Ultrasound Imaging/Guidance for Insertional Achilles Tendinopathy.

Objectives: This observational study aimed to define a standardized sonographic approach for evaluating the elementary lesions of the tendon-bone junction (TBJ) in insertional Achilles tendinopathy (IAT).

Methods: Using high-frequency transducers, we matched the histological microarchitecture and the anatomical features of the TBJ of the Achilles tendon in patients with a clinical diagnosis of IAT. Color/power Doppler assessments have been performed as well.

Results: Fifty eight patients, with a mean age of 54 years (54.50 ± 11.72) and a gender distribution of 32 males (55.17%) and 26 females (44.83%), were enrolled in this observational study. Five elementary lesions of IAT were sonographically defined: bone spur, calcified longitudinal fissuration, intra-tendinous bony formation, tendon-bone disjunction, and fibrocartilage hyperemia. Moreover, specific sonographic signs have been identified to differentiate bony spurs in the growing phase and end-stage.

Conclusions: Using high-frequency B-mode and high-sensitive Doppler imaging, detailed sonographic assessment of the TBJ can be performed in IAT patients. The aforementioned five elementary lesions can be considered as a standardized approach for prompt examination of this complex/anatomical region.

Advances in knowledge: Recent advances in ultrasound equipment allow for accurate assessment of the TBJ of the AT. The present observational study defined five elementary sonographic lesions of the IAT as bone spur, calcified longitudinal fissuration, intra-tendinous bony formation, tendon-bone disjunction, and fibrocartilage hyperemia. Pertinent ultrasound-guided procedures targeting the TBJ are also discussed.