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Intratendinous Air Phenomenon: A New Ultrasound Marker of Tendon Damage?

ABSTRACT: Purpose: To explore the presence of intratendinous air in physically active males after different types of strenuous physical exercise. Materials and Methods: To detect foci (air bubbles) in the quadriceps femoris tendon (QFT) and the proximal and distal parts of the patellar tendon, ultrasound examination was performed under two conditions: (1) after high-intensity cycling on a cycle ergometer (metabolic); (2) after 200 drop jumps (exercise-induced muscle damage). Based on the results of these two interventions, the presence of air in the tendons after 100 drop jumps was examined further with frequently repeated ultrasound measurements. Results: Foci were detected in exercise-induced muscle damage. Twenty-three of Sixty investigated tendons (38.3%) were observed to contain hyperechoic foci after 100 drop jumps. QFT foci were present in 13/23 cases (56.5%). The location of foci in the QFT was mostly lateral and centro-lateral (76.9%). The foci disappeared completely between 40 and 180 min after completing 100 drop jumps. Conclusions: The presence of intratendinous air seems related to high-magnitude, high-force, high-strain exercise of the particular tendon areas. It might represent the stress response of tendons to overload condition.

SUBMITTER: Rutkauskas S

PROVIDER: S-EPMC5541021 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Project description: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.

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Intratendinous Air Phenomenon: A New Ultrasound Marker of Tendon Damage?

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