Skip to main content

Advertisement

SpringerLink
Log in

Post-operative MRI and US appearance of the Achilles tendons

  • Review Paper
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

The Achilles tendon is one of the most commonly ruptured tendons in the human body. Minimally invasive and open surgical repairs are commonly undertaken to manage acute Achilles ruptures. This article describes the postoperative imaging findings and their evolution after surgery. Ultrasound and magnetic resonance imaging provide crucial information regarding the morphology, structure, vascularization and mobility of the Achilles tendon on the surrounding planes. Morphologically, a repaired tendon is physiologically larger and wider than an intact one, with a loss of its fibrillary structure; the presence of surgical material in the context of the tendon is normal after the rupture has been repaired. After surgery, the tendon is more vascularized in power-Doppler imaging. Elastography and diffusion tensor Imaging are innovative tools which allow for the visualization of microstructural abnormalities not apprehensible using conventional imaging techniques. A treated Achilles tendon is unlikely to regain a normal imaging appearance, and the health care professional must distinguish between postoperative findings and actual pathological features. In this context, clinical examination still reigns supreme.

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
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

Availability of data and material

The authors are able to provide complete data transparency.

References

  1. Doral MN, Alam M, Bozkurt M et al (2010) Functional anatomy of the Achilles tendon. Knee Surgery, Sport Traumatol Arthrosc 18:638–643

    Article  Google Scholar 

  2. Sarman H, Atmaca H, Cakir O et al (2015) Assessment of postoperative tendon quality in patients with achilles tendon rupture using diffusion tensor imaging and tendon fiber tracking. J Foot Ankle Surg 54:782–786. https://doi.org/10.1053/j.jfas.2014.12.025

    Article  PubMed  Google Scholar 

  3. Franceschi F, Papalia R, Paciotti M et al (2014) Obesity as a risk factor for tendinopathy: a systematic review. Int J Endocrinol 2014:670262. https://doi.org/10.1155/2014/670262

    Article  PubMed  PubMed Central  Google Scholar 

  4. Egger AC, Berkowitz MJ (2017) Achilles tendon injuries. Curr Rev Musculoskelet Med 10:72–80. https://doi.org/10.1007/s12178-017-9386-7

    Article  PubMed  PubMed Central  Google Scholar 

  5. Maffulli N (1999) Rupture of the Achilles tendon. J Bone Jt Surg Am 81:1019–1036

    Article  CAS  Google Scholar 

  6. Maffulli N, Peretti GM (2019) Surgery or conservative management for Achilles tendon rupture? BMJ 364:k5344. https://doi.org/10.1136/bmj.k5344

    Article  PubMed  Google Scholar 

  7. Maffulli N, Peretti GM (2020) Treatment decisions for acute Achilles tendon ruptures. Lancet (London, England) 395:397

    Article  Google Scholar 

  8. Soroceanu A, Sidhwa F, Aarabi S et al (2012) Surgical versus nonsurgical treatment of acute Achilles tendon rupture: a meta-analysis of randomized trials. J Bone Jt Surg Am 94:2136–2143. https://doi.org/10.2106/JBJS.K.00917

    Article  Google Scholar 

  9. Arner O, Lindholm A, Orell SR (1959) Histologic changes in subcutaneous rupture of the Achilles tendon; a study of 74 cases. Acta Chir Scand 116:484–490

    CAS  PubMed  Google Scholar 

  10. Longo UG, Petrillo S, Maffulli N, Denaro V (2013) Acute Achilles tendon rupture in athletes. Foot Ankle Clin 18:319–338

    Article  Google Scholar 

  11. Davidsson L, Salo M (1969) Pathogenesis of subcutaneous tendon ruptures. Acta Chir Scand 135:209–212

    CAS  PubMed  Google Scholar 

  12. Józsa L, Kannus P (1997) Histopathological findings in spontaneous tendon ruptures. Scand J Med Sci Sports 7:113–118

    Article  Google Scholar 

  13. Kannus P, Józsa L (1991) Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Jt Surg Am 73:1507–1525

    Article  CAS  Google Scholar 

  14. Barfred T (1973) Achilles tendon rupture. Aetiology and pathogenesis of subcutaneous rupture assessed on the basis of the literature and rupture experiments on rats. Acta Orthop Scand Suppl, pp 3–126

  15. Gulati V, Jaggard M, Al-Nammari SS et al (2015) Management of achilles tendon injury: a current concepts systematic review. World J Orthop 6:380–386. https://doi.org/10.5312/wjo.v6.i4.380

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sadek AF, Fouly EH, Laklok MA, Amin MF (2015) Functional and MRI follow-up after reconstruction of chronic ruptures of the Achilles tendon Myerson type III using the triple-loop plantaris tendon wrapped with central turndown flap: a case series. J Orthop Surg Res 10:109. https://doi.org/10.1186/s13018-015-0256-y

    Article  PubMed  PubMed Central  Google Scholar 

  17. Razik Ibrahim SA (2009) Surgical Treatment of chronic Achilles tendon rupture. J Foot Ankle Surg 48:340–346. https://doi.org/10.1053/j.jfas.2009.02.007

    Article  Google Scholar 

  18. Lee Y-S, Lin C-C, Chen C-N et al (2005) Reconstruction for neglected Achilles tendon rupture: the modified Bosworth technique. Orthopedics 28:647–650

    Article  Google Scholar 

  19. Lim J, Dalai R, Waseem M (2001) Percutaneous vs. open repair of the ruptured Achilles tendon—a prospective randomized controlled study. Foot Ankle Int 22:559–568. https://doi.org/10.1177/107110070102200705

    Article  CAS  PubMed  Google Scholar 

  20. Pedowitz D, Kirwan G (2013) Achilles tendon ruptures. Curr Rev Musculoskelet Med 6:285–293. https://doi.org/10.1007/s12178-013-9185-8

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ma GW, Griffith TG (1977) Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res, pp 247–55

  22. Metz R, Verleisdonk E-JMM, van der Heijden GJ-M-G et al (2008) Acute achilles tendon rupture. Am J Sports Med 36:1688–1694. https://doi.org/10.1177/0363546508319312

    Article  PubMed  Google Scholar 

  23. Diao Z-B, Chu H-K, Li N et al (2012) Short-term clinical effects of Achillon in repair of acute Achilles tendon rupture. Zhongguo Gu Shang 25:959–961

    PubMed  Google Scholar 

  24. Klein EE, Weil L, Baker JR et al (2013) Retrospective analysis of mini-open repair versus open repair for acute Achilles tendon ruptures. Foot Ankle Spec 6:15–20. https://doi.org/10.1177/1938640012463052

    Article  PubMed  Google Scholar 

  25. Henríquez H, Muñoz R, Carcuro G, Bastías C (2012) Is percutaneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res 470:998–1003. https://doi.org/10.1007/s11999-011-1830-1

    Article  PubMed  Google Scholar 

  26. Chan VO, Morrison WB, Kavanagh EC (2012) Postoperative infection in the foot and ankle. Semin Musculoskelet Radiol 16:241–253

    Google Scholar 

  27. Gitto S, Draghi AG, Bortolotto C, Draghi F (2016) Sonography of the Achilles tendon after complete rupture repair: what the radiologist should know. J Ultrasound Med 35:2529–2536. https://doi.org/10.7863/ultra.16.01092

    Article  PubMed  Google Scholar 

  28. Barbuto L, Di Serafino M, Della Vecchia N et al (2019) Pediatric musculoskeletal ultrasound: a pictorial essay. J Ultrasound 22:491–502

    Article  Google Scholar 

  29. Fornage BD (1986) Achilles tendon: us examination. Radiology 159:759–764. https://doi.org/10.1148/radiology.159.3.3517959

    Article  CAS  PubMed  Google Scholar 

  30. Maffulli N, Dymond NP, Regine R (1990) Surgical repair of ruptured Achilles tendon in sportsmen and sedentary patients: a longitudinal ultrasound assessment. Int J Sports Med 11:78–84

    Article  CAS  Google Scholar 

  31. Blei CL, Nirschl RP, Grant EG (1986) Achilles tendon: us diagnosis of pathologic conditions. Work in progress. Radiology 159:765–767. https://doi.org/10.1148/radiology.159.3.3517960

    Article  CAS  PubMed  Google Scholar 

  32. Möller M, Kälebo P, Tidebrant G et al (2002) The ultrasonographic appearance of the ruptured Achilles tendon during healing: a longitudinal evaluation of surgical and nonsurgical treatment, with comparisons to MRI appearance. Knee Surg Sports Traumatol Arthrosc 10:49–56. https://doi.org/10.1007/s001670100245

    Article  PubMed  Google Scholar 

  33. Cohen M (2012) US imaging in operated tendons. J Ultrasound 15:69–75. https://doi.org/10.1016/j.jus.2011.11.001

    Article  CAS  PubMed  Google Scholar 

  34. Ateschrang A, Körner D, Joisten K et al (2018) Incidence and risk factors for postoperative Achilles tendon calcifications after percutaneous repair. Arch Orthop Trauma Surg 138:203–210

    Article  Google Scholar 

  35. Chun KA, Cho K-H (2015) Postoperative ultrasonography of the musculoskeletal system. Ultrason (Seoul, Korea) 34:195–205. https://doi.org/10.14366/usg.15006

    Article  Google Scholar 

  36. Zappia M, Maggialetti N, Natella R et al (2019) Diagnostic imaging: pitfalls in rheumatology. Radiol Med 124(11):1167–1174

    Article  Google Scholar 

  37. Zappia M, Cuomo G, Martino MT et al (2016) The effect of foot position on power doppler ultrasound grading of Achilles enthesitis. Rheumatol Int 36:871–874. https://doi.org/10.1007/s00296-016-3461-z

    Article  PubMed  Google Scholar 

  38. Klauser AS, Faschingbauer R, Jaschke WR (2010) Is sonoelastography of value in assessing tendons? Semin Musculoskeletal Radiol 14(3):323–333

    Article  Google Scholar 

  39. Sconfienza LM, Silvestri E, Cimmino MA (2010) Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. Clin Exp Rheumatol 28:373–378

    PubMed  Google Scholar 

  40. Sconfienza LM, Albano D, Allen G et al (2018) Clinical indications for musculoskeletal ultrasound updated in 2017 by European Society of Musculoskeletal Radiology (ESSR) consensus. Eur Radiol 28:5338–5351

    Article  Google Scholar 

  41. Robotti G, Draghi F, Bortolotto C, Canepa MG (2020) Ultrasound of sports injuries of the musculoskeletal system: gender differences. J Ultrasound. https://doi.org/10.1007/s40477-020-00438-x

    Article  Google Scholar 

  42. Zhang L, Wan W, Wang Y et al (2016) Evaluation of elastic stiffness in healing Achilles tendon after surgical repair of a tendon rupture using in vivo ultrasound shear wave elastography. Med Sci Monit 22:1186–1191. https://doi.org/10.12659/MSM.895674

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tan S, Kudaş S, Özcan AŞ et al (2012) Real-time sonoelastography of the Achilles tendon: pattern description in healthy subjects and patients with surgically repaired complete ruptures. Skelet Radiol 41:1067–1072. https://doi.org/10.1007/s00256-011-1339-4

    Article  Google Scholar 

  44. Rupp S, Tempelhof S, Fritsch E (1995) Ultrasound of the Achilles tendon after surgical repair: morphology and function. Br J Radiol 68:454–458. https://doi.org/10.1259/0007-1285-68-809-454

    Article  CAS  PubMed  Google Scholar 

  45. Shih K-S, Huang Y-P, Wang T-G, et al (2008) Sonographic appearance of surgically repaired Achilles tendons. 台灣復健醫學雜誌 36:23–30

  46. Zappia M, Berritto D, Oliva F et al (2017) High resolution real time ultrasonography of the sural nerve after percutaneous repair of the Achilles tendon. Foot Ankle Surg 37:636–643. https://doi.org/10.1016/j.fas.2017.03.006

    Article  Google Scholar 

  47. Kammar H, Carmont MR, Kots E et al (2014) Anatomy of the sural nerve and its relation to the achilles tendon by ultrasound examination. Orthopedics 37:e298–e301. https://doi.org/10.3928/01477447-20140225-64

    Article  PubMed  Google Scholar 

  48. Shalabi A, Kristoffersen-Wiberg M, Aspelin P, Movin T (2001) MR evaluation of chronic Achilles tendinosis. A longitudinal study of 15 patients preoperatively and two years postoperatively. Acta Radiol 42:269–276

    CAS  PubMed  Google Scholar 

  49. Barile A, Bruno F, Mariani S et al (2017) Follow-up of surgical and minimally invasive treatment of Achilles tendon pathology: a brief diagnostic imaging review. Musculoskelet Surg 101:51–61. https://doi.org/10.1007/s12306-017-0456-1

    Article  CAS  PubMed  Google Scholar 

  50. Fujikawa A, Kyoto Y, Kawaguchi M et al (2007) Achilles tendon after percutaneous surgical repair: serial MRI observation of uncomplicated healing. AJR Am J Roentgenol 189:1169–1174. https://doi.org/10.2214/AJR.07.2260

    Article  PubMed  Google Scholar 

  51. Karjalainen PT, Aronen HJ, Pihlajamäki HK et al (1997) Magnetic resonance imaging during healing of surgically repaired achilles tendon ruptures. Am J Sports Med 25:164–171. https://doi.org/10.1177/036354659702500204

    Article  CAS  PubMed  Google Scholar 

  52. Hahn F, Meyer P, Maiwald C et al (2008) Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI Findings. Foot Ankle Int 29:794–802. https://doi.org/10.3113/FAI.2008.0794

    Article  PubMed  Google Scholar 

  53. Doniselli FM, Albano D, Chianca V et al (2017) Gadolinium accumulation after contrast-enhanced magnetic resonance imaging: what rheumatologists should know. Clin Rheumatol. 36(5):977–980. https://doi.org/10.1007/s10067-017-3604-y

    Article  PubMed  Google Scholar 

  54. Karjalainen PT, Ahovuo J, Pihlajamäki HK et al (1996) Postoperative MR imaging and ultrasonography of surgically repaired achilles tendon ruptures. Acta Radiol 37:639–646. https://doi.org/10.1177/02841851960373P244

    Article  CAS  PubMed  Google Scholar 

  55. Chianca V, Albano D, Messina C et al (2017) Diffusion tensor imaging in the musculoskeletal and peripheral nerve systems: from experimental to clinical applications. Eur Radiol Exp 1:1–8

    Article  Google Scholar 

Download references

Funding

No funding was received for this review.

Author information

Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Vito Chianca

  2. Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

    Marcello Zappia & Brunese Luca

  3. Musculoskeletal Radiology Unit, Varelli Institute, Naples, Italy

    Marcello Zappia

  4. Radiology Unit, Campolongo Hospital, Eboli, SA, Italy

    Marcello Zappia

  5. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy

    Francesco Oliva & Nicola Maffulli

  6. Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131, Salerno, Italy

    Francesco Oliva & Nicola Maffulli

  7. Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England, UK

    Nicola Maffulli

  8. Faculty of Medicine, School of Pharmacy and Bioengineering, Guy Hilton Research Centre, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England, UK

    Nicola Maffulli

Authors
  1. Vito Chianca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcello Zappia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Oliva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brunese Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicola Maffulli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marcello Zappia.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

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

Chianca, V., Zappia, M., Oliva, F. et al. Post-operative MRI and US appearance of the Achilles tendons. J Ultrasound 23, 387–395 (2020). https://doi.org/10.1007/s40477-020-00479-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-020-00479-2

Keywords

Search

Navigation