Ultrasound imaging/guidance for insertional Achilles tendinopathy

Objectives: This observational study aimed to define a standardized sonographic approach for evaluating the elementary lesions of the tendon-bone junction (TBJ) in insertional Achilles tendinopathy (IAT). Methods: Using high-frequency transducers, we matched the histological microarchitecture and the anatomical features of the TBJ of the Achilles tendon in patients with a clinical diagnosis of IAT. Colour/power Doppler assessments have been performed as well. Results: Fifty-eight patients, with a mean age of 54years (54.50±11.72) and a gender distribution of 32 males (55.17%) and 26 females (44.83%), were enrolled in this observational study. Five elementary lesions of IAT were sonographically defined: bone spur, calcified longitudinal fissuration, intra-tendinous bony formation, tendon-bone disjunction, and fibrocartilage hyperemia. Moreover, specific sonographic signs have been identified to differentiate bony spurs in the growing phase and end-stage. Conclusions: Using high-frequency B-mode and high-sensitive Doppler imaging, detailed sonographic assessment of the TBJ can be performed in IAT patients. The aforementioned 5 elementary lesions can be considered as a standardized approach for prompt examination of this complex/anatomical region. Advances in knowledge: Recent advances in ultrasound equipment allow for accurate assessment of the TBJ of the AT. The present observational study defined 5 elementary sonographic lesions of the IAT as bone spur, calcified longitudinal fissuration, intra-tendinous bony formation, tendon-bone disjunction, and fibrocartilage hyperemia. Pertinent ultrasound-guided procedures targeting the TBJ are also discussed.