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63 Ultrasound And Utc For The Evaluation Of Plantaris Tendon Involvement In Midportion Achilles Tendinopathy
  1. Lorenzo Masci1,
  2. Christoph Spang2,
  3. Hans TM van Schie3,
  4. Håkan Alfredson1,4
  1. 1Pure Sports Medicine Clinic, London, UK
  2. 2Department of Integrative Medical Biology (IMB), Anatomy Section, Umea University, Sweden
  3. 3Department of Scientific Research, UTC Imaging, Stein, The Netherlands
  4. 4Department of Surgical and Perioperative Sciences, Sports Medicine Unit, Umea University, Sweden


Introduction Recent cadaveric [Van Sterenberg et al. 2011], histological [Spang et al. 2013], and clinical/surgical (Alfredson, 2011) studies lend support to the theory that the plantaris tendon may be involved in the aetiology and/or pathogenesis of midportion Achilles tendinopathy. Unfortunately, it is not easy to detect a plantaris tendon, especially when it is localised close to the medial side of the Achilles tendon.

Ultrasound+Doppler (US+CD) has been used for many years as a first line diagnostic tool to detect tendinosis-like changes in tendons [Ohberg et al. 2001, Fornage et al. 1986]. Although there is evidence that the plantaris tendon can be detected by ultrasound (US) [Mackay et al. 1990, Spina 2007], there are no studies comparing macroscopic findings with ultrasound findings. Recently, Ultrasound Tissue Characterisation (UTC), has been used to visualise Achilles tendon structure, and to quantify tendon matrix integrity [Van Schie et al. 2001].

The aim of this study was to compare US+CD and UTC findings with macroscopic surgical (in wound) findings in patients with chronic painful midportion

Method and Material In this study on 16 patients (11 men, mean age: 38 years and 5 women, mean age: 41 years) and 20 tendons (4 patients with bilateral tendons) with plantaris tendon involvement in mid-portion Achilles tendinopathy, we used Ultrasound and Colour Doppler (US+CD) and Ultrasound Tissue Characterisation (UTC) findings and compared these findings with the macroscopic findings (in wound).

Results At surgery, in all 20 Achilles tendinopathy tendons, we found a thickened plantaris tendon located close to, or invaginating into, the medial side of the Achilles tendon. There was richly vascularised fat tissue in between the Achilles and plantaris tendons [fig 1]. For US+CD, 16/20 tendons had a tendon-like structure interpreted to be the plantaris tendon and localised high blood flow, in close relation to the medial side of the Achilles [fig 2]. For UTC, 19/20 tendons had disorganised (type 3 and 4) echopixels in the medial part of the Achilles tendon indicating possible plantaris tendon involvement [fig 3].

Conclusions US+CD can directly, and UTC indirectly, detect a plantaris tendon located close to the medial Achilles in a high percentage of patients with midportion Achilles tendinopathy.

Abstract 63 Figure 1

Surgical findings

Abstract 63 Figure 2

US/CD results: Plantaris tendon-like structure and high medial blood flow

Abstract 63 Figure 3

UTC results: Focal disorganised echopixels in the medial part of midportion of Achilles

References Alfredson, Br J Sports Med. 2011;45:407–410

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Ohberg, et al . Knee Surg Sports Traumatol Arthroosc 2001;9:233–288

Spina, J Can Chiropr Assoc. 2007;51:158–165

Van Sterkenburg, et al. J Anat. 2011;218:336–341

Van Schie, et al. Am J Vet Res. 2001;62:159–166

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