Skip to main content

Advertisement

SpringerLink
Log in

Shear wave elastography assessment and comparison study of the Achilles tendons in optimally conditioned asymptomatic young collegiate athletes

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

A Correction to this article was published on 20 May 2021

This article has been updated

Abstract

Objective

To assess the functional parameters of the Achilles tendons among asymptomatic college level athletes using shear wave elastography (SWE) and to describe the relationship to athlete demographics and anthropometric lower extremity measurements.

Material and methods

Sixty-five athletes were included in this IRB-approved study. SWE measurements were made on two tendon positions (neutral state and active maximum dorsiflexion) with two different probe orientations (longitudinal and transverse). Associations were assessed with BMI, tibial/foot length, type of sports, and resting/maximal dorsiflexion-plantar flexion angles.

Results

Thirty-five (53.8%) males and 30 (46.2%) females with an overall mean age of 20.9 years (± 2.8), mean height of 176 cm (± 0.11), and mean weight of 74.1 kg (± 12) were studied. In the neutral state, the mean wave velocity of 7.5 m sec−1 and the mean elastic modulus of 176.8 kPa were recorded. In active maximum dorsiflexion, the mean velocity was 8.3 m sec−1 and mean elastic modulus was 199 kPa. On the transverse view, the mean velocity and elastic measurements were significantly lower (p = 0.0001). No significant differences in SWE parameters were seen between male and female athletes regardless of probe orientation (p < 0.05) with SWE values being higher in the running group vs non-running group (p < 0.05). In neutral state, longitudinal SWE measurements correlated with the tibia-foot length whereas transverse measurements correlated with the tendon diameter and ankle resting angle (ARA) (p < 0.005).

Conclusion

SWE can distinguish functional differences in Achilles tendon stiffness between athletes engaged in running-intensive sports compared with other athletes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

References

  1. Longo UG, Petrillo S, Maffulli N, Denaro V. Acute achilles tendon rupture in athletes. Foot Ankle Clin. 2013;18(2):319–38.

    Article  Google Scholar 

  2. Thompson J, Baravarian B. Acute and chronic Achilles tendon ruptures in athletes. Clin Podiatr Med Surg. 2011;28(1):117–35.

    Article  Google Scholar 

  3. Alrashidi Y, Fernandez-Marin MR, Galhoum A, Alrabai HM, Valderrabano V. Achilles tendon and athletes. Update Manag Foot Ankle Disorders. 2018;19:1.

    Google Scholar 

  4. Li LJ, Zhang YX. Biomechanical simulation of Achilles tendon strains during hurdling. In: In Advanced Materials Research, vol. 647; 2013. p. 462–5. Trans Tech Publications Ltd.

    Google Scholar 

  5. Rettig AC, Liotta FJ, Klootwyk TE, Porter DA, Mieling P. Potential risk of rerupture in primary Achilles tendon repair in athletes younger than 30 years of age. Am J Sports Med. 2005;33(1):119–23.

    Article  Google Scholar 

  6. Parekh SG, Wray WH III, Brimmo O, Sennett BJ, Wapner KL. Epidemiology and outcomes of Achilles tendon ruptures in the National Football League. Foot Ankle Special. 2009;2(6):283–6.

    Article  Google Scholar 

  7. Kongsgaard M, Aagaard P, Kjaer M, Magnusson SP. Structural Achilles tendon properties in athletes subjected to different exercise modes and in Achilles tendon rupture patients. J Appl Physiol. 2005;99(5):1965–71.

    Article  CAS  Google Scholar 

  8. Biewener AA, Roberts TJ. Muscle and tendon contributions to force, work, and elastic energy savings: a comparative perspective. Exerc Sport Sci Rev. 2000;28(3):99–107.

    CAS  PubMed  Google Scholar 

  9. Cook JL, Khan KM, Purdam C. Achilles tendinopathy. Man Ther. 2002;7(3):121–30.

    Article  CAS  Google Scholar 

  10. Smart GW, Taunton JE, Clement DB. Achilles tendon disorders in runners—a review. Med Sci Sports Exerc. 1980;12(4):231–43.

    Article  CAS  Google Scholar 

  11. O’Connor PJ, Grainger AJ, Morgan SR, Smith KL, Waterton JC, Nash AF. Ultrasound assessment of tendons in asymptomatic volunteers: a study of reproducibility. Eur Radiol. 2004;14(11):1968–73.

    Article  Google Scholar 

  12. Fornage BD, Rifkin MD. Ultrasound examination of tendons. Radiol Clin N Am. 1988;26(1):87–107.

    CAS  PubMed  Google Scholar 

  13. Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 2005;32(12):2485–7.

    PubMed  Google Scholar 

  14. Martinoli C, Bianchi S, Dahmane MH, Pugliese F, Bianchi-Zamorani M, Valle M. Ultrasound of tendons and nerves. Eur Radiol. 2002;12(1):44–55.

    Article  Google Scholar 

  15. Patel NN, Labib SA. The Achilles tendon in healthy subjects: an anthropometric and ultrasound mapping study. J Foot Ankle Surg. 2018;57(2):285–8.

    Article  Google Scholar 

  16. Allison SJ, Nazarian LN. Musculoskeletal ultrasound: evaluation of ankle tendons and ligaments. Am J Roentgenol. 2010;194(6):W514.

    Article  Google Scholar 

  17. Aubry S, Nueffer JP, Tanter M, Becce F, Vidal C, Michel F. Viscoelasticity in Achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. Radiology. 2015;274(3):821–9.

    Article  Google Scholar 

  18. Siu WL, Chan CH, Lam CH, Lee CM, Ying M. Sonographic evaluation of the effect of long-term exercise on Achilles tendon stiffness using shear wave elastography. J Sci Med Sport. 2016;19(11):883–7.

    Article  Google Scholar 

  19. Aubry S, Risson JR, Kastler A, Barbier-Brion B, Siliman G, Runge M, et al. Biomechanical properties of the calcaneal tendon in vivo assessed by transient shear wave elastography. Skelet Radiol. 2013;42(8):1143–50.

    Article  Google Scholar 

  20. Gonzalez FM, Gleason CN, Reiter DA, Dunham J, Sayyid SK, Labib SA. In vivo Sonographic characterization of the Achilles tendons in healthy young collegiate athletes as a function of ankle position. J Foot Ankle Surg. 2020;59(5):898–902.

    Article  Google Scholar 

  21. Stephenson AL, Wu W, Cortes D, Rochon PA. Tendon injury and fluoroquinolone use: a systematic review. Drug Saf. 2013;36(9):709–21.

    Article  CAS  Google Scholar 

  22. Halasi T, Kynsburg Á, Tállay A, Berkes I. Development of a new activity score for the evaluation of ankle instability. Am J Sports Med. 2004;32(4):899–908.

    Article  Google Scholar 

  23. Carmont MR, Silbernagel KG, Mathy A, Mulji Y, Karlsson J, Maffulli N. Reliability of Achilles tendon resting angle and calf circumference measurement techniques. Foot Ankle Surg. 2013;19(4):245–9.

    Article  CAS  Google Scholar 

  24. Robinson JM, Cook JL, Purdam C, et al. VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001;35(5):335–41.

    Article  CAS  Google Scholar 

  25. Carmont MR, Silbernagel KG, Brorsson A, Olsson N, Maffulli N, Karlsson J. The Achilles tendon resting angle as an indirect measure of Achilles tendon length following rupture, repair, and rehabilitation. Asia-PacificJ Sports Med Arthr Rehab Technol. 2015;2(2):49–55.

    Google Scholar 

  26. Comin J, Cook JL, Malliaras P, McCormack M, Calleja M, Clarke A, et al. The prevalence and clinical significance of sonographic tendon abnormalities in asymptomatic ballet dancers: a 24-month longitudinal study. Br J Sports Med. 2013;47(2):89–92.

    Article  Google Scholar 

  27. Ooi CC, Schneider ME, Malliaras P, Counsel P, Connell DA. Prevalence of morphological and mechanical stiffness alterations of mid Achilles tendons in asymptomatic marathon runners before and after a competition. Skelet Radiol. 2015;44(8):1119–27.

    Article  CAS  Google Scholar 

  28. Visnes H, Tegnander A, Bahr R. Ultrasound characteristics of the patellar and quadriceps tendons among young elite athletes. Scand J Med Sci Sports. 2015;25(2):205–15.

    Article  CAS  Google Scholar 

  29. Dirrichs T, Schrading S, Gatz M, Tingart M, Kuhl CK, Quack V. Shear wave elastography (SWE) of asymptomatic achilles tendons: a comparison between semiprofessional athletes and the nonathletic general population. Acad Radiol. 2019;26(10):1345–51.

    Article  Google Scholar 

  30. Slane LC, Martin J, DeWall R, Thelen D, Lee K. Quantitative ultrasound mapping of regional variations in shear wave speeds of the aging Achilles tendon. Eur Radiol. 2017;27(2):474–82.

    Article  Google Scholar 

  31. Khan KM, Forster BB, Robinson J, Cheong Y, Louis L, Maclean L, et al. Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study. Br J Sports Med. 2003;37(2):149–53.

    Article  CAS  Google Scholar 

  32. Maffulli N, Regine R, Angelillo M, Capasso G, Filice S. Ultrasound diagnosis of Achilles tendon pathology in runners. Br J Sports Med. 1987;21(4):158–62.

    Article  CAS  Google Scholar 

  33. Kayser R, Mahlfeld K, Heyde CE. Partial rupture of the proximal Achilles tendon: a differential diagnostic problem in ultrasound imaging. Br J Sports Med. 2005;39(11):838–42.

    Article  CAS  Google Scholar 

  34. Klauser AS, Miyamoto H, Tamegger M, et al. Achilles tendon assessed with sonoelastography: histologic agreement. Radiology. 2013;267(3):837–42.

    Article  Google Scholar 

  35. Dirrichs T, Quack V, Gatz M, Tingart M, Kuhl CK, Schrading S. Shear wave elastography (SWE) for the evaluation of patients with tendinopathies. Acad Radiol. 2016;23(10):1204–13.

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Emory University athletic trainers Karli Dill, Tristan Rodik, and Holli Dawson and statistician Yi Guo for their dedicated support with this work.

Author information

Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory School of Medicine, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA

    Felix M. Gonzalez & David A Reiter

  2. Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA

    Felix M. Gonzalez

  3. Department of Orthopaedic Surgery, Emory School of Medicine, Atlanta, Ga, USA

    Courtney A Gleason, Sameh A Labid & David A Reiter

  4. Department of Radiology, University of Wisconsin, Madison, WI, USA

    Kenneth S. Lee

  5. Department of Radiology, Thomas Jefferson University and Hospitals, Philadelphia, PA, USA

    Levon N Nazarian & William B Morrison

Authors
  1. Felix M. Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Courtney A Gleason
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth S. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sameh A Labid
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Levon N Nazarian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William B Morrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. David A Reiter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Felix M. Gonzalez.

Ethics declarations

None of the authors have financial disclosures.

Conflict of interest

The authors declare no conflicts of interest. STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gonzalez, F.M., Gleason, C.A., Lee, K.S. et al. Shear wave elastography assessment and comparison study of the Achilles tendons in optimally conditioned asymptomatic young collegiate athletes. Skeletal Radiol 50, 2381–2392 (2021). https://doi.org/10.1007/s00256-021-03798-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-021-03798-5

Keywords

Search

Navigation