Assessment of Postoperative Tendon Quality in Patients With Achilles Tendon Rupture Using Diffusion Tensor Imaging and Tendon Fiber Tracking.
Although pre- and postoperative imaging of Achilles tendon rupture (ATR) has been well documented, radiographic evaluations of postoperative intratendinous healing and microstructure are still lacking. Diffusion tensor imaging (DTI) is an innovative technique that offers a noninvasive method for describing the microstructure characteristics and organization of tissues. DTI was used in the present study for quantitative assessment of fiber continuity postoperatively in patients with acute ATR. The data from 16 patients with ATR from 2005 to 2012 were retrospectively analyzed. The microstructure of ART was evaluated using tendon fiber tracking, tendon continuity, fractional anisotropy, and apparent diffusion coefficient values by way of DTI. The distal and proximal portions were measured separately in both the ruptured and the healthy extremities of each patient. The mean patient age was 41.56 ± 8.49 (range 26 to 56) years. The median duration of follow-up was 21 (range 6 to 80) months. The tendon fractional anisotropy values of the ruptured Achilles tendon were significantly lower statistically than those of the normal side (p = .001). However, none of the differences between the 2 groups with respect to the distal and proximal apparent diffusion coefficient were statistically significant (p = .358 and p = .899, respectively). In addition, the fractional anisotropy and apparent diffusion coefficient measurements were not significantly different in the proximal and distal regions of the ruptured tendons compared with the healthy tendons. The present study used DTI and fiber tracking to demonstrate the radiologic properties of postoperative Achilles tendons with respect to trajectory and tendinous fiber continuity. Quantifying DTI and fiber tractography offers an innovative and effective tool that might be able to detect microstructural abnormalities not appreciable using conventional radiologic techniques.
Assistant Professor, Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey. Electronic address: hakansarman@yahoo.com.
Hakan
H
Sarman
Assistant Professor, Department of Orthopedics and Traumatology, Akdeniz University School of Medicine, Antalya, Turkey.
Halil
H
Atmaca
Radiology Specialist Physician, Department of Radiology, Ministry of Health Batman Regional Hospital, Batman, Turkey.
Ozgur
O
Cakir
Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Umit Sefa
US
Muezzinoglu
Professor, Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Yonca
Y
Anik
Associate Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Kaya
K
Memisoglu
Resident Physician, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey.
Tuncay
T
Baran
Assistant Professor, Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey.
Cengiz
C
Isik
D000125:Achilles Tendon / Q000293:injuries* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D016880:Anisotropy; D016022:Case-Control Studies; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011786:Quality Control; D012016:Reference Values; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
Achilles tendon rupture; diffusion tensor imaging; fractional anisotropy; surgery; tendon fiber continuity; trauma