title: Real-time sonoelastography as novel follow-up method in Achilles tendon surgery.
abstract: OBJECTIVE
  To evaluate the sonoelastographic features of Achilles tendon healing after percutaneous treatment using real-time sonoelastography, a new tool able to quantify deformation in biological tissues.
  
  
  METHODS
  Patients with atraumatic Achilles tendon ruptures, treated with a percutaneous technique, were assessed. Sonoelastographic evaluations were performed at the myotendinous junction, tendon body/lesion site and osteotendinous junction, both for the operated and contralateral side, at 40 days, 6 months and 1 year after surgery. Using standard regions of interest, the "strain index" (SI) was calculated as an indicator of tendon elasticity. Clinical outcomes were assessed by the ATRS questionnaire at 6 months and 1 year post-operatively and correlated with sonoelastographic findings. Sixty healthy tendons from 30 volunteers were used to provide a healthy control range.
  
  
  RESULTS
  Twenty-five patients were recruited for this study. The SI in treated tendons showed progressive stiffening over time, especially at myotendinous junction and at the site of the sutured lesion, resulting in significantly higher stiffness than both the contralateral tendon and healthy volunteers. Peak thickness of treated tendons occurred at 6 months, with a tendency to reduce at 1 year, while never achieving a normal physiological state. Greatest remodelling was seen at the lesion site. The contralateral tendon showed significant thickening at the myotendinous and osteotendinous junctions. The SI of the contralateral tendon was found to be stiffer than physiological values found in the control group. ATRS score improved significantly between 6 months and 1 year, being negatively correlated with the SI (p < 0.001).
  
  
  CONCLUSIONS
  RTSE showed that operatively treated Achilles tendons become progressively stiffer during follow-up, while the ATRS score improved. From a biomechanical point of view, at 1 year after surgery Achilles tendons did not show a "restitutio ad integrum". Real-time sonoelastography provides more qualitative and quantitative details in the diagnostics and follow-up of Achilles tendon conditions as the post-operative evolution of the repairing tissue.
  
  
  METHODS
  Diagnostic and therapeutic study, Level III.
authors.affiliation: Clinical Orthopaedics - Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, Italy. albertobusilacchi@yahoo.it.
authors.forename: A
authors.initials: A
authors.lastname: Busilacchi
authors.affiliation: Department of Radiology, Azienda Ospedaliero -Universitaria "Ospedali Riuniti", Via Conca 71, 60126, Ancona, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Olivieri
authors.affiliation: Department of Radiology, Azienda Ospedaliero -Universitaria "Ospedali Riuniti", Via Conca 71, 60126, Ancona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ulisse
authors.affiliation: Epidemiology and Biostatistics Centre - School of Medicine, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Gesuita
authors.affiliation: Epidemiology and Biostatistics Centre - School of Medicine, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Skrami
authors.affiliation: Orthopedic Department, Frankston Hospital, Hastings Rd, Frankston, VIC, 3199, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Lording
authors.affiliation: Clinical Orthopaedics - Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Fusini
authors.affiliation: Clinical Orthopaedics - Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, Via Tronto 10/A, 60126, Ancona, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gigante
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D000359:Aftercare / Q000379:methods*; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D003199:Computer Systems; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012421:Rupture / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016037:Single-Blind Method; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Elastography, Achilles tendon; Elastosonography, tendon healing; Real-time sonoelastography (RTSE); Tendon biomechanics