Distribution of sonographically detected tendon abnormalities in patients with a clinical diagnosis of chronic Achilles tendinosis

Purpose. We conducted a retrospective study of the distribution of sonograp hically detected abnormalities in the heels of patients who had a clinical diagnosis of Achilles tendinosis. Methods. One hundred eighteen symptomatic heels in 73 patients who had a cl inical diagnosis of chronic Achilles tendinosis were examined over a 12-mon th period by the same experienced sonologist. The distribution of altered t endon architecture and features suggesting retrocalcaneal bursitis or Achil les paratendinosis were evaluated. Results. Sonograms of 118 symptomatic heels demonstrated that 96 (81%) had abnormalities confined to the proximal two thirds of the Achilles tendon, 9 (8%) had abnormalities in the distal third alone, and 13 (11%) had abnorma lities at both sites. Of the 109 heels with proximal two-third Achilles ten don disease, 99 (91%) had medial tendon involvement; 22 of the 99 showed di ffuse tendon changes. Lateral tendon segment changes were seen in 22 (19%) of the 118 symptomatic heels. No lateral tendon segment was involved in iso lation. Of the 22 heels with distal third abnormalities, 14 (64%) had sonog raphic evidence of Achilles paratendinitis, and 13 (59%) had sonographic ev idence of Achilles tendinosis. Eighteen of the 22 had sonographic evidence of retrocalcaneal bursitis. In all cases of distal third tendinosis, the de ep surface of the tendon was primarily involved. In the heels with both pro ximal and distal changes, superficial segment involvement of the mid-Achill es tendon was present. Conclusions. Sonography provides information that helps to accurately diagn ose clinical Achilles tendinopathy and may help to determine the biomechani cal processes involved in the injury. (C) 2000 John Wiley & Sons, Inc.