Achilles tendons in patients with tendinopathy versus healthy individuals.

Main Methods:

• A prospective, case-control sonographic study involving 21 patients and 50 controls.
• Assessment of Achilles tendon thickness, echogenicity, fibrillar pattern, vascularity (Power Doppler), and surrounding structures.
• Evaluation included Kager's fat pad, retrocalcaneal bursa, and calcaneal contour.

Main Results:

• Tendinopathic tendons showed increased size (cross-sectional area, antero-posterior diameter) and hypoechoic areas.
• Disrupted fibrillar pattern, increased vascularity, Kager's fat pad echogenicity, and paratenon thickening were specific to tendinopathy.
• Retrocalcaneal bursitis and calcaneal abnormalities were observed in both groups.

Conclusions:

• Sonographic findings of tendon enlargement, disrupted fibrillar pattern, and increased vascularity are indicative of Achilles tendinopathy.
• Increased Kager's fat pad echogenicity and paratenon thickening are additional diagnostic signs.
• Tendon calcifications and bursal/bony changes are not specific to Achilles tendinopathy.