Sound Touch Elastography of Achilles Tendons in Patients with Type 2 Diabetes Mellitus Versus Healthy Adults

Overview

Journal Diabetol Metab Syndr

Publisher Biomed Central

Specialty Endocrinology

Date 2023 Aug 20

PMID 37599363

Authors

Xinxin Huang

Xingyu Chen

Xiu Chen

Ping Chi

Pengfei Wang

Xiaomei Zhan

Chunpeng Zou

Liang Wang

Yanyan Dong

Affiliations

Soon will be listed here.

Abstract

Background: The studies of the effect of diabetes on the stiffness of Achilles tendon (AT) tissue remain inconclusive, we believe it is necessary to find a reliable method which can be used to detect the stiffness changes of the AT in the diabetic state. The objective of the present study was to investigate the effectiveness of sound touch elastography (STE) as a tool for detecting diabetic Achilles tendinopathy.

Methods: We conducted a retrospective review of 180 participants, consisting of 82 patients with type 2 diabetes mellitus (T2DM) and 98 healthy adults, who had undergone AT ultrasonography. Young 's modulus (E) values of the distal, middle, and proximal segments of bilateral ATs of all participants were measured using STE technique. The E values of each AT segment between the case and control group were compared.

Results: The E values of the three segments of ATs in T2DM patients were lower than the healthy controls (P < 0.05). In both groups, the E values of the distal segments were lower than those of the middle segments, and the latter were lower than those of the proximal segments (P < 0.05). The E value of each segment of AT was inversely related to FPG, HbA1c, and diabetes duration (P < 0.05). The best cut-off points for the E values of the three segments of the AT for detecting diabetic tendinopathy were 347.44 kPa (AUC, 0.779), 441.57 kPa (AUC, 0.692), and 484.35 kPa (AUC, 0.676), respectively.

Conclusion: STE can be used as a complementary diagnostic tool for the diagnosis of diabetic Achilles tendinopathy.

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References

Ganestam A, Kallemose T, Troelsen A, Barfod K . Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients. Knee Surg Sports Traumatol Arthrosc. 2015; 24(12):3730-3737. DOI: 10.1007/s00167-015-3544-5. View

Armstrong D, Boulton A, Bus S . Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017; 376(24):2367-2375. DOI: 10.1056/NEJMra1615439. View

Zellers J, Eekhoff J, Walk R, Hastings M, Tang S, Lake S . Human Achilles tendon mechanical behavior is more strongly related to collagen disorganization than advanced glycation end-products content. Sci Rep. 2021; 11(1):24147. PMC: 8683434. DOI: 10.1038/s41598-021-03574-4. View

Zhang F, Wang J, Ma Y, Wang Y, Wang W, Wang Y . Evaluation of Achilles Tendon in Patients with Diabetic Foot Ulcer by High-Frequency Ultrasound Combined with Real-Time Shear-Wave Elastography. J Healthc Eng. 2022; 2022:4866240. PMC: 8816553. DOI: 10.1155/2022/4866240. View

Giacomozzi C, DAmbrogi E, Uccioli L, Macellari V . Does the thickening of Achilles tendon and plantar fascia contribute to the alteration of diabetic foot loading?. Clin Biomech (Bristol). 2005; 20(5):532-9. DOI: 10.1016/j.clinbiomech.2005.01.011. View

Helfenstein-Didier C, Andrade R, Brum J, Hug F, Tanter M, Nordez A . In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis. Phys Med Biol. 2016; 61(6):2485-96. DOI: 10.1088/0031-9155/61/6/2485. View

Nallamshetty L, Nazarian L, Schweitzer M, Morrison W, Parellada J, Articolo G . Evaluation of posterior tibial pathology: comparison of sonography and MR imaging. Skeletal Radiol. 2005; 34(7):375-80. DOI: 10.1007/s00256-005-0903-1. View

. 11. Microvascular Complications and Foot Care: . Diabetes Care. 2019; 43(Suppl 1):S135-S151. DOI: 10.2337/dc20-S011. View

Aubry S, Nueffer J, Tanter M, Becce F, Vidal C, Michel F . Viscoelasticity in Achilles tendonopathy: quantitative assessment by using real-time shear-wave elastography. Radiology. 2014; 274(3):821-9. DOI: 10.1148/radiol.14140434. View

10.

Qiu H, Yang H, Yang Z, Yao Q, Duan S, Qin J . The value of radiomics to predict abnormal bone mass in type 2 diabetes mellitus patients based on CT imaging for paravertebral muscles. Front Endocrinol (Lausanne). 2022; 13:963246. PMC: 9606777. DOI: 10.3389/fendo.2022.963246. View

11.

Turhan Iyidir O, Rahatli F, Bozkus Y, Ramazanova L, Turnaoglu H, Nar A . Acoustic Radiation Force Impulse Elastography and Ultrasonographic Findings of Achilles Tendon in Patients With and Without Diabetic Peripheral Neuropathy: A Cross-Sectional Study. Exp Clin Endocrinol Diabetes. 2019; 129(2):99-103. DOI: 10.1055/a-0840-3292. View

12.

Connizzo B, Bhatt P, Liechty K, Soslowsky L . Diabetes alters mechanical properties and collagen fiber re-alignment in multiple mouse tendons. Ann Biomed Eng. 2014; 42(9):1880-8. PMC: 4125419. DOI: 10.1007/s10439-014-1031-7. View

13.

Squier K, Scott A, Hunt M, Brunham L, Wilson D, Screen H . The effects of cholesterol accumulation on Achilles tendon biomechanics: A cross-sectional study. PLoS One. 2021; 16(9):e0257269. PMC: 8445482. DOI: 10.1371/journal.pone.0257269. View

14.

Schneebeli A, Falla D, Clijsen R, Barbero M . Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study. BMJ Open Sport Exerc Med. 2020; 6(1):e000726. PMC: 7047478. DOI: 10.1136/bmjsem-2019-000726. View

15.

Liu C, Li Y, Wang X, Zhang Z . Quantifying the Stiffness of Achilles Tendon: Intra- and Inter-Operator Reliability and the Effect of Ankle Joint Motion. Med Sci Monit. 2018; 24:4876-4881. PMC: 6069534. DOI: 10.12659/MSM.909531. View

16.

Lindemann I, Coombes B, Tucker K, Hug F, Dick T . Age-related differences in gastrocnemii muscles and Achilles tendon mechanical properties in vivo. J Biomech. 2020; 112:110067. DOI: 10.1016/j.jbiomech.2020.110067. View

17.

Otter S, Payne C, Jones A, Webborn N, Watt P . Differences in Achilles tendon stiffness in people with gout: a pilot study. BMC Musculoskelet Disord. 2020; 21(1):658. PMC: 7542740. DOI: 10.1186/s12891-020-03598-3. View

18.

Gatos I, Drazinos P, Yarmenitis S, Theotokas I, Zoumpoulis P . Comparison of Sound Touch Elastography, Shear Wave Elastography and Vibration-Controlled Transient Elastography in Chronic Liver Disease Assessment using Liver Biopsy as the "Reference Standard". Ultrasound Med Biol. 2020; 46(4):959-971. DOI: 10.1016/j.ultrasmedbio.2019.12.016. View

19.

Claessen F, Vos R, Reijman M, Meuffels D . Predictors of primary Achilles tendon ruptures. Sports Med. 2014; 44(9):1241-59. DOI: 10.1007/s40279-014-0200-z. View

20.

Grant W, Sullivan R, Sonenshine D, Adam M, Slusser J, Carson K . Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. J Foot Ankle Surg. 1997; 36(4):272-8; discussion 330. DOI: 10.1016/s1067-2516(97)80072-5. View