The Ability of Ultrasonography, Magnetic Resonance Imaging and Bone Mineral Densitometry to Predict the Strength of Human Achilles' Tendons
Abstract
Devitt D, Koike Y, Doherty GP, Ramachandran N, Dinh L, Uhthoff HK, Lecompte M, Trudel G. The ability of ultrasonography, magnetic resonance imaging and bone mineral densitometry to predict the strength of human Achilles' tendons.
Objective
To assess the value of ultrasonography (US), magnetic resonance imaging (MRI), and bone mineral densitometry (BMD) in evaluating human Achilles' tendon strength.
Design
Cross-sectional observational study.
Setting
Tertiary care hospital.
Participants
Ninety-eight Achilles' tendons from 49 consecutive cadavers (26 men and 23 women with a mean age of 66.6 years) undergoing hospital autopsy were assessed.
Interventions
Not applicable.
Main Outcome Measures
Tendon dimensions on US and MRI, and T1-weighted optical density were measured. Areas of hypodensity, hyperdensity, calcification, and heterogeneity were identified on US. The BMD of each calcaneus was recorded. The tendons were mechanically tested to determine peak load at failure.
Results
Sixteen patients (32.7%, 27 tendons) had abnormalities in 1 or both tendons on US and/or MRI (17 on US, 17 on MRI). Fifty-seven tendons (58%) ruptured in their midsubstance, at an average peak load of 4722±990N. Tendons with and without abnormalities on imaging had similar strengths (P>.05). Calcaneal BMD correlated weakly with peak load at failure (r=.21, P<.05).
Conclusions
The prevalence of Achilles' tendons abnormalities on US or MRI was 32.7% in our study group. Abnormalities on clinical imaging (US or MRI) were not predictive of the load at failure. Therefore, tendons with imaging abnormalities are not necessarily weaker, and one cannot predict the likelihood of rupture based on imaging results. Further, higher-powered studies could explore the ability of BMD to detect minimal clinically important differences and to predict Achilles' tendon weakness.
aBone and Joint Research Laboratory, University of Ottawa, Ottawa, ON, Canada
bDivision of Radiology, University of Ottawa, Ottawa, ON, Canada
cDivision of Nuclear Medicine, University of Ottawa, Ottawa, ON, Canada
dDivision of Orthopedic Surgery, University of Ottawa, Ottawa, ON, Canada
eDivision of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada
Correspondence to Deanna Devitt, MD, Bone and Joint Research Laboratory, 505 Smyth Rd, Rm 2503, Ottawa, ON, Canada, K1H 8M2
Supported by the Workplace Safety and Insurance Board of Ontario (grant no. 1104031) and the Canadian Institutes of Health Research (grant no MOP-81395).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
ABSTRACT