IMAGING IN CHRONIC ACHILLES TENDINOPATHY - A COMPARISON OF ULTRASONOGRAPHY, MAGNETIC-RESONANCE-IMAGING AND SURGICAL FINDINGS IN 27 HISTOLOGICALLY VERIFIED CASES

Objective. To compare information gained by ultrasonography and magnet ic resonance imaging (MRI) in chronic achilles tendinopathy with regar d to the nature and severity of the lesion. Design. Imaging of both ac hilles tendons with ultrasonography and MRI was performed prior to uni lateral surgery. Operative findings and histological biopsies together served as a reference. Patients. Twenty-seven patients (22 men, 5 wom en; mean age 44 years; 21 athletes) suffering from chronic achilles te ndinopathy participated in the study. Eighteen patients had unilateral and 9 had bilateral symptoms. Results and conclusions. Surgical findi ngs included 4 partial ruptures, 21 degenerative lesions and 2 macrosc opically normal cases. Microscopy revealed tendinosis (degeneration) i n all tendon biopsies, including cases with a partial rupture, but onl y slight changes in the paratendinous tissues (paratenon). Ultrasonogr aphy was positive in 21 of 26 and MRI in 26 of 27 cases. Severe intrat endinous abnormalities and a sagittal tendon diameter >10 mm suggested a partial rupture. In tendons with a false negative result histopatho logical changes were mild and a tendency towards a better clinical out come was noted in the sonographic cases. Assessment of the paratenon w as unreliable with both methods. Ultrasonography and MRI give similar information and may have their greatest potential as prognostic instru ments.