Ultrasound diagnosis and percutaneous treatment of Achilles tendon tethering: a case series.
The purpose of this article is to report 3 cases of Kager's fat pad scarring and tethering to the deep surface of the Achilles tendon in patients with Achilles tendinosis symptomatology. The 3 patients were diagnosed sonographically by the use of a dynamic maneuver we described and named the "Kager's squeeze" technique. The key finding for diagnosis is the deformation and bowing of the deep fibers of the Achilles tendon during dynamic squeezing of Kager's fat pad. After diagnosis, the patients were treated with ultrasound-guided hydrodissection and scar release to restore normal motion between Kager's fat pad and the Achilles tendon. All 3 patients experienced significant clinical improvement shortly after treatment. Therefore, we suspect that Kager's fat pad scarring with Achilles tendon tethering may mimic or exacerbate Achilles tendinosis symptomatology and should be considered a possible diagnosis when conservative treatments for Achilles tendinosis fail. We demonstrate that Kager's fat pad scarring with Achilles tendon tethering can be diagnosed and treated with a simple in-office hydrodissection technique, leading to improved patient outcomes.
Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, USA. HEL@ccf.org.
Lulu
L
He
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Jason
J
Genin
Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, USA.
Patricia
P
Delzell
D000125:Achilles Tendon / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D000273:Adipose Tissue / Q000000981:diagnostic imaging; D000328:Adult; D002921:Cicatrix; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000628:therapy*; D014463:Ultrasonography
Achilles tendinitis; Achilles tendinopathy; Ankle pain; Kager’s fat pad; Pre-Achilles fat; Ultrasound-guided hydrodissection