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Holmgren JG, Kottapalli V, Ngo T, Tran A, Roberts T, Johnson T, Gao J. Anisotropy and reproducibility of ultrasound shear wave elastography in patella tendons with and without tendinopathy. Clin Imaging 2023; 102:71-77. [PMID: 37633230 DOI: 10.1016/j.clinimag.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/04/2023] [Accepted: 08/08/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Ultrasound shear wave elastography (SWE) is a tool that can be utilized to assess biomechanical properties of tendons. Anisotropy, an ultrasound imaging artifact has been commonly cited as a potential source of error in the accuracy and reproducibility of SWE. The aim of the study was to assess reproducibility in performing SWE of patella tendons and differences in SWE and anisotropy between normal patella tendons and patellar tendinopathy. METHODS After obtaining the Institutional Review Board approval and written informed consent, we prospectively measured the shear wave velocity (SWV) of patella tendons with and without tendinopathy in 25 volunteers. SWVs were measured in three anatomic planes: longitudinal, perpendicular transverse, and tilted transverse with the probe tilted 15-30° from the perpendicular transverse plane by three operators with varied levels of experience. Anisotropy coefficient (A) was calculated by formula of A = (SWVLongitudinal - SWVTransverse) / SWVTransverse. RESULTS Differences in SWV and anisotropy coefficient between normal tendons and tendons with tendinopathy were significant (p < 0.05). The intra- and inter-observer reproducibility in performing SWE were moderate to good (intraclass correlation coefficient: 0.81-0.95). The mean difference of 95% Bland-Altman limits of agreement for measuring tendon SWV ranged -0.08 to 0.41 (upper 0.08 to 1.14, lower -1.22 to -0.22) between senior and junior operators. CONCLUSION The results of this study suggest that SWE and anisotropy coefficient are feasible tools to differentiate patellar tendinopathy from normal patella tendons. The reproducibility of performing SWE of patella tendons is moderate to good.
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Affiliation(s)
| | | | - Thien Ngo
- Rocky Vista University, Ivins, UT, USA
| | | | | | | | - Jing Gao
- Rocky Vista University, Ivins, UT, USA.
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Crawford SK, Kliethermes SA, Heiderscheit BC, Bashford GR. Influence of ultrasound machine settings on quantitative measures derived from spatial frequency analysis of muscle tissue. BMC Musculoskelet Disord 2023; 24:664. [PMID: 37608370 PMCID: PMC10463672 DOI: 10.1186/s12891-023-06790-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Ultrasound is a powerful tool for diagnostic purposes and provides insight into both normal and pathologic tissue structure. Spatial frequency analysis (SFA) methods characterize musculoskeletal tissue organization from ultrasound images. Both sonographers in clinical imaging and researchers may alter a minimized range of ultrasound settings to optimize image quality, and it is important to know how these small adjustments of these settings affect SFA parameters. The purpose of this study was to investigate the effects of making small adjustments in a typical default ultrasound machine setting on extracted spatial frequency parameters (peak spatial frequency radius (PSFR), Mmax, Mmax%, and Sum) in the biceps femoris muscle. METHODS Longitudinal B-mode images were collected from the biceps femoris muscle in 36 participants. The window depth, foci locations, and gain were systematically adjusted consistent with clinical imaging procedures for a total of 27 images per participant. Images were analyzed by identifying a region of interest (ROI) in the middle portion of the muscle belly in a template image and using a normalized two-dimensional cross-correlation technique between the template image and subsequent images. The ROI was analyzed in the frequency domain using conventional SFA methods. Separate linear mixed effects models were run for each extracted parameter. RESULTS PSFR was affected by modifications in focus location only (p < 0.001) with differences noted between all locations. Mmax% was influenced by the interaction of gain and focus location (p < 0.001) but was also independently affected by increasing window depth (p < 0.001). Both Mmax and Sum parameters were sensitive to small changes in machine settings with the interaction of focus location and window depth (p < 0.001 for both parameters) as well as window depth and gain (p < 0.001 for both) influencing the extracted values. CONCLUSIONS Frequently adjusted imaging settings influence some SFA statistics. PSFR and Mmax% appear to be most robust to small changes in image settings, making them best suited for comparison across individuals and between studies, which is appealing for the clinical utility of the SFA method.
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Affiliation(s)
- Scott K Crawford
- Department of Kinesiology, University of Wisconsin-Madison, 1300 University Ave, Madison, WI, 53706, USA.
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
| | - Stephanie A Kliethermes
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Greg R Bashford
- Department of Biological Systems Engineering, University of Nebraska, Lincoln, NE, USA
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Vila-Dieguez O, Heindel MD, Awokuse D, Kulig K, Michener LA. Exercise for rotator cuff tendinopathy: Proposed mechanisms of recovery. Shoulder Elbow 2023; 15:233-249. [PMID: 37325389 PMCID: PMC10268139 DOI: 10.1177/17585732231172166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 06/17/2023]
Abstract
Rotator cuff (RC) tendinopathy is a common recurrent cause of shoulder pain, and resistance exercise is the first-line recommended intervention. Proposed causal mechanisms of resistance exercise for patients with RC tendinopathy consist of four domains: tendon structure, neuromuscular factors, pain and sensorimotor processing, and psychosocial factors. Tendon structure plays a role in RC tendinopathy, with decreased stiffness, increased thickness, and collagen disorganization. Neuromuscular performance deficits of altered kinematics, muscle activation, and force are present in RC tendinopathy, but advanced methods of assessing muscle performance are needed to fully assess these factors. Psychological factors of depression, anxiety, pain catastrophizing, treatment expectations, and self-efficacy are present and predict patient-reported outcomes. Central nervous system dysfunctions also exist, specifically altered pain and sensorimotor processing. Resisted exercise may normalize these factors, but limited evidence exists to explain the relationship of the four proposed domains to trajectory of recovery and defining persistent deficits limiting outcomes. Clinicians and researchers can use this model to understand how exercise mediates change in patient outcomes, develop subgroups to deliver patient-specific approach for treatment and define metrics to track recovery over time. Supporting evidence is limited, indicating the need for future studies characterizing mechanisms of recovery with exercise for RC tendinopathy.
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Affiliation(s)
- Oscar Vila-Dieguez
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Matthew D. Heindel
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Daniel Awokuse
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A. Michener
- Division of Biokinesiology & Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Gao J, Rosander A, Rubin JM. Quantitative Assessment of Tendon Backscatter Anisotropy in B-Mode Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1408-1414. [PMID: 36878827 DOI: 10.1016/j.ultrasmedbio.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 05/11/2023]
Abstract
To test the anisotropy of human tendons in conventional B-mode ultrasound, we prospectively performed ultrasound scans of 40 normal patella tendons and 24 patella tendons with chronic tendinopathy in adults. We scanned all tendons in longitudinal orientation (parallel to tendon fibers) using a linear array transducer (8.5 MHz) with beam steering at 0°, 5°, 10°, 15° and 20°. We used ImageJ histogram analysis to process B-mode images offline for assessing backscatter as a function of angle, known as backscatter anisotropy, between normal tendons and the subcutaneous tissues and between normal tendons and tendons with tendinopathy. We compared the results using the slopes of linear regression lines drawn through the angle-dependent data, and we concluded that the tissue anisotropy was significantly different if the 95% confidence intervals of the line slopes for different tissues did not overlap. We observed significant differences between normal tendons and both the adjacent subcutaneous tissues and tendons with tendinopathy. However, the difference in the regression slopes between tendons with tendinopathy and the adjacent subcutaneous soft tissues was not significant. It appears that changes in anisotropic backscatter could be used to detect tendon abnormalities and in assessing the significance of disease and the effectiveness of therapy.
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Affiliation(s)
- Jing Gao
- Rocky Vista University, Ivins, UT, USA; Weill Cornell Medicine, Department of Radiology, Cornell University, New York, NY, USA.
| | | | - Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Diagnostic accuracy of ultrasound and MRI for Achilles tendon xanthoma in people with familial hypercholesterolemia: A systematic review. J Clin Lipidol 2018; 13:40-48. [PMID: 30503304 DOI: 10.1016/j.jacl.2018.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/19/2018] [Accepted: 10/31/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Achilles tendon xanthoma (ATX) results from tendon thickening and subclinical inflammation triggered by hypercholesterolemia, and is associated with more severe coronary artery disease and a higher risk of cardiovascular events. The ability to detect ATX by clinical examination is limited, and diagnostic imaging, for instance, using ultrasonography or magnetic resonance imagine (MRI), may improve the identification of ATX. However, the accuracy of ultrasound (US) imaging or MRI in identifying ATX in people with familial hypercholesterolemia (FH) has not been systematically reviewed. OBJECTIVE The objective of this study was to systematically review the accuracy of US imaging or MRI in diagnosing ATX in individuals with FH. METHODS Searches in Medline, Embase, Cochrane Central, and Cochrane Database of Systematic Reviews on the Ovid platform from inception to April 15, 2018, were conducted to identify articles. Any study design that included US imaging or MRI of Achilles tendon xanthoma in people with FH, and that included a control group of non-FH participants with either normal or symptomatic Achilles tendons, was considered eligible. All of the included studies were reviewed according to the STAndards for the Reporting of Diagnostic accuracy (STARD) method. A qualitative synthesis of the included studies was undertaken. RESULTS Fifteen studies with 699 patients with FH and 868 non-FH participants were included. Among the non-FH participants, 26 individuals had other documented Achilles tendon pathology (trauma or overuse). Evaluation with the STARD checklist suggested that the quality of evidence was low. US imaging and MRI may have acceptable sensitivity in detecting tendon thickening associated with ATX. There is a wide range in the suggested thickness thresholds and in the estimates of diagnostic accuracy. CONCLUSIONS A small amount of low-quality evidence suggests that ultrasonography or MRI can improve clinicians' accuracy in identifying ATX in people with FH, thereby identifying those with more severe coronary artery disease.
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Pearson SJ, Engel AJ, Bashford GR. Changes in tendon spatial frequency parameters with loading. J Biomech 2017; 57:136-140. [PMID: 28410739 DOI: 10.1016/j.jbiomech.2017.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/20/2017] [Accepted: 03/24/2017] [Indexed: 10/19/2022]
Abstract
To examine and compare the loading related changes in micro-morphology of the patellar tendon. Fifteen healthy young males (age 19±3yrs, body mass 83±5kg) were utilised in a within subjects matched pairs design. B mode ultrasound images were taken in the sagittal plane of the patellar tendon at rest with the knee at 90° flexion. Repeat images were taken whilst the subjects were carrying out maximal voluntary isometric contractions. Spatial frequency parameters related to the tendon morphology were determined within regions of interest (ROI) from the B mode images at rest and during isometric contractions. A number of spatial parameters were observed to be significantly different between resting and contracted images (Peak spatial frequency radius (PSFR), axis ratio, spatial Q-factor, PSFR amplitude ratio, and the sum). These spatial frequency parameters were indicative of acute alterations in the tendon micro-morphology with loading. Acute loading modifies the micro-morphology of the tendon, as observed via spatial frequency analysis. Further research is warranted to explore its utility with regard to different loading induced micro-morphological alterations, as these could give valuable insight not only to aid strengthening of this tissue but also optimization of recovery from injury and treatment of conditions such as tendinopathies.
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Affiliation(s)
- Stephen J Pearson
- Centre of Health, Sport and Rehabilitation Sciences Research, University of Salford, Manchester M6 6PU, United Kingdom.
| | - Aaron J Engel
- Dept. of Biological Systems Engineering, University of Nebraska-Lincoln, USA
| | - Gregory R Bashford
- Dept. of Biological Systems Engineering, University of Nebraska-Lincoln, USA
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Kolovou G, Daskalova D, Mastorakou I, Anagnostopoulou K, Cokkinos DV. Regression of Achilles Tendon Xanthomas Evaluated by CT Scan After Hypolipidemic Treatment with Simvastatin. Angiology 2016; 55:335-9. [PMID: 15156269 DOI: 10.1177/000331970405500314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Familial hypercholesterolemia (FH) is a relatively common autosomal monogenic disease with dominant inheritance and threefold to fourfold increase in relative risk of cardiovascular death in untreated patients. For a “definitive” clinical diagnosis of FH the Simon Broome Register proposes the presence of tendon xanthomas as a key feature. However, detection of tendon xanthomas by physical examination is subjective and difficult to use for follow-up purposes. Several instrumental methods have been reported to be more sensitive than physical examination for the evaluation of xanthomas. The present case illustrates the usefulness of computed tomography (CT) to detect xanthomas in the Achilles tendons (XAT) and their regression in response to hypolipidemic drug treatment in a heterozygous FH patient. As XAT are atherosclerotic plaque-like depositions of lipids it is likely that their progression or regression follows the behavior of vascular atherosclerotic lesions.
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Affiliation(s)
- Genovefa Kolovou
- 1st Cardiology Department of the Onassis Cardiac Surgery Center, Athens, Greece.
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Nadeau MJ, Desrochers A, Lamontagne M, Larivière C, Gagnon DH. Quantitative ultrasound imaging of Achilles tendon integrity in symptomatic and asymptomatic individuals: reliability and minimal detectable change. J Foot Ankle Res 2016; 9:30. [PMID: 27540416 PMCID: PMC4989299 DOI: 10.1186/s13047-016-0164-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background Quantifying the integrity of the Achilles tendon (AT) is a rehabilitation challenge. Adopting quantitative ultrasound measurements (QUS measurements) of the AT could fill this gap by 1) evaluating the test-retest reliability and accuracy of QUS measurements of the AT; 2) determining the best protocol for collecting QUS measurements in clinical practice. Methods A total of 23 ATs with symptoms of Achilles tendinopathy and 63 asymptomatic ATs were evaluated. Eight images were recorded for each AT (2 visits × 2 evaluators × 2 images). Multiple sets of QUS measurements were taken: geometric (thickness, width, area), first-order statistics (computed from a grayscale histogram distribution: echogenicity, variance, skewness, kurtosis, entropy) and texture features (computed from co-occurrence matrices: contrast, energy, homogeneity). A generalizability study quantified the reliability and standard error of measurement (accuracy) of each QUS measurement, and a decision study identified the best measurement taking protocols. Results Geometric QUS measurements demonstrated excellent accuracy and reliability. QUS measurements computed from the grayscale histogram distribution revealed poor accuracy and reliability. QUS measurements derived from co-occurrence matrices showed variable accuracy and moderate to excellent reliability. In clinical practice, using an average of the results of three images collected by a single evaluator during a single visit is recommended. Conclusions The use of geometric QUS measurements enables quantification of AT integrity in clinical practice and research settings. More studies on QUS measurements derived from co-occurrence matrices are warranted.
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Affiliation(s)
- Marie-Josée Nadeau
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada
| | - Amélie Desrochers
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Christian Larivière
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; Occupational Health and Safety Research Institute Robert-Sauvé (IRSST), Montreal, Canada
| | - Dany H Gagnon
- Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - Institut de réadaptation Lindsay-Gingras de Montréal, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada ; School of Rehabilitation, Université de Montréal, Pavillon 7077 Avenue du Parc, Station Centre-Ville, P.O. Box 6128, Montreal, Quebec H3C 3J7 Canada
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Kulig K, Chang YJ, Winiarski S, Bashford GR. Ultrasound-Based Tendon Micromorphology Predicts Mechanical Characteristics of Degenerated Tendons. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:664-673. [PMID: 26718836 DOI: 10.1016/j.ultrasmedbio.2015.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/10/2015] [Accepted: 11/15/2015] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to explore the relationship between tendon micro-morphology quantified from a sonogram and tendon mechanical characteristics measured in vivo. Nineteen adults (nine with unilateral Achilles tendinosis) participated. A commercial ultrasound scanner was used to capture longitudinal B-mode ultrasound images from the mid-portion of bilateral Achilles tendons and a custom image analysis program was used to analyze the spatial frequency content of manually defined regions of interest; in particular, the average peak spatial frequency of the regions of interest was acquired. In addition, a dynamometer and a motion analysis system indirectly measured the tendon mechanical (stiffness) and material (elastic modulus) properties. The peak spatial frequency correlated with tendon stiffness (r = 0.74, p = 0.02) and elastic modulus (r = 0.65, p = 0.05) in degenerated tendons, but not healthy tendons. This is the first study relating the mechanical characteristics of degenerated human Achilles tendon using a non-invasive micro-morphology analysis approach.
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Affiliation(s)
- Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA.
| | - Yu-Jen Chang
- Division of Physical Therapy, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Slawomir Winiarski
- Department of Biomechanics, University School of Physical Education in Wroclaw, Wroclaw, Poland
| | - Gregory R Bashford
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Buschmann J, Puippe G, Bürgisser GM, Bonavoglia E, Giovanoli P, Calcagni M. Correspondence of high-frequency ultrasound and histomorphometry of healing rabbit Achilles tendon tissue. Connect Tissue Res 2014; 55:123-31. [PMID: 24283274 DOI: 10.3109/03008207.2013.870162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Static and dynamic high-frequency ultrasound of healing rabbit Achilles tendons were set in relationship to histomorphometric analyses at three and six weeks post-surgery. MATERIALS AND METHODS Twelve New Zealand White rabbits received a clean-cut Achilles tendon laceration (the medial and lateral Musculus gastrocnemius) and were repaired with a four-strand Becker suture. Six rabbits got additionally a tight polyester urethane tube at the repair site in order to vary the adhesion extent. Tendons were analysed by static and dynamic ultrasound (control: healthy contralateral legs). The ultrasound outcome was corresponded to the tendon shape, tenocyte and tenoblast density, tenocyte and tenoblast nuclei width, collagen fibre orientation and adhesion extent. RESULTS The spindle-like morphology of healing tendons (ultrasound) was confirmed by the swollen epitenon (histology). Prediction of adhesion formation by dynamic ultrasound assessment was confirmed by histology (contact region to surrounding tissue). Hyperechogenic areas corresponded to acellular zones with aligned fibres and hypoechogenic zones to not yet oriented fibres and to cell-rich areas. CONCLUSIONS These findings add new in-depth structural knowledge to the established non-invasive analytical tool, ultrasound.
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Affiliation(s)
- Johanna Buschmann
- Department for Plastic Surgery and Hand Surgery, University Hospital Zurich , Zurich , Switzerland
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Yu TY, Tsai WC, Cheng JW, Yang YM, Liang FC, Chen CH. The effects of aging on quantitative sonographic features of rotator cuff tendons. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:471-478. [PMID: 22508403 DOI: 10.1002/jcu.21919] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 02/24/2012] [Indexed: 05/31/2023]
Abstract
PURPOSE Grayscale analysis is a practical, objective, and easy way to quantify echogenicity during ultrasonography. The purpose of the current study was to measure the changes in thickness and echogenicity that result from aging of the rotator cuff and long head of the biceps tendons. METHODS The study comprised 45 volunteers, aged between 20 and 84 years and without history of shoulder pain. Participants were divided into three groups: young, middle-aged, and old. All subjects underwent standard ultrasonography of both shoulders. Tendon thickness and tear were recorded, and images in both transverse and longitudinal scans were taken for grayscale analysis. To reduce the attenuation effect from skin and subcutaneous fat, we used the ratio of echogenicity of the tendon to that of the reference muscle and compared the tendon echogenicity among the different age groups. Sonographic findings were also correlated with age. RESULTS The supraspinatus tendon was significantly thicker in elderly participants and this was positively correlated with age. Moreover, the echogenicity ratio of the supraspinatus tendon decreased in the elderly group and showed a negative correlation with age. There was a higher prevalence of supraspinatus tendon tears in the older participants. CONCLUSIONS Our results indicate that supraspinatus tendons became thickened, hypoechogenic, and more likely to tear with age. The study presents a simple and useful method to investigate the echogenicity of the rotator cuff quantitatively.
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Affiliation(s)
- Tung-Yang Yu
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
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Chamberlain CS, Crowley EM, Kobayashi H, Eliceiri KW, Vanderby R. Quantification of collagen organization and extracellular matrix factors within the healing ligament. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2011; 17:779-87. [PMID: 21910939 PMCID: PMC3263369 DOI: 10.1017/s1431927611011925] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Ligament healing of a grade III injury (i.e., a complete tear) involves a multifaceted chain of events that forms a neoligament, which is more scar-like in character than the native tissue. The remodeling process may last months or even years with the injured ligament never fully recovering pre-injury mechanical properties. With tissue engineering and regenerative medicine, understanding the normal healing process in ligament and quantifying it provide a basis to create and assess innovative treatments. Ligament fibroblasts produce a number of extracellular matrix (ECM) components, including collagen types I and III, decorin and fibromodulin. Using a combination of advanced histology, molecular biology, and nonlinear optical imaging approaches, the early ECM events during ligament healing have been better characterized and defined. First, the dynamic changes in ECM factors after injury are shown. Second, the factors associated with creeping substitution are identified. Finally, a method to quantify collagen organization is developed and used. Each ECM factor described herein as well as the temporal quantification of fiber organization helps elucidate the complexity of ligament healing.
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Affiliation(s)
- Connie S Chamberlain
- Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI 53705, USA
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Du YC, Chen YF, Lin CJ, Lin YC, Chen T. The application of quantitative ultrasound (QUS) on study of aging effects of achilles tendons. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2005:6344-7. [PMID: 17281718 DOI: 10.1109/iembs.2005.1615948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recently, the quantitative ultrasound (QUS) technique has been widely applied for the characterization of tissues. For example, it can be used for the quantization of Achilles tendons based on the broadband ultrasound attenuation (BUA) and speed of sound (SOS) when the ultrasound wave passes through the tissues. The main purpose of this study is to develop an integrated system to investigate the correlations between the measurements of Achilles tendons using QUS (UBIS 5000) and 2D ultrasound instrument (HDI 5000). Subjects including young (32 females and 17 males; mean age: 23.7+/-2.0) and middle-age groups (8 female and 8 males; mean age: 47.3+/-8.5 s) were recruited and tested for this study. All the subjects were ensured to have no habit of regular exercise and no record of tendon injury. The results show that BUA is significantly higher for the young group (45.2+/-1.6 dB/MHz) than the middle-age group (40.5+/-1.9 dB/MHz), while SOS is significantly lower for the young (1601.9+/-11.2m/s) than the middle-age (1624.1+/-8.7m/s). The thickness of Achilles tendons for both groups (young: 4.31+/-0.23mm; middle age: 4.24+/-0.23mm) are very similar. The noninvasive ultrasonic assessment of Achilles tendons might be helpful in clinical diagnosis and in evaluation of a therapeutic regimen. In the future, further animal studies should be made by measuring the BUA and SOS invasively to evaluate the accuracy of the parameters measured using QUS parametric images.
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Affiliation(s)
- Yi-Chun Du
- Institute of Biomeddical Engineering ,National Cheng Kung Univiversity, Tainan, Taiwan
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Bashford GR, Tomsen N, Arya S, Burnfield JM, Kulig K. Tendinopathy discrimination by use of spatial frequency parameters in ultrasound B-mode images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2008; 27:608-615. [PMID: 18450534 DOI: 10.1109/tmi.2007.912389] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The structural characteristics of a healthy tendon are related to the anisotropic speckle patterns observed in ultrasonic images. This speckle orientation is disrupted upon damage to the tendon structure as observed in patients with tendinopathy. Quantification of the structural appearance of tendon shows promise in creating a tool for diagnosing, prognosing, or measuring changes in tendon organization over time. The current work describes a first step taken towards this goal-classification of Achilles tendon images into tendinopathy and control categories. Eight spatial frequency parameters were extracted from regions of interest on tendon images, filtered and classified using linear discriminant analysis. Resulting algorithms had better than 80% accuracy in categorizing tendon image kernels as tendinopathy or control. Tendon images categorized wrongly provided for an interesting clinical association between incorrect classification of tendinopathy kernels as control and the symptom and clinical time history based inclusion criteria. To assess intersession reliability of image acquisition, the first 10 subjects were imaged twice during separate sessions. Test-retest of repeated measures was excellent (tau = 0.996, ICC = (2, 1) = 0.73 with one outlier) indicating a general consistency in imaging techniques.
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Affiliation(s)
- G R Bashford
- Department of Biological Systems Engineering, University of Nebraska-Lincoln, 230 L. W. Chase Hall, Lincoln, NE 68583, USA.
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Tsouli SG, Kiortsis DN, Argyropoulou MI, Mikhailidis DP, Elisaf MS. Pathogenesis, detection and treatment of Achilles tendon xanthomas. Eur J Clin Invest 2005; 35:236-44. [PMID: 15816992 DOI: 10.1111/j.1365-2362.2005.01484.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tendon xanthomatosis often accompanies familial hypercholesterolaemia, but it can also occur in other pathologic states. Achilles tendons are the most common sites of tendon xanthomas. Low-density lipoprotein (LDL) derived from the circulation accumulates into tendons. The next steps leading to the formation of Achilles tendon xanthomas (ATX) are the transformation of LDL into oxidized LDL (oxLDL) and the active uptake of oxLDL by macrophages within the tendons. Although physical examination may reveal Achilles tendon xanthomas (ATX), there are several imaging methods for their detection. It is worth mentioning that ultrasonography is the method of choice in everyday clinical practice. Although several treatments for Achilles tendon xanthomas (ATX) have been proposed (LDL apheresis, statins, etc.), they target mostly in the treatment of the basic metabolic disorder of lipid metabolism, which is the main cause of these lesions. In this review we describe the formation, detection, differential diagnosis and treatment of ATX as well as the relationship between tendon xanthomas and atheroma.
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Garcia T, Hornof WJ, Insana MF. On the ultrasonic properties of tendon. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:1787-1797. [PMID: 14698346 DOI: 10.1016/s0301-5629(03)01069-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The strong dependence of tendon echogenicity on insonation angle is explored by analyzing echo spectra. Combining echo spectra with high-resolution images from several modalities reveals that fluid spaces surrounding fascicles and bundles are likely sources of ultrasonic scatter. Mathematical models of tendon structure are proposed to explain how the anisotropic microstructure of tendon gives rise to angle-dependent echogenicity. Echo spectra from spontaneously damaged equine tendon samples were compared with normal equine tendon and found to exhibit a dramatic decrease in anisotropic properties that appears to be related to the spatial organization and type of collagen generated during repair. Variation in echo spectra with insonation angle is a robust indicator of mechanical damage.
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Affiliation(s)
- Tanya Garcia
- Department of Surgical and Radiological Sciences; University of California, Davis, CA 95616, USA
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Micklethwaite L, Wood AK, Sehgal CM, Polansky M, Dowling BA, Dart AJ, Rose RJ, Hodgson DR. Use of quantitative analysis of sonographic brightness for detection of early healing of tendon injury in horses. Am J Vet Res 2001; 62:1320-7. [PMID: 11497458 DOI: 10.2460/ajvr.2001.62.1320] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine whether quantitative analysis of sonographic brightness could be used to detect healing of an induced injury of the superficial digital flexor tendon in horses and whether rate of healing was influenced by equine recombinant growth hormone. ANIMALS 8 clinically normal Standardbreds. PROCEDURES A localized injury was created in the left and right superficial digital flexor tendons of each horse by injection of 2,000 units of collagenase. After injury, 4 horses received equine recombinant growth hormone, a possible promoter of tendon healing. Sonographic images (7.5 MHz) of the flexor tendons and ligaments of the metacarpal region were recorded on videotape prior to injury and weekly for 7 weeks after injury. Images were digitized, and sonographic brightness of tendons and ligaments was calculated. RESULTS Collagenase-induced injury was sonographically similar to naturally occurring injury. After injury, sonographic brightness of the tendon decreased; after 3 weeks, brightness progressively increased, although by 7 weeks brightness had not returned to preinjury value. Equine recombinant growth hormone had no significant effect on the rate of tendon healing, as evaluated sonographically or at necropsy. CONCLUSIONS AND CLINICAL RELEVANCE As healing developed, alterations in sonographic brightness of injured tendons coincided with real changes in tendon structure. Quantitative sonographic brightness could be used to accurately monitor healing of equine tendon and ligament injuries and investigate the efficacy of various treatment regimens.
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Affiliation(s)
- L Micklethwaite
- Department of Veterinary Clinical Sciences, University of Sydney, Camden, NSW, Australia
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