G

Evaluation of Achilles Tendon Injuries with Findings from Diagnostic Musculoskeletal Ultrasound in Canines – 43 Cases

Lauri-Jo Gamble, Debra A Canapp, Sherman O Canapp

Published:  12/09/2017    in:  Articles
Views
124
HTML:
11
PDF:
13



G
Abstract

Objective: The objective was to describe clinical and ultrasonographic characteristics of canine Achilles tendon injuries.

Background: Even though there have been publications describing characteristics of the normal and injured Achilles tendon by diagnostic ultrasound, there has been no previous in-depth ultrasonic evaluation and characterisation of Achilles tendon strains.

Evidentiary value: This is a retrospective case series report of 43 dogs that underwent musculoskeletal diagnostic ultrasound evaluation of their strained Achilles tendons, with and without surgical repair.

Methods: Data was collected from medical records of patients from August 2009 to May 2016. Inclusion criteria for dogs included a diagnosis of Achilles tendon injury based on the presence of fibre pattern modification within one or more components of the Achilles mechanism on initial diagnostic ultrasound.

Results: It was found on the diagnostic ultrasound that Achilles tendon injuries were strictly unilateral in 51.2% (n=22/43) of cases and bilateral on presentation in 48.8% (n=21/43) of cases. 18.2% of the unilateral case progressively became bilateral over time (n=4/22). The injury was partial in 90.7% (n=39/43) of the cases and all three components of the Achilles mechanism were completely disrupted in only 9.3% of the cases (n=4/43). The partial injuries incorporated changes within the fibre patterns of all 3 components of the Achilles in 53.8% (n=21/39) of the cases and alteration of both the gastrocnemius tendon (GT) and common tendon (CT) in 41.0% (n=16/39) of the cases. Grade III strains were predominant (44.3%), followed by grade I (28.6%) and grade II (27.1%). Damage occurred most commonly at the tendino-osseous insertion (77%), with injury occurring less frequently diffusely along the body of the tendon (12.5%) or at the musculotendinous junction (10.5%).

Conclusion: Diagnostic musculoskeletal ultrasound was used to identify lesions of Achilles tendon consistent with different grade of strain, as well as identifying the specific region of injury. Diagnostic ultrasound findings were correlated to the surgical findings and previous literature.

Application: Diagnostic musculoskeletal ultrasound provides a non-invasive diagnostic modality for patients suspected of having Achilles tendon strain. Further investigation is needed to establish treatment protocols based on ultrasonographic 3-tier grading scheme for Achilles tendon strain injury.

Abbreviations: Common tendon (CT), computed tomography scan (CT scan), gastrocnemius tendon (GT), magnetic resonance imaging (MRI), myotendinous junction (MTJ), superficial digital flexor tendon (SDFT).


Open AccessPeer Reviewed
Full Text:

HTML PDF


Click to see References Click to hide References
References

  1. Archambault, J. M., Wiley, J. P., Bray, R. C., Verhoef, M., Wiseman, D. A., & Elliott, P. D. (1998). Can sonography predict the outcome in patients with achillodynia? Journal of Clinical Ultrasound: JCU, 26(7), 335–9. http://dx.doi.org/10.1002/(SICI)1097-0096(199809)26:7%3C335::AID-JCU1%3E3.0.CO;2-A
  2. Baltzer, W.I. & Rist, P., 2009. Achilles Tendon Repair in Dogs Using the Semitendinosus Muscle: Surgical Technique and Short-Term Outcome in Five Dogs. Veterinary Surgery, 38(6), pp.770–779. http://dx.doi.org/10.1111/j.1532-950X.2009.00565.x
  3. Caine, A. et al., 2009. Sonography of the soft tissue structures of the canine tarsus. Veterinary Radiology and Ultrasound, 50(3), pp.304–308. http://dx.doi.org/10.1111/j.1740-8261.2009.01539.x
  4. Case, J.B. et al., 2013. Gastrocnemius Tendon Strain in a Dog Treated With Autologous Mesenchymal Stem Cells and a Custom Orthosis. Veterinary Surgery, 42(4), pp.355–360. http://dx.doi.org/10.1111/j.1532-950X.2013.12007.x
  5. Cervi, M., Brebner, N. & Liptak, J., 2010. Short- and long-term outcomes of primary achilles tendon repair in cats: 21 cases. Veterinary and Comparative Orthopaedics and Traumatology, 23(5), pp.348–353. http://dx.doi.org/10.3415/VCOT-09-10-0109
  6. Claessen, F.M. et al., 2014. Predictors of primary Achilles tendon ruptures. Sports medicine (Auckland, N.Z.), 44(9), pp.1241–1259. http://dx.doi.org/10.1007/s40279-014-0200-z
  7. Cook, C.R., 2016. Ultrasound Imaging of the Musculoskeletal System. Veterinary Clinics of North America - Small Animal Practice, 46(3), pp.355–371. http://dx.doi.org/10.1016/j.cvsm.2015.12.001
  8. Corr, S. a et al., 2010. Retrospective study of Achilles mechanism disruption in 45 dogs. Veterinary Record, 167, pp.407–411. http://dx.doi.org/10.1136/vr.c4190
  9. Evans, H.E. & De Lahunta, A., 2013. Miller’s Anatomy Of The Dog (4th edition) Elsevier H., St Louis, Missouri.
  10. Ganestam, A. et al., 2015. 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 Surgery, Sports Traumatology, Arthroscopy, 24(12) http://dx.doi.org/10.1007/s00167-015-3544-5
  11. Griffith, J.F., 2014. Diagnostic Ultrasound: Musculoskeletal AMIRSYS; 1 Har/Psc edition
  12. Harasen, G., 2006. Ruptures of the common calcaneal tendon. Canadian Veterinary Journal, 47(12), pp.1219–1220.
  13. Henderson, R.E.A., Walker, B.F. & Young, K.J., 2015. The accuracy of diagnostic ultrasound imaging for musculoskeletal soft tissue pathology of the extremities: a comprehensive review of the literature. Chiropractic & manual therapies, 23(1), pp.31. http://dx.doi.org/10.1186/s12998-015-0076-5
  14. Hossain, M.A. et al., 2008. Dexamethasone induces apoptosis in proliferative canine tendon cells and chondrocytes. Veterinary and Comparative Orthopaedics and Traumatology, 21(4), pp.337–342. http://dx.doi.org/10.3415/VCOT-07-06-0060
  15. Johnson, A., 2005. Achilles Tendon Repair. In Atlas of Orthopedic Surgical Procedures of the Dog and Cat, pp. 74–77. http://dx.doi.org/10.1016/B978-0-7216-9381-1.50028-4
  16. Kainberger, F. et al., 1990. Injury of the Achilles tendon: diagnosis with sonography. American Journal of Roentgenology, 155(5), pp.1031–1036. http://dx.doi.org/10.2214/ajr.155.5.2120931
  17. Kälebo, P. et al 1992. Diagnostic value of ultrasonography in partial ruptures of the Achilles tendon. Am J Sports Med., 20(4), pp.378–381. http://dx.doi.org/10.1177/036354659202000402
  18. King, M. & Jeram, R., 2003. Achilles tendon rupture in dogs. Compendium On Continuing Education For The Practicing Veterinarian, 25(8), pp.613–620.
  19. Kramer, M. et al., 1998. Diseases of the achilles tendon in dogs and cats. Tierarzliche Praxis Ausgabe Kleintiere Heimtiere, 26(4), pp.238–246. [Article in German]
  20. Kramer, M. et al., 1997. Sonography of the musculoskeletal system in dogs and cats. Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association, 38(2), pp.139–149. http://dx.doi.org/10.1111/j.1740-8261.1997.tb00829.x
  21. Kramer, M. et al., 2001. Ultrasonographic examination of injuries to the achilles tendon in dogs and cats. The Journal of small animal practice, 42(11), pp.531–535. http://dx.doi.org/10.1111/j.1748-5827.2001.tb06022.x
  22. Lamb, C.R. & Duvernois, A., 2005. Ultrasonographic anatomy of the normal canine calcaneal tendon. Veterinary Radiology and Ultrasound, 46(4), pp.326–330. http://dx.doi.org/10.1111/j.1740-8261.2005.00061.x
  23. Lim, S. et al., 2008. The effects of enrofloxacin on canine tendon cells and chondrocytes proliferation in vitro. Veterinary Research Communications, 32(3), pp.243–253. http://dx.doi.org/10.1007/s11259-007-9024-8
  24. Luscombe, K.L., Sharma, P. & Maffulli, N., 2003. Achilles tendinopathy. Trauma, 7, pp.215–225. http://dx.doi.org/10.1191/1460408603ta285oa
  25. Maffulli, N., Sharma, P. & Luscombe, K.L., 2004. Achilles tendinopathy: aetiology and management. Journal of the Royal Society of Medicine, 97(10), pp.472–476. 1258/jrsm.97.10.472
  26. Meutstege, F., 1993. The classification of canine Achilles tendon lesions. Veterinary and Comparative Orthopaedics and Traumatology, 6, pp.53–55.
  27. Millis DL, Levine D, Taylor RA. Canine Rehabili- tation and Physical Therapy. 1st edition. Elsevier; 2004. p. 182.
  28. Morton, M. et al., 2015. Repair of chronic rupture of the insertion of the gastrocnemius tendon in the dog using a polyethylene terephthalate implant. Early clinical experience and outcome. Veterinary and Comparative Orthopaedics and Traumatology, 28, pp.282–287. doi: 10.3415/VCOT-14-08-0133.
  29. Mueller, M.C. et al., 2009. Conservative treatment of partial gastrocnemius muscle avulsions in dogs using therapeutic ultrasound - A force plate study. Veterinary and Comparative Orthopaedics and Traumatology, 22(3), pp.243–248. doi: 10.3415/VCOT-08-07-0059.
  30. Mughannam, A. & Reinke, J., 1994. Avulsion of the gastrocnemius tendon in 3 cats. Journal of the American Animal Hospital Association, 30(6), pp.550–556.
  31. Nielsen, C. & Pluhar, G.E., 2006. Outcome following surgical repair of achilles tendon rupture and comparison between postoperative tibiotarsal immobilization methods in dogs: 28 cases (1997-2004). Veterinary and Comparative Orthopaedics and Traumatology, 19(4), pp.246–254.
  32. Nyyssonen T. et al., 2008. The increasing incidence and difference in sex distribution of Achilles tendon rupture in Finland in 1987-1999. Scand J Surg, 97(3), pp.272–275. http://dx.doi.org/10.1177/145749690809700312
  33. Reinke, J., Mughannam, A. & Owens, J., 1993. Avulsion of the gastrocnemius tendon in 11 dogs. Journal of the American Animal Hospital Association, 29(5), pp.410–418.
  34. Rivers, B., et al, 1997. Sonographic findings in canine common calcaneal tendon injury. Veterinary and Comparative Orthopaedics and Traumatology , 10(1), pp.45–53.
  35. Royall, N. a, 2011. Ultrasound-assisted musculoskeletal procedures: A practical overview of current literature. World Journal of Orthopedics, 2(7), pp.57-66. http://dx.doi.org/10.5312/wjo.v2.i7.57
  36. Shakibaei, M. et al., 2001. Biochemical changes in Achilles tendon from juvenile dogs after treatment with ciprofloxacin or feeding a magnesium-deficient diet. Archives of Toxicology, 75(6), pp.369–374. http://dx.doi.org/10.1007/s002040100243
  37. Silbernagel, K.G., 2015. Sex differences in outcome after an acute achilles tendon. Orthop J Sports Med, 29(3), pp.6. doi: 10.1177/2325967115586768.
  38. Spinella, G. et al., 2010. Surgical repair of Achilles tendon rupture in dogs : a review of the literature, a case report and new perspectives. Veterinarni Medicina, 55(7), pp.303–310.
  39. Takebayashi, S., Takasawa, H., Banzai, Y., Miki, H., Sasaki, R., Itoh, Y., & Matsubara, S. (1995). Sonographic findings in muscle strain injury: clinical and MR imaging correlation. Journal of Ultrasound in Medicine, 14(12), 899–905. http://dx.doi.org/10.7863/jum.1995.14.12.899
  40. Vaughan, L.C., 1981. The use of carbon fibre implants for the repair of Achilles tendon rupture in dogs. The Journal of small animal practice, 22(10), pp.629–634. http://dx.doi.org/10.1111/j.1748-5827.1981.tb00565.x
  41. Worth, A.J. et al., 2004. Ability to work and owner satisfaction following surgical repair of common calcanean tendon injuries in working dogs in New Zealand. New Zealand veterinary journal, 52(May 2015), pp.109–116. http://dx.doi.org/10.1080/00480169.2004.36415


Refbacks
  • There are currently no refbacks.


Copyright (c) 2017 Lauri-Jo Gamble, Debra A Canapp, Sherman O Canapp

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

Made possible through a project grant from the RCVS Council.

RCVS