2015 ISAKOS Biennial Congress ePoster #117

An Ultrasonographic Evaluation of the Early Healing Process after Achilles Tendon Repair

Kunihiko Hiramatsu, MD, PhD, Han-Nan, Osaka JAPAN
Tomoki Mitsuoka, MD, Kashiba City, Nara JAPAN

Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao City, Osaka, JAPAN

FDA Status Not Applicable

Summary: We evaluated the healing process of repaired Achilles tendon using ultrasonography focusing on the early stage of healing, and demonstrated that the intratendinous ultrasonographic status of the repaired tendon became almost same as normal Achilles tendon by 6 months.

Rate:

Abstract:

Purpose

There are few reports that evaluate time course transition in healing condition of Achilles tendon following repair surgery. Specifically, early healing process of repaired tendon has not been clearly elucidated. The purpose of this study was to evaluate the healing process of repaired Achilles tendon using ultrasonography, focusing on the early stage of healing.
[Materials & Methods]
Eleven ruptured Achilles tendon of 11 consecutive patients underwent tendon repair (ten males and one female; average age at the time of operation, 41.8 years old) were evaluated by ultrasonography at 1, 2, 3, 4, and 6 months postoperatively. Ultrasonography was performed by two experienced technicians using real-time scanner (Hitachi Aloka Medical, ProSound F75 Premier), provided by an 8-18 MHz linear array probe (UST-5415). The affected and unaffected tendons were scanned in both longitudinal and axial planes. Two sonographers and one orthopaedic surgeon made triplicate measurements.

Results

were evaluated by cross-sectional area (CSA) and intratendinous molphology of the repaired tendon. CSA of the tendon was measured at the rupture site. The ratio of CSA (affected / unaffected) was calculated. Then, intratendinous molphology of the repaired tendon was evaluated with the modified Moller’s grading system, in which aechoic tendon defect area with discontinuity of the fibrillar echo texture, intratendinous hyperechoic area, continuity of intratendinous fibrillar pattern, and peritendinous edema were evaluated. Collectively, scores of repaired tendon were summed and evaluated at ten points as maximum.

Results

The percent increase of CSAs of the repaired Achilles tendon for unaffected side at 1, 2, 3, 4 and 6 months were 358 ± 116, 523 ± 118, 608 ± 122, 630 ± 137, and 590 ± 148 %, respectively. Tendon repair scores (up to 10 points) at 1, 2, 3, 4 and 6 months were 3.9 ± 0.6, 5.1 ± 1.6, 6.6 ± 1.5, 8.0 ±1.2, 9.1 ± 1.1 points, respectively. The intratendinous hyperechoic area of repaired tendon was decreased, and the fibrillar pattern of repaired tendon, which aligned along the long axis of the tendon tissue, was detected around 4 months and was normal appearance at 6 months following surgery. The intratendinous ultrasonographic status of the repaired tendon became almost same as normal Achilles tendon by 6 months.

Discussion

CSAs of the repaired Achilles tendon reached 630% of unaffected side at 4 months, and were maintained the same thereafter. Bruns et al. reported that ruptured tendons in a sheep-model were compensated the strength by thickening, and reached the maximum rupture force after 3 months. Likewise, the tensile strength of clinically repaired Achilles tendon might have come to the plateau level at 4 months after surgery.

Conclusions

By ultrasonographic evaluation, CSAs of repaired Achilles tendon reached 630% of unaffected side at 4 months, the intratendinous ultrasonographic status of the repaired tendon became almost same as normal Achilles tendon by 6 months.