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Shear-Wave Elastography of the Achilles tendon: reliability analysis and impact of parameters modulating elasticity values

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Abstract

Purpose

Shear wave elastography (SWE) has seen many advancements in Achilles tendon evaluation in recent years, yet standardization of this technique is still problematic due to the lack of knowledge regarding the optimal way to perform the examination. The purpose of this study was to evaluate the effects of ankle position, probe frequency and physical effort on the shear modulus of the Achilles tendon, but also to determine the intra and inter-observer reliability of the technique.

Methods

37 healthy volunteers were included; SWE protocol was performed by two examiners. We analyzed the shear modulus of the tendon with the ankle in neutral, maximum dorsiflexion and maximum plantar flexion using two different high frequency probes. Afterwards, the subjects performed a brief physical exercise and SWE measurements were repeated.

Results

The L18-5 probe showed the highest ICC values (ICC = 0.798, 95% CI 0.660–0.880, p < 0.001) when positioned at 2 cm from the calcaneal insertion with the ankle in a neutral state. Conversely, utilizing the same L18-5 probe at 1 cm from the insertion during maximum plantar flexion of the ankle resulted in the lowest ICC (ICC = 0.422, 95% CI 0.032–0.655, p = 0.019). Significant variations in elasticity values were noted among different ankle positions and probe types, while no significant changes in elasticity were observed post-physical exercise.

Conclusion

Ankle position and probe frequency are factors that influence elasticity values of the Achilles tendon. An ankle position between 10 and 20 degrees of plantar flexion is the most suitable for SWE evaluation. However, more research focusing on Achilles tendon SWE is essential due to the challenges encountered in standardizing this region.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We are thankful to Mr. George Dobre from Pondera Medical for his continuous support and to all the participants who gave their time and patience for the completion of this study.

Funding

No funding was received for conducting this study.

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Author notes

  1. Michael-Andrei Pelea and Oana Serban are sharing the first authorship.

Authors and Affiliations

  1. 2nd Internal Medicine Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 2-4 Clinicilor Street, 400006, Cluj-Napoca Napoca, Romania

    Michael-Andrei Pelea, Oana Serban, Maria Badarinza, Roxana Gutiu & Daniela Fodor

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  1. Michael-Andrei Pelea
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  2. Oana Serban
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  3. Maria Badarinza
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Michael-Andrei Pelea, Oana Serban, Maria Badarinza and Roxana Rosca. The first draft of the manuscript was written by Michael Andrei Pelea, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daniela Fodor.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the local Ethics Committee (nr.100/03.05.2022).

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Written informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided written informed consent for publication of the images in Figure(s) 1a, 1b, 1c and 1d.

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Pelea, MA., Serban, O., Badarinza, M. et al. Shear-Wave Elastography of the Achilles tendon: reliability analysis and impact of parameters modulating elasticity values. J Ultrasound (2024). https://doi.org/10.1007/s40477-024-00877-w

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