Onarılmış Tendonlarda İyileşme Sürecinin Ultrason ve Strain Elastografi ile Değerlendirilmesi

Year 2020, Volume: 30 Issue: 4, 235 - 241, 01.12.2020

Ersen Ertekin Zehra Seznur Kasar Hulki Başaloğlu

Abstract

Amaç: Rüptür sonrası tendon iyileşmesi zorlu bir süreçtir. Tedavi sırasında erken dönemde kas iyileşmesini tespit etmek için, bazı uygulama güçlükleri olan kas gücü testi dışında etkin bir yöntem yoktur. Bu çalışmanın amacı, önkol fleksör tendonlarında kesi sonrası onarılmış tendonların iyileşme sürecinin değerlendirilmesinde Strain Elastografinin etkinliğini belirlemektir.Gereç ve Yöntem: Çalışma öncesi kurumumuz ‘İnvazif Olmayan Klinik Araştırmalar Etik Kurulu’ndan onay alındı . Çalışmaya katılan tüm katılımcılardan imzalı bir gönüllü onam formu alındı. Kesi sonrası tendon onarımı yapılan 38 hasta çalışmaya dahil edildi. Aynı hastaların yaralanmamış ekstremite ölçümleri kontrol grubu olarak kaydedildi. Onarılmış tendonlar, ilk önce 4 haftalık Kleinert rehabilitasyon programı ve ardından 8 hafta boyunca fizik tedavi ile tedavi edildi. Onarılmış tendonlar ve yaralanmamış kontrol tendonları, Ultrason ve Srain Elastografi ile belirli aralıklarla üç kez değerlendirildi. Tedaviden önce ve sonra, onarılmış tendonlara kas gücü testi yapıldı. Onarılmış tendonlardan elde edilen veriler grup içinde ve kontrol grubu ile karşılaştırıldı.Bulgular: Fizik tedavi öncesi ve sonrası onarılmış tendonlarla kontrol grubu arasında çap ve gerinim oranları açısından anlamlı bir fark vardı p

Keywords

Sonoelastografi, strain Elastografi, tendon yaralanmaları, tedaviye yanıt

Evaluation of the healing process in repaired tendons by ultrasound and strain elastography

Abstract

Objective: Tendon healing after the rupture is a challenging process. There is no method to detect muscle recovery during treatment, except for the muscle strength test that has application difficulties in early period. The purpose of the study is to determine the effectiveness of Strain Elastography for evaluation of the healing process in the forearm flexor tendons after cut.Material and Methods: An approval was taken from “Non-invasive clinical researches ethical board” of our local ethic committee . A signed voluntary information-consent form was obtained from all of the participants in the study. 38 patients who underwent tendon repair after cut were included in the study. Measurements of the non-injured extremities of the same patients were recorded as the control group. The repaired tendons were first treated with a 4-week Kleinert rehabilitation program, followed by a physical therapy for 8 weeks. Repaired tendons and the non-injured side control tendons evaluated with Ultrasound and SE three times at certain intervals. Muscle strength test were performed before and after the therapy. The data obtained from repaired tendons were compared within the group and with the control group.Results: There was a significant difference between repaired tendon and control group diameters and strain ratios before and after the physical therapy p

Keywords

Sonoelastography, strain elastography, tendon injuries, treatment response

References

• Sanal HT. Radiologic Imaging Methods in Evaluation of the Musculoskeletal System. TOTBID Journal 2013;12:1-6.
• Yakut Z, Turan A, Teber M. Ultrasound Elastography in Musculoskleletal System Applications. Selcuk Med J 2014;30:88-92.
• Verim S, Samet S. Ultrasound in Musculoskeletal and Soft Tissue Lesions. TOTBID Journal 2013;12:7-12.
• Klauser AS, Miyamoto H, Bellmann-Weiler R, Feuchtner GM, Wick MC, Jaschke WR. Sonoelastography: Musculos- keletal Applications. Radiology 2014;272:622-33.
• Zhang LN, Wan WB, Wang YX, Jiao ZY, Zhang LH, Luo YK, et al. 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 2016;22:1186-91.
• Zellers JA, Cortes DH, Silbernagel KG. From acute achil- les tendon rupture to return to play–a case report evalu- ating recovery of tendon structure, mechanical properties, clinical and functional outcomes. Int J Sports Phys Ther 2016;11:1150-9.
• Karatekin YS, Karaismailoglu B, Kaynak G, Ogut T, Dikici AS, Ure Esmerer E, et al. Does elasticity of Achilles tendon change after suture applications? Evaluation of repair area by acoustic radiation force impulse elastography. J Orthop Surg Res 2018;13:45
• Freedman BR, Gordon JA, Soslowsky LJ. The Achilles ten- don: fundamental properties and mechanisms governing healing. Muscles Ligaments Tendons J 2014;4:245-55.
• Docheva D, Müller SA, Majewski M, Evans CH. Biologics for tendon repair. Adv Drug Deliv Rev 2015;84:222-39.
• O’Connor PJ, Grainger AJ, Morgan SR, Smith KL, Waterton JC, Nash AF. Ultrasound assessment of tendons in asymp- tomatic volunteers: a study of reproducibility. Eur Radiol 2004;14:1968-73.
• McNally EG. The development and clinical applications of musculoskeletal ultrasound. Skeletal Radiol 2011;40:1223- 31.
• Bühler M, Johnson G, Meikle G. Longitudinal in vivo ult- rasound observations of the surgically repaired zone II flexor digitorum profundus tendon. Ultrasound Med Biol 2015;41:3018-22.
• De Zordo T, Chhem R, Smekal V, Feuchtner G, Reindl M, Fink C, et al. Real-time sonoelastography: findings in pa- tients with symptomatic achilles tendons and comparison to healty volunteer. Ultraschall Med 2010;31:394-400.
• Chen XM, Cui LG, He P, Shen WW, Qian YJ, Wang JR. Shear wave elastographic characterization of normal and torn achilles tendons: a pilot study. J Ultrasound Med 2013;32:449-55.
• Lee SY, Park HJ, Choi YJ, Choi SH, Kook SH, Rho MH, et al. Value of adding sonoelastography to conventional ult- rasound in patients with congenital muscular torticollis. Pediatr Radiol 2013;43:1566-72.
• Teber MA, Oğur T, Bozkurt A, Er B, Turan A, Gülbay M, et al. Real-time sonoelastography of the quadriceps tendon in patients undergoing chronic hemodialysis. J Ultrasound Med 2015;34:671-7.
• Yamamoto Y, Yamaguchi S, Sasho T, Fukawa T, Akatsu Y, Nagashima K, et al. Quantitative ultrasound elastography with an acoustic coupler for achilles tendon elasticity: Mea- surement, repeatability and normative values. J Ultrasound Med 2016;35:159-66.
• Ooi CC, Richards PJ, Maffulli N, Ede D, Schneider ME, Connell D, et al. A soft patellar tendon on ultrasound elas- tography is associated with pain and functional deficit in voleyball players. J Sci Med Sport 2016;19:373-8.
• Karjalainen PT, Ahovuo J, Pihlamajamaki HK, Soila K, Aronen HJ. Postoperative MR imaging and ultrasonograp- hy of surgically repaired Achilles tendon ruptures. Acta Ra- diol 1996;37:639-46.
• Verdano MA, Zanelli M, Aliani D, Corsini T, Pellegrini A, Ceccarelli F. Quadriceps tendon tear rupture in healty pa- tients treated with patellar drilling holes: clinical and ultra- sonographic analysis after 36 months of follow-up. Muscles Ligaments Tendons J 2014;4:194-200.
• Lee SC, Williams D, Endo Y. The repaired rotator cuff: MRI and Ultrasound evaluation. Curr Rev Musculoskelet Med 2018;11:92-101.
• Tan S, Kudaş S, Özcan AS, İpek A, Karaoğlanoğlu M, Ars- lan H, et al. Real-time sonoelastography of the achilles tendon: Pattern description in healty subjects and patients with surgically repaired complete ruptures. Skeletal Radiol 2012;41:1067-72.
• Paternostro-Sluga T, Grim-Stieger M, Posch M, Schuhfried O, Vacariu G, Mittermaier C, et al. Reliability and validity of the Medical Research Council (MRC) scale and a modi- fied scale for testing muscle strength in patients with radial palsy. J Rehabil Med 2008;40:665-71.
• Ciesla N, Dinglas V, Fan E, Kho M, Kuramoto J, Needham D. Manual muscle testing: a method of measuring extre- mity muscle strength applied to critically ill patients. J Vis Exp 2011;50:2632.
• Dekkers KJ, Rameckers EA, Smeets RJ, Janssen-Potten YJ. Upper extremity strength measurement for children with cerebral palsy: a systematic review of available instruments. Phys Ther 2014;94:609-22.
• Bohannon RW. Reliability of Manual Muscle Testing: A Sys- tematic Review. Isokinetics and Exercise Science 2018;26:1- 8.