Achilles tendon injuries: the role of MR imaging

Eight magnetic resonance (MR) examinations were performed in seven patients with Achilles tendon injuries and correlated with physical examination and surgical and clinical follow-up. The MR examinations depicted the Achilles tendon in excellent detail and Achilles tendon abnormalities with greater accuracy than physical examination. Of five tendons shown to be at least partially torn on MR, palpable tendinous defects were found in only one, and plantarflexion weakness was found in four. The MR and surgical findings precisely correlated in one case. Magnetic resonance proved valuable in the evaluation of clinically equivocal Achilles tendon tears and may ultimately play a greater role as a research tool in the determination of optimal forms of therapy for specific Achilles tendon injuries.     

自体半腱肌及股薄肌肌腱桥接修补陈旧性MyersonⅢ型跟腱断裂疗效分析

目的:探讨半腱肌及股薄肌肌腱桥接修补陈旧性MyersonⅢ型跟腱断裂的临床疗效。方法:2006年4月至2008年10月,根据术前MRI检查测量跟腱缺损长度,共收治陈旧性MyersonⅢ型跟腱断裂患者共24例,运用自体半腱肌及股薄肌肌腱进行桥接修补,术后给予石膏外固定,进行常规康复治疗。采用Amer-Lindholm法评定疗效。结果:所有患者均获得随访,随访时间12～30个月,平均18个月。依据Amer-Lindholm疗效评定标准,优21例,良2例,差1例,优良率95.8%。随访期内无跟腱再断裂、周围神经损伤及切口深部感染等并发症。结论:自体半腱肌及股薄肌肌腱桥接修补陈旧性MyersonⅢ型跟腱断裂是一种安全、疗效满意的方法。     

Hormone therapy is associated with smaller Achilles tendon diameter in active post-menopausal women

The effects of hormonal status and activity levels on Achilles tendon structure were examined in asymptomatic post-menopausal women. It was hypothesized that women using hormone replacement therapy (HRT) would have better tendon structure than those not using HRT and that active women would have poorer tendon structure than inactive women. Eighty-five women including 53 active women (regular golf players) and 32 controls (healthy but inactive women) recorded their HRT and menopausal history and underwent basic anthropometric measurements. Women were divided into two groups based on their hormonal status: those currently using HRT; and those who had never used HRT or ceased using HRT at least 12 months prior to the study. Achilles tendons were examined with ultrasound and categorized as normal or abnormal, and the diameter of each tendon (mm) was recorded. Active women had a greater prevalence of tendon abnormality (P=0.10) and thicker Achilles tendons than inactive women (P<0.05). Active women on HRT had less tendon abnormality (P=0.056) than active women not on HRT and significantly less tendon thickness (P<0.05). This study indicates that Achilles tendon diameter is greater in active post-menopausal women. Hormone replacement therapy appeared to ameliorate this effect in active women. A similar effect from HRT on the Achilles tendons of inactive women was not apparent.     

Sonography of the Achilles tendon and adjacent bursae

Abnormalities of the Achilles tendon and adjacent bursae are common problems that may be difficult to diagnose clinically. Twenty patients with symptoms involving the Achilles tendon and 10 control subjects were evaluated with real-time sonography in order to explore the role of sonography in defining abnormalities of the tendon and adjacent bursae and in differentiating between conditions requiring surgery and those needing conservative therapy. Normal anatomic structures seen consistently included the Achilles tendon, the musculotendinous junction, the retrocalcaneal bursa, and the calcaneal tendon insertion site. The normal range of tendon thickness was 4-9 mm (mean, 6.2 mm). All patients had repeat sonograms after either clinical resolution (14 cases) or surgical intervention (six cases). Twelve of the symptomatic patients had abnormal findings. Partial ruptures of the Achilles tendon were reliably differentiated from other lesions. No evidence of tendon thickening was found in tendinitis. Tendon thickening was found only in cases of previous tendon rupture. The superficial tendo Achillis bursa was imaged only when inflamed. Sonography was found to differentiate reliably between conditions that require surgical intervention and those that will respond to conservative therapy.     

MRI在跟腱撕裂的诊断价值

目的：探讨不同程度跟腱撕裂的MRI表现的具体特点,评估MRI在跟腱损伤病例中的诊断价值。方法：本院自2007年8月-2009年10月MRI共诊断跟腱损伤11例,所有患者均行MRI常规TSE序列轴位、矢状、冠状位扫描,并追加矢状SPIR序列。结果：全部病例均显示相应跟腱撕裂MRI表现,其中完全撕裂4例,部分撕裂7例,表现为跟腱周围及腱旁脂肪垫积液、跟腱形态的改变、跟腱信号异常以及在完全性撕裂中显示缺口的范围及大小。结论：利用MRI诊断跟腱撕裂,可以精确判定其撕裂程度、范围以及是否合并骨髓水肿。     

Management of partial tears of the gastro-soleus complex

Although Achilles tendon is the strongest tendon in the human body, it is one of the most commonly injured tendons. Most Achilles ruptures are associated with sports activity. Up to one-fourth of all Achilles tendon pathologies are partial ruptures. Increased recognizability of partial rupture of Achilles tendon is connected with the development of ultrasound and MRI techniques. Partial ruptures of Achilles tendon are a clinical demonstration of asymmetric loading of Achilles tendon caused by its special anatomic structure. To describe those partial injuries, the author created histologic and anatomic classification. In this article detailed treatment options has been proposed.     

急性跟腱撕裂的影像学诊断

目的探讨跟腱撕裂的X线平片和MRI诊断价值。方法分析21例有急性踝关节损伤病史、经手术证实为跟腱完全撕裂或部分撕裂患者的X线平片和MRI表现，并与手术结果对照。结果21例MRI均有异常表现，诊断跟腱完全撕裂7例，部分撕裂14例，MRI表现为跟腱增粗，腱内信号增高，腱束连续性完全中断或部分中断。X线片5例诊断跟腱撕裂，12例疑似撕裂，4例正常。手术结果完全撕裂9例，部分撕裂12例。结论MRI能准确显示跟腱撕裂的程度和部位，对临床治疗具有重要的指导意义；X线可作为跟腱撕裂初诊的辅助检查，但明确诊断还有赖于MRI。     

Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis

OBJECTIVE: To assess the number and distribution of tendon microtears in asymptomatic controls and athletes with chronic Achilles tendinitis or partial thickness tears using high resolution ultrasound. METHODS: The mean number of microtears in three random tendon cross sections were recorded per tendon third in 19 asymptomatic volunteers, 16 athletes with symptomatic chronic Achilles tendinitis, and eight athletes with partial Achilles tendon rupture. RESULTS: Microtears were most numerous in the middle third section of the Achilles tendon. Some 67% of tendons in the control group had no microtears, and 28% showed a single microtear. Only 18% of the athletes with chronic Achilles tendinitis and none of the athletes with partial tendon rupture were without microtears in the middle third of their Achilles tendon. Of the tendons with chronic tendinitis, 13% had more than three microtears per section which increased to 87% in tendons exhibiting partial rupture. CONCLUSIONS: There appears to be an association between microtear formation and Achilles tendon rupture.     

中医药治疗跟腱运动损伤的实验研究

通过对大强度训练后兔跟腱的组织学和生物力学观察，发现跟腱随训练发生不同程度的运动损伤，同时伴有某些生物力学性质的增强，中医药对这些损伤的治疗效果明显。     

Achilles tendon lesions in sport

Achilles tendon pain is a common cause of disability in sportsmen. The majority of cases are due to overuse injury often exacerbated or precipitated by specific and recognisable factors. A variety of pathologies is demonstrable in Achilles tendon pain which accounts for the considerable variation in the described natural history of the disease. The study of patients with Achilles tendon pain is almost impossible unless an accurate diagnosis is made first. The specific factors of the various conditions demonstrated as causes of Achilles tendon pain are set out and the value of different laboratory and other investigations indicated in the particular pathological conditions. Conservative management of Achilles tendon pain may be unrewarding except in acute crepitating peritendinitis. Various forms of conservative treatment are discussed and the literature reviewed. The role of surgery in management of chronic resistent Achilles tendon pain is discussed in detail with particular reference to the indications and the surgical procedures available. The postoperative management of patients following Achilles tendon surgery is discussed and the outcome indicated.     

外伤性跟腱撕裂的MRI诊断

目的：评价磁共振(MRI)对外伤性跟腱撕裂的诊断价值。方法：收集经删检查并由手术证实的外伤性跟腱撕裂患者10例，回顾、分析其MRI表现。结果：10例患者均诊断正确(敏感性100％，特异性100％)。其中完全性撕裂8例，不完全性撕裂2例；撕裂发生在跟腱中上段2例、跟腱中段7例、跟腱下段1例；MRI主要表现为肌腱增粗10例，肌腱内信号增高10例，宽径／前后径比值缩小8例，肌腱连续性中断9例，断端分离、肌腱缩短3例。跟腱周围软组织肿胀及积液9例。结论：MRI能够直接显示跟腱的形态及其内部结构．对跟腱撕裂的术前诊断具有很高的敏感件和特异性．     

Muscle-tendon glucose uptake in Achilles tendon rupture and tendinopathy before and after eccentric rehabilitation: Comparative case reports

Achilles tendon rupture (ATR) is the most common tendon rupture injury. The consequences of ATR on metabolic activity of the Achilles tendon and ankle plantarflexors are unknown. Furthermore, the effects of eccentric rehabilitation on metabolic activity patterns of Achilles tendon and ankle plantarflexors in ATR patients have not been reported thus far. We present a case study demonstrating glucose uptake (GU) in the Achilles tendon, the triceps surae, and the flexor hallucis longus of a post-surgical ATR patient before and after a 5-month eccentric rehabilitation. At baseline, three months post-surgery, all muscles and Achilles tendon displayed much higher GU in the ATR patient compared to a healthy individual despite lower plantarflexion force. After the rehabilitation, plantarflexion force increased in the operated leg while muscle GU was considerably reduced. The triceps surae muscles showed similar values to the healthy control. When compared to the healthy or a matched patient with Achilles tendon pain after 12 weeks of rehabilitation, Achilles tendon GU levels of ATR patient remained greater after the rehabilitation. Past studies have shown a shift in the metabolic fuel utilization towards glycolysis due to immobilization. Further research, combined with immuno-histological investigation, is needed to fully understand the mechanism behind excessive glucose uptake in ATR cases.     

Range of motion,muscle torque and training habits in runners with and without Achilles tendon problems

Achilles tendon injuries are common in runners. The aim of the present study was to analyse the training programme, any Achilles tendon problems, muscle eightness and range of motion of the ankle joint, and concentric and eccentric musle torques of the calf muscles in middle-distance runners with and without Achilles tendon problems. Eighty-three middle-distance runners answered a questionnaire on their sports background, training habits and any injuries. Thirty-four percent had suffered from some type of problem relating to the Achilles tendon. Ten of the athletes who had suffered from Achilles tendon problems and ten who had never had any Achilles tendon trouble were randomly selected. These 20 runners underwent a clinical examination. The range of motion of the ankle joint was recorded objectively by a hydraulic and computerised isokinetic dynamometer by measuring resistance to passive motion. Concentric and eccentric muscle torques of the gastrocnemius-soleus complex were recorded. The runners with Achilles tendon problems had trained for significantly more years and covered significantly longer distances per weck than runners without Achilles tendon problems. There were no significant differences in other training methods or in best results over 800 m and 1500 m. Runners with Achilles tendon problems had a significantly lower range of motion of the ankle joint. They also had significantly lower eccentric torques of the gastroenemius-soleus complex, but no differences in concentric torques were found between the groups.     

火针治疗对跟腱末端病大鼠跟腱止点组织IL-6与iNOS表达的影响

目的:探讨在跟腱末端病的治疗中火针对跟腱止点处IL-6与iNOS阳性细胞表达的影响。方法:将88只1月龄雄性SD大鼠随机分为正常组(8只)和造模组(80只)。采用电击跳跃法对造模组大鼠进行跳跃训练。造模装置内一次放入8只大鼠,通电电压由小渐大,直至大鼠出现有效跳跃,每15 s通电1次,持续20 min,休息10 min,再持续20 min。每天造模1次,每周6天,周日休息,持续8周。造模组跳跃训练8周后,随机分为1次火针治疗组及其对照组(各32只,即治疗1、2、3、4组和对照1、2、3、4组)和4次火针治疗组及其对照组(各8只,即治疗5组和对照5组),于第2天用火针分别对治疗1、2、3、4组(只进行1次治疗)和治疗5组(1次/3天,共4次)大鼠跟腱止点处点刺(快进、快出)施针,深度约为0.1寸,每次治疗只施针1次。治疗1、2、3、4组分别于施针后第1、2、3、4天取材,治疗5组完成第4次治疗2天后取材,其对照组同期取材,正常组于第1天取材。取大鼠右后足跟腱和完整跟腱末端区组织,采用HE染色观察末端区细胞和组织形态结构,采用免疫组化方法检测末端区跟腱、纤维软骨区、钙化软骨区、跟骨、跟骨骨髓区、腱骨关节面处IL-...     

Ultrasonic morphology of the normal Achilles tendon and pattern of pathological changes

The anatomical structure of the Achilles tendon causes a fibrillary echo texture with fine, parallel echogenic lines. The peritendineum outlining the tendon can be delineated. Achilles tendon ruptures can easily be detected by ultrasound, as can the structural changes in achillodynia. The typical sonographic patterns of rupture of the Achilles tendon and achillodynia are demonstrated.     

Cerebrotendinous xanthomatosis presenting with bilateral Achilles tendon xanthomata

We report on a case of a 36-year-old lady who presented with large, painful soft-tissue swellings of both Achilles tendons. MRI demonstrated fusiform enlargement involving the Achilles tendons bilaterally. The tendons returned heterogeneous signal intensity characterised by a diffuse reticulated appearance. The right tendon mass was treated with a wide marginal excision and Achilles tendon reconstruction. The histology confirmed Achilles tendon xanthoma. Further metabolic investigation revealed the patient to have a rare autosomal recessive condition called cerebrotendinous xanthomatosis (CTX). Her brother was also affected. CTX is easily treatable if diagnosed early, and should be suspected in patients presenting with bilateral Achilles tendon xanthomas and normal plasma lipid levels.     

Achilles tendon: US diagnosis of pathologic conditions. Work in progress

Twenty-three patients were prospectively examined with ultrasound (US) for acute or recurrent Achilles tendon symptoms. Three types of pathologic conditions of the Achilles tendon were found: tendinitis/tenosynovitis, acute tendon trauma, and postoperative changes. US appears to enable differentiation of these conditions and to contribute to the diagnosis of a broad range of Achilles tendon disorders.     

Achillodynia--an unsolvable problem?

Achillodynia has its cause in disorders in the M. gastrocnemius due to overcharge of this muscle. Painful inflammation of the Achilles tendon and the necrosis of tendon are a secondary phenomena. We describe a new type of manual therapy for these problems. The results of our treatment in 35 patients are discussed.     

MRI诊断闭合性跟腱损伤的价值

目的: 评价MRI术前诊断闭合性跟腱损伤的价值.材料和方法: 对18例闭合性跟腱损伤患者行MRI检查,分析其MRI表现并与手术结果对照.结果: 18例中16例行手术治疗,MRI显示10例为跟腱完全断裂,表现为跟腱广泛增粗、跟腱前缘明显凸起、出血及水肿等;6例为不完全断裂,表现为局限性跟腱增粗及跟腱前缘稍凸起等,均与手术所见相符合.结论: MRI术前诊断跟腱闭合性损伤的准确性较高,有助于制定跟腱撕裂手术方案.     

Low incoporation of soleus tendon: a potential diagnostic pitfall on MR imaging

We describe a case of thickening and longitudinal increased signal within the Achilles tendon in a patient denying any recent or previous history of Achilles tendon injury. The MR appearance, while simulating tendinosis or rupture, was compatible with incomplete incorporation of the soleus tendon into the gastrocnemius tendon. This constitutes a normal anatomical variant, not previously described in the radiologic literature, and should not be confused with increased signal and thickening due to disease of the Achilles tendon.