SONOGRAPHY OF ACHILLES-TENDON CORRELATED TO OPERATIVE FINDINGS

Ultrasound examination (US) with a 5 MHz linear array probe was used t o examine 30 patients (34 Achilles tendons) with overuse injuries. The results were compared with surgical findings in all cases. Most of th e patients had two or more sonographical findings. In this study US ha d an overall sensitivity of 0.96 in the detection of Achilles tendon p athology. Partial Achilles tendon rupture,vas suspected in ten tendons . During an operation ruptures were found in eleven tendons, of which two were fibrotic scars. Changes in inflammatory tendopathy (tendiniti s, paratenonitis and paratenonitis with tendinosis) were found by US i n 28 tendons and in the operation in 27 tendons. US showed tendinitis in 21 cases, of which four had a positive operative finding. In the se venteen negative cases, the surface of the tendon looked normal during the operation. Most of these cases (14 out of 17) were classified as paratenonitis during the operation. In three cases, paratenonitis with tendinosis tvas classified as paratenonitis in the operation and in o ne case the findings were similar in US and in surgery. US was underdi agnostic in paratenonitis and overdiagnostic in tendinitis. Bursitis w as detected during the operation in ten cases, but only in three cases by US. False positive bursitis was diagnosed three times in US compar ed to the operative finding. In chronic bursitis, the bursa can be sma ll, thickened by its wall and undetectable by US. High-resolution sono graphy is a relatively reliable diagnostic method in Achillodynia and mainly useful as a preoperative study to differentiate a partial ruptu re from inflammatory states.