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. 2012 Feb;15(1):69-75.
doi: 10.1016/j.jus.2011.11.001. Epub 2011 Nov 21.

US imaging in operated tendons

M Cohen  1
Affiliations

US imaging in operated tendons

M Cohen. J Ultrasound. 2012 Feb.

Abstract
in English, Italian

Ultrasound (US) plays an essential role in the follow-up of operated tendons. The US operator must keep in mind three main elements: healing of traumatic injuries of the tendons seems to follow the biological model of histologic healing, surgical repair of a tendon rupture improves the structural parameters of the operated tendon, but it does not grant restitutio ad integrum, and US findings therefore seem poorly correlated with the functional evolution.Before examination, the US operator should be familiar with the nature of the tendon injury that has led to surgery including location, severity, time elapsed between tendon injury and surgical repair, surgical technique, postoperative course and possible complications. US findings in operated as well as non-operated tendons depend on several factors: morphology, structure, vascularization of the tendon, mobility of the tendon and mobility of the peritendinous tissues. Particular features are therefore considered according to the location: shoulder, elbow, wrist, hand, knee, ankle and foot. Interpretation of the US image requires knowledge of the surgical technique and "normal" postoperative appearance of the operated tendon in order to detect pathological findings such as thinning, persistent fluid collections within or around the tendon, persistent hypervascularization, intratendinous calcifications and adhesions.

SommarioL’ecografia riveste un ruolo essenziale nel follow-up dei tendini operati. Nella sua esecuzione l’ecografista deve tenere ben presenti tre punti: la cicatrizzazione delle lesioni traumatiche dei tendini, all’esame ecografico, sembra seguire il modello biologico di cicatrizzazione istologica, la riparazione chirurgica di una rottura tendinea migliora i parametri strutturali del tendine operato, ma non apporta una restitutio ad integrum, i segni ecografici sembrano mal correlati all’evoluzione funzionale.Prima di iniziare l’esame l’ecografista deve conoscere alcuni dati: la natura della lesione tendinea per cui è stato realizzato l’intervento chirurgico, la sede, la gravità, l’intervallo temporaneo tra la lesione tendinea e la sua riparazione chirurgica, il tipo di tecnica, il decorso e le eventuali complicanze post-operatorie.Come per il tendine non operato la semiotica ecografica è basata su vari elementi: morfologia, struttura, vascolarizzazione del tendine, sua mobilità e mobilità dei tessuti peritendinei.Vengono quindi presi in considerazione problemi particolari a seconda della sede: spalla, gomito, polso e mano, ginocchio, caviglia e piede.L’interpretazione delle immagini dell’ecografia richiede la conoscenza della tecnica operatoria e dell’aspetto “normale” del tendine operato.È importante mettere in evidenza i reperti peggiorativi quali: assottigliamento, raccolta liquida intra o peritendea persistente, ipervascularizzazione persistente, calcificazioni intratendinee, aderenze.

Keywords: Operated Tendons; Tendons; Ultrasound.

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Figures

Figure 1
Figure 1
Tendon callus: longitudinal scan (A) and axial scan (B). US shows focal thickening of the tendon on the surgical site.
Figure 2
Figure 2
Re-rupture of the patellar tendon. On the surgical site the patellar tendon appears thinned instead of thickened; this is a US sign highly suggestive of re-rupture.
Figure 3
Figure 3
Complete rupture of the Achilles tendon. After percutaneous tenotomy, US shows maintained continuity but irregular contours still within normal limits.
Figure 4
Figure 4
Outcome of percutaneous tenotomy of the Achilles tendon. US image shows a hypoechoic peritendinous area, which may persist for up to 3 months.
Figure 5
Figure 5
Tenosynovitis after tendon sheath surgery. US shows a hypo-anechoic fluid collection of the sheath surrounding the tendon (A: sagittal scan; B: axial scan).
Figure 6
Figure 6
Tenotomy of the Achilles tendon. Seven months after surgery US shows loss of normal fibrillar tendon appearance.
Figure 7
Figure 7
Tenotomy of the Achilles tendon. US shows small hypoechoic areas surrounding the stitches (a characteristic image during the first 6 months) and fluid collection (suggestive of a poor prognosis when more than 50% of the tendon is affected).
Figure 8
Figure 8
Flexor tendon surgery of the third finger. Postoperative x-ray shows the presence of surgical material (A); US shows that it is intratendinous (B).
Figure 9
Figure 9
Distal biceps tendon surgery. Postoperative x-ray shows extensive calcifications (A); US shows that they are intratendinous (B).
Figure 10
Figure 10
Color Doppler US evaluation of operated tendons. Three months after surgery the tendons appear constantly hypervascular (A), whereas vascularity of the peritendinous tissue is less constant (B).
Figure 11
Figure 11
Reconstruction of the supraspinatus tendon. US shows continuity of the tendon, which is in the correct position, adequate thickness and correct tension of the surgical wires.
Figure 12
Figure 12
Tenotomy of the common extensor tendon. US shows the localization far from the enthesis (arrows).
Figure 13
Figure 13
Reconstruction of the long flexor tendon of the thumb. MRI using axial scan (A) and sagittal scan (B) and also US (C) show the presence of callus due to elongation.
Figure 14
Figure 14
Reconstruction of the patellar tendon. US performed during rehabilitation shows thickening of the tendon and loss of normal fibrillar appearance (A). Color Doppler US shows abnormal vascularity due to postsurgical tendinopathy (B).
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