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Staging achilles tendinopathy using ultrasound imaging: the development and investigation of a new ultrasound imaging criteria based on the continuum model of tendon pathology.

ABSTRACT: Aim:To develop a standardised ultrasound imaging (USI)-based criteria for the diagnosis of tendinopathy that aligns with the continuum model of tendon pathology. Secondary aims were to assess both the intra-rater and inter-rater reliability of the criteria. Methods:A criteria was developed following a face validity assessment and a total of 31 Achilles tendon ultrasound images were analysed. Intra-rater and inter-rater reliability were assessed for overall tendinopathy stage (normal, reactive/early dysrepair or late dysrepair/degenerative) as well as for individual parameters (thickness, echogenicity and vascularity). Quadratic weighted kappa (kw) was used to report on reliability. Results:Intra-rater reliability was 'substantial' for overall tendinopathy staging (kw rater A; 0.77, 95%?CI 0.59 to 0.94, rater B; 0.70, 95%?CI 0.52 to 0.89) and ranged from 'substantial' to 'almost perfect' for thickness (kw rater A; 0.75, 95%?CI 0.59 to 0.90, rater B; 0.84, 95%?CI 0.71 to 0.98), echogenicity (kw rater A; 0.78, 95%?CI 0.62 to 0.95, rater B; 0.73, 95%?CI 0.58 to 0.89) and vascularity (kw rater A; 0.86, 95%?CI 0.74 to 0.98, rater B; 0.89, 95%?CI 0.79 to 0.99). Inter-rater reliability ranged from 'substantial' to 'almost perfect' for overall tendinopathy staging (kw round 1; 0.75, 95%?CI 0.58 to 0.91, round 2; 0.81, 95%?CI 0.63 to 0.99), thickness (kw round 1; 0.65, 95%?CI 0.48 to 0.83, round 2; 0.77, 95%?CI 0.60 to 0.93), echogenicity (kw round 1; 0.70, 95%?CI 0.54 to 0.85, round 2; 0.76, 95%?CI 0.58 to 0.94) and vascularity (kw round 1; 0.89, 95%?CI 0.79 to 0.99, round 2; 0.86, 95%?CI 0.74 to 0.98). Inter-rater reliability increased from 'substantial' in round 1 (kw 0.75, 95%?CI 0.58 to 0.91) to 'almost perfect' in round 2 (0.81, 95%?CI 0.63 to 0.99). Conclusion:Intra-rater and inter-rater reliability were 'substantial' to 'almost perfect' when utilising an USI-based criteria to diagnose Achilles tendinopathy. This is the first study to use the continuum model of tendon pathology to develop an USI-based criteria to diagnose tendinopathy.

SUBMITTER: Matthews W

PROVIDER: S-EPMC7173997 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Staging achilles tendinopathy using ultrasound imaging: the development and investigation of a new ultrasound imaging criteria based on the continuum model of tendon pathology.

Matthews Wesley W Ellis Richard R Furness James W JW Rathbone Evelyne E Hing Wayne W

BMJ open sport & exercise medicine 20200325 1

<h4>Aim</h4>To develop a standardised ultrasound imaging (USI)-based criteria for the diagnosis of tendinopathy that aligns with the continuum model of tendon pathology. Secondary aims were to assess both the intra-rater and inter-rater reliability of the criteria.<h4>Methods</h4>A criteria was developed following a face validity assessment and a total of 31 Achilles tendon ultrasound images were analysed. Intra-rater and inter-rater reliability were assessed for overall tendinopathy stage (norm ...[more]

PMID: 32341798

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Project description:BackgroundFamilial hypercholesterolemia is a genetic condition characterized by life-long elevations of plasma low-density lipoprotein cholesterol. In addition to life-threatening cardiovascular complications, intratendinous cholesterol deposits (xanthomas) can lead to pain and tendon thickening, particularly in the Achilles. Clinical detection of xanthomas currently relies upon visual assessment and palpation, or ultrasound-based measures of tendon thickening or echotexture. Misdiagnosis of xanthoma can delay the commencement of potentially life-saving lipid-lowering therapy. Our primary purpose was to determine whether analysis of separated fat and water magnetic resonance images may be able to differentiate between xanthomatic and nonxanthomatic Achilles tendons through quantification of intratendinous fat content. The main hypothesis was that Achilles tendon xanthomas will demonstrate greater lipid content than Achilles tendinopathy or healthy control tendons.MethodsBilateral MRI scans of Achilles tendons from 30 participants (n = 10 Achilles tendon xanthoma, n = 10 Achilles overuse tendinopathy, n = 10 healthy controls) were analyzed for total lipid content using the Dixon method of fat and water signal separation. Secondary outcome measures included tendon water content, as well as ultrasound characterization of tendon tissue organization and thickness.ResultsFat content was greater in Achilles tendon xanthomas compared to the tendinopathy (p < 0.0001) and control groups (p < 0.0001). Water content was also greater in Achilles tendon xanthomas compared to the tendinopathy (p < 0.0001) and control groups (p = 0.0002). Ultrasound tissue characterization revealed worse tissue organization in Achilles tendon xanthoma tendons compared to Achilles tendinopathy (p < 0.05) but demonstrated largely overlapping distributions. Achilles tendon xanthoma tendons were, on average, significantly thicker than the tendons of the other two groups (p < 0.01 and p < 0.001, respectively).ConclusionMRI-derived measures of Achilles tendon fat content may be able to distinguish xanthomas from control and tendinopathic tissue. Dixon method MRI warrants further evaluation in an adequately powered study to develop and test clinically relevant diagnostic thresholds.

Project description:OBJECTIVES:The objective of the current cross-sectional study was to examine Achilles tendon transverse stiffness in a group of recreational runners with Achilles tendinopathy, in comparison to an asymptomatic group of runners with similar training history. We also aimed to determine the between-week intra-individual reliability of this measurement technique. DESIGN:Cross-sectional cohort study. METHODS:A hand-held dynamometer was used to assess the transverse stiffness of the Achilles tendon (AT) in twenty-five recreational runners. In ten people with midportion Achilles tendinopathy (5 men, 5 women), measurements were taken directly over the most symptomatic location. In 15 people who were free of AT symptoms (7 men, 8 women), measurements were taken at an equivalent location on the tendon. Participants returned after one week to determine measurement reliability (intra-class correlation coefficient/ICC and minimum detectable change/MDC95). We also collected information about people's tendon loading activities, tendon thickness (ultrasound mesaurement), and symptoms (Victorian Institute of Sports Assessment-Achilles / VISA-A score). RESULTS:The AT transverse stiffness was lower in people with Achilles tendinopathy (777 N/m ± 86) compared to those who were asymptomatic (873 N/m ± 72) (p < 0.05). AT transverse stiffness was negatively correlated with age and tendon thickness, and positively correlated with VISA-A score and waist circumference. Reliability was good, with ICC of 0.81 in people with tendinopathy and 0.80 in healthy controls, and an MDC95 of 118 and 87N/m in these two respective groups. CONCLUSIONS:Transverse Achilles tendon stiffness can be reliably measured in people with midportion Achilles tendinopathy, and appears to be lower in people who are older, more symptomatic, and with more extensive tendon thickening. The potential clinical utility of monitoring tendon stiffness in the management of tendon injuries merits further study.

Dataset Information

Staging achilles tendinopathy using ultrasound imaging: the development and investigation of a new ultrasound imaging criteria based on the continuum model of tendon pathology.

Publications

Staging achilles tendinopathy using ultrasound imaging: the development and investigation of a new ultrasound imaging criteria based on the continuum model of tendon pathology.

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