title: How does a cadaver model work for testing ultrasound diagnostic capability for rheumatic-like tendon damage?
abstract: To establish whether a cadaver model can serve as an effective surrogate for the detection of tendon damage characteristic of rheumatoid arthritis (RA). In addition, we evaluated intraobserver and interobserver agreement in the grading of RA-like tendon tears shown by US, as well as the concordance between the US findings and the surgically induced lesions in the cadaver model. RA-like tendon damage was surgically induced in the tibialis anterior tendon (TAT) and tibialis posterior tendon (TPT) of ten ankle/foot fresh-frozen cadaveric specimens. Of the 20 tendons examined, six were randomly assigned a surgically induced partial tear; six a complete tear; and eight left undamaged. Three rheumatologists, experts in musculoskeletal US, assessed from 1 to 5 the quality of US imaging of the cadaveric models on a Likert scale. Tendons were then categorized as having either no damage, (0); partial tear, (1); or complete tear (2). All 20 tendons were blindly and independently evaluated twice, over two rounds, by each of the three observers. Overall, technical performance was satisfactory for all items in the two rounds (all values over 2.9 in a Likert scale 1-5). Intraobserver and interobserver agreement for US grading of tendon damage was good (mean κ values 0.62 and 0.71, respectively), with greater reliability found in the TAT than the TPT. Concordance between US findings and experimental tendon lesions was acceptable (70-100 %), again greater for the TAT than for the TPT. A cadaver model with surgically created tendon damage can be useful in evaluating US metric properties of RA tendon lesions.
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain. iustinajanta@yahoo.com.
authors.forename: Iustina
authors.initials: I
authors.lastname: Janta
authors.affiliation: Department of Traumatology and Orthopaedic Surgery, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Morán
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Nieto
authors.affiliation: Department of Rheumatology, Hospital Universitario de Móstoles, Madrid, Spain.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Uson
authors.affiliation: Department of Rheumatology, Instituto Poal, Barcelona, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Möller
authors.affiliation: Department of Rheumatology, Instituto Poal, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Bong
authors.affiliation: Department of Rheumatology, MC Groep, Lelystad, The Netherlands.
authors.forename: George A W
authors.initials: GA
authors.lastname: Bruyn
authors.affiliation: Department of Rheumatology, Hôpital Ambroise Paré, APHP, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Boulogne-Billancourt, France.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: D Agostino
authors.affiliation: Department of Rheumatology, Clinica Reumatologica, Universitá Politecnica delle Marche, Jesi, Ancona, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Filippucci
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Hilde Berner
authors.initials: HB
authors.lastname: Hammer
authors.affiliation: Department of Rheumatology, Sapienza Università di Roma, Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.affiliation: Department of Rheumatology, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Copenhagen, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Terslev
authors.affiliation: Department of Human Anatomy and Embryology, Faculty of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: Jorge Murillo
authors.initials: JM
authors.lastname: González
authors.affiliation: Department of Human Anatomy and Embryology, Faculty of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Mérida
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Carreño
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D000843:Ankle Joint / Q000000981:diagnostic imaging*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011897:Random Allocation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013708:Tendon Injuries / Q000000981:diagnostic imaging*; D013710:Tendons / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Cadaver; Specimen; Tendon damage; Tendon tear; Ultrasound