Real-time sonoelastography evaluation of the Achilles tendonfollowing ultrasound-guided platelet-rich plasma injection and eccentricexercise for the treatment of refractory Achilles tendinopathy

摘要

The objective of this study was to investigate the feasibility of usingsonoelastography to depict Achilles tendon stiffness after platelet-rich plasmainjection and eccentric exercise for chronic Achilles tendinopathy, and tocorrelate sonoelastography findings with clinical outcome up to 12 months aftertreatment. Forty-five Achilles tendons from 45 patients (33 males, 12 females;mean age 51 years) were examined using sonoelastography and ultrasound atbaseline, 4–6 weeks, 6 months and 12 months post-treatment. The strain ratio(between Achilles tendon and Kager's fat) during sonoelastography was obtained.The proportion of tendons with hypoechogenicity and neovascularity weredocumented. Clinical outcomes were assessed by the Victorian Institute of SportAssessment-Achilles questionnaire and correlated with sonographic findings. TheVictorian Institute of Sport Assessment-Achilles improved significantly from38.4 (±14.1) at baseline, 77.2 (±12.5) at 6 months(p < 0.001) to 81.2 (±10.8) at 12 months(p < 0.001). The strain ratio values were 2.16 (±1.02) atbaseline, 2.03 (±0.67) at 4–6 weeks, 1.81 (±0.62) at 6 months and 1.19 (±0.34)at 12 months with a significant reduction observed at 6 months (p = 0.006) and12 months (p < 0.001). At 12-month evaluation, none of thetendons regained a normal echotexture. Strain ratio demonstrated a moderatelygood inverse correlation with Victorian Institute of Sport Assessment-Achilles(r = −0.610, p<0.001) while B-mode and Doppler ultrasound did not show asignificant correlation (r = −0.041, p = 0.817, and r = −0.116, p = 0.514).Achilles tendon stiffness shows moderately good correlation with clinicalsymptom at 12-month post-treatment. Sonoelastography using strain ratio could bea promising ancillary tool for monitoring Achilles tendon healing aftertreatment.