The value of ultrasonography of the Achilles tendon in traumatology

Method: In an experimental study on ten isolated human cadaver tendons, the ultrasound anatomy and the reproducibility of aretefacts was determined using 10- and 13-MHz probes. With these in vitro data, the form and diameter of a non-injured tendon were documented in a series of 30 patients between 3 and 60 years old. In a second series of 32 patients with acute, traumatic ruptures of the Achilles tendon and 40 patients with chronic disorders, we distinguished the pathological anatomy. Results: Injuries to a tendon with chronic disorders, reruptures and complications in the postoperative period after tendon repair can be made more difficult by calcification, scars, oedema, haematoma and suture materials. It is necessary to check the changing ultrasound patterns owing to an haematoma or oedema with tendon corpulence, the missing linear signals in a fresh rupture and the different signals after operative or non-operative treatment. Conclusion: Using high-frequency probes with 10 or more MHz, it is possible to examine even the insertion area of the tendon or the pathology of a subachilleal bursa by tilting the probe. The dynamic examination and the comparison with the contralateral side in two planes should be included in a standardized examination procedure and are of great importance in some cases of fresh tendon ruptures. Knowledge of the physical principles and the possibility of misleading artefacts is crucial.