Editorial Type:
Musculoskeletal System

Reproducibility and feasibility of acoustoelastography in the superficial digital flexor tendons of clinically normal horses

Michelle E. Ellison Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53705.

Search for other papers by Michelle E. Ellison in
Current site
Google Scholar
PubMed Close
 VMD
,
Sarah Duenwald-Kuehl Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705.

Search for other papers by Sarah Duenwald-Kuehl in
Current site
Google Scholar
PubMed Close
 PhD
,
Lisa J. Forrest Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53705.

Search for other papers by Lisa J. Forrest in
Current site
Google Scholar
PubMed Close
 VMD
,
Ray Vanderby Jr Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705.

Search for other papers by Ray Vanderby Jr in
Current site
Google Scholar
PubMed Close
 PhD
, and
Sabrina H. Brounts Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53705.

Search for other papers by Sabrina H. Brounts in
Current site
Google Scholar
PubMed Close
 DVM, MS
DOI:
https://doi.org/10.2460/ajvr.75.6.581
Volume/Issue:
Volume 75: Issue 6
Online Publication Date:
01 Jun 2014
Restricted access
Sign In Reprints and Permissions Purchase Article

Abstract

Objective—To evaluate the feasibility and repeatability of in vivo measurement of stiffness gradients by means of acoustoelastography in the superficial digital flexor tendons (SDFTs) of clinically normal horses.

Animals—15 clinically normal horses.

Procedures—For each horse, stiffness gradient index and dispersion values for SDFTs in both forelimbs were evaluated in longitudinal orientation by use of acoustoelastography at 3 sites (5, 10, and 15 cm distal to the accessory carpal bone) by 2 observers; for each observer, data were acquired twice per site. The left forelimb was always scanned before the right forelimb. Lifting of the contralateral forelimb with the carpus flexed during image acquisition resulted in the required SDFT deformation in the evaluated limb. Interobserver repeatability, intraobserver repeatability, and right-to-left limb symmetry for stiffness gradient index and dispersion values were evaluated.

Results—Stiffness gradient index and dispersion values for SDFTs at different locations as well as effects of age or sex did not differ significantly among the 15 horses. Interclass correlation coefficients for interobserver repeatability, intraobserver repeatability, and limb symmetry revealed good to excellent agreement (intraclass correlation coefficients, > 0.74).

Conclusions and Clinical Relevance—Results indicated that acoustoelastography is a feasible and repeatable technique for measuring stiffness gradients in SDFTs in clinically normal horses, and could potentially be used to compare healthy and diseased tendon states.

Abstract

Objective—To evaluate the feasibility and repeatability of in vivo measurement of stiffness gradients by means of acoustoelastography in the superficial digital flexor tendons (SDFTs) of clinically normal horses.

Animals—15 clinically normal horses.

Procedures—For each horse, stiffness gradient index and dispersion values for SDFTs in both forelimbs were evaluated in longitudinal orientation by use of acoustoelastography at 3 sites (5, 10, and 15 cm distal to the accessory carpal bone) by 2 observers; for each observer, data were acquired twice per site. The left forelimb was always scanned before the right forelimb. Lifting of the contralateral forelimb with the carpus flexed during image acquisition resulted in the required SDFT deformation in the evaluated limb. Interobserver repeatability, intraobserver repeatability, and right-to-left limb symmetry for stiffness gradient index and dispersion values were evaluated.

Results—Stiffness gradient index and dispersion values for SDFTs at different locations as well as effects of age or sex did not differ significantly among the 15 horses. Interclass correlation coefficients for interobserver repeatability, intraobserver repeatability, and limb symmetry revealed good to excellent agreement (intraclass correlation coefficients, > 0.74).

Conclusions and Clinical Relevance—Results indicated that acoustoelastography is a feasible and repeatable technique for measuring stiffness gradients in SDFTs in clinically normal horses, and could potentially be used to compare healthy and diseased tendon states.

Contributor Notes

Dr. Ellison's present address is Department of Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803.

Presented in part as abstracts at the 2013 American College of Veterinary Surgeons Symposium, 2013 Annual Scientific Conference of the American College of Veterinary Radiology, and 2013 Annual Meeting of the British Equine Veterinary Association.

Supported by a Companion Animal Grant through the University of Wisconsin School of Veterinary Medicine.

The authors thank Hirohito Kobayashi of Echometrix LLC for technical assistance.

Dr. Vanderby Jr holds a patent associated with some aspects of this concept for ultrasound analysis. No other authors have any conflicts of interest with the present study.

Address correspondence to Dr. Brounts (brounts@svm.vetmed.wisc.edu).
Cover American Journal of Veterinary Research
American Journal of Veterinary Research
Publication Date:
01 Jun 2014

  • 1. Avella CS, Ely ER, Verheyen KLP, et al. Ultrasonographic assessment of the superficial digital flexor tendons of National Hunt racehorses in training over two racing seasons. Equine Vet J 2009; 41: 449–454.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 2. Dowling BA, Dart AJ, Hodgson DR, et al. Superficial digital flexor tendonitis in the horse. Equine Vet J 2000; 32: 369–378.

  • 3. Jorgensen JS, Genovese RL. Superficial digital flexor tendonitis in racehorses. In: Ross MW, Dyson SJ, eds. Diagnosis and management of lameness in the horse. St Louis: Saunders, 2003; 628–635.

    • Search Google Scholar
    • Export Citation

  • 4. Thorpe CT, Clegg PD, Birch HL. A review of tendon injury: why is the equine superficial digital flexor tendon most at risk? Equine Vet J 2010; 42: 174–180.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 5. Dowling BA, Dart AJ. Mechanical and functional properties of the equine superficial digital flexor tendon. Vet J 2005; 170: 184–192.

  • 6. Dahlgren LA. Pathobiology of tendon and ligament injuries. Clin Tech Equine Pract 2007; 6: 168–173.

  • 7. Patterson-Kane JC, Firth EC. The pathobiology of exercise-induced superficial digital flexor tendon injury in Thoroughbred racehorses. Vet J 2009; 181: 79–89.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 8. Gillis C. Ultrasonography for monitoring healing and rehabilitation. Clin Tech Equine Pract 2007; 6: 174–178.

  • 9. Micklethwaite L, Wood AKW, Sehgal CM, et al. Use of quantitative analysis of sonographic brightness for detection of early healing of tendon injury in horses. Am J Vet Res 2001; 62: 1320–1327.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 10. Rantanen NW, Jorgensen JS, Genovese RL. Ultrasonographic evaluation of the equine limb: technique. In: Ross MW, Dyson SJ, eds. Diagnosis and management of lameness in the horse. St Louis: Saunders, 2003; 166–188.

    • Search Google Scholar
    • Export Citation

  • 11. van Schie HTM, Bakker EM, Cherdchutham W, et al. Monitoring of the repair process of surgically created lesions in equine superficial digital flexor tendons by use of computerized ultrasonography. Am J Vet Res 2009; 70: 37–48.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 12. Fleming BC, Beynnon BD. In vivo measurement of ligament/tendon strains and forces: a review. Ann Biomed Eng 2004; 32: 318–328.

  • 13. Maganaris CN. Tensile properties of in vivo human tendinous tissue. J Biomech 2002; 35: 1019–1027.

  • 14. Quapp KM, Wiess JA. Material characterization of human medial collateral liagment. J Biomech Eng 1998; 120: 757–763.

  • 15. Sheehan FT, Drace JE. Human patellar tendon strain: a noninvasive, in vivo study. Clin Orthop Relat Res 2000; 370: 201–207.

  • 16. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg 2005; 87: 187–202.

  • 17. Lustgarten M, Redding WR, Labens R, et al. Elastographic characteristics of the metacarpal tendons in horses without clinical evidence of tendon injury [published online ahead of print Sep 17, 2013]. Vet Radiol Ultrasound doi: 10.1111/vru.12104.

    • Search Google Scholar
    • Export Citation

  • 18. Pourcelot P, Defontaine M, Ravary B, et al. A non-invasive method of tendon force measurement. J Biomech 2005; 38: 2124–2129.

  • 19. Vergari C, Pourcelot P, Ravary-Plumioen B, et al. First application of axial speed of sound to follow up injured equine tendons. Ultrasound Med Biol 2012; 38: 162–167.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 20. Vergari C, Pourcelot P, Ravary-Plumioen B, et al. Axial speed of sound for the monitoring of injured equine tendons: a preliminary study. J Biomech 2012; 45: 53–58.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 21. Vergari C, Ravary-Plumioen B, Evrard D, et al. Axial speed of sound is related to tendon's nonlinear elasticity. J Biomech 2012; 45: 263–268.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 22. Crevier-Denoix N, Ravary-Plumioen B, Evrard D, et al. Reproducibility of a non-invasive ultrasonic technique of tendon force measurement, determined in vitro in equine superficial digital flexor tendons. J Biomech 2009; 42: 2210–2213.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 23. Duenwald S, Kobayashi H, Frisch K, et al. Ultrasound echo is related to stress and strain in tendon. J Biomech 2011; 44: 424–429.

  • 24. Ellison M, Kobayashi H, Delaney F, et al. Feasibility and repeatability for in vivo measurements of stiffness gradients in the canine gastrocnemius tendon using an acoustoelastic strain gauge. Vet Radiol Ultrasound 2013; 54: 548–554.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 2. Kobayashi H, Vanderby R. New strain energy function for acoustoelastic analysis of dilatational waves in nearly incompressible, hyper-elastic materials. J Appl Mech 2005; 72: 843.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 26. Kobayashi H, Vanderby R. Acoustoelastic analysis of reflected waves in nearly incompressible, hyper-elastic materials: forward and inverse problems. J Acoust Soc Am 2007; 121: 879–887.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 27. Herson M. Comprehensive handbook of psychological assessments: personality assessment. 2nd ed. Ames, Iowa: John Wiley & Sons, 2004.

  • 28. Lacroix AS, Duenwald-Kuehl SA, Lakes RS et al. Relatioship between tendon stiffness and failure: a metaanalysis. J Appl Physiol 2013; 115: 43–51.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 29. Duenwald-Kuehl S, Kondratko J, Lakes RS, et al. Damage mechanics of porcine flexor tendon: mechanical evaluation and modeling. Ann Biomed Eng 2012; 40: 1692–1707.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 30. Crevier-Denoix N, Pourcelot P, Denoix J-M, et al. Segmental variations of in vitro mechanical properties in equine superficial digital flexor tendons. Am J Vet Res 1996; 57: 1111–1117.

    • Search Google Scholar
    • Export Citation

  • 31. Whitcomb MB. Ultrasonographic evaluation of the metacarpus, metatarsus, and pastern. Clin Tech Equine Pract 2004; 3: 238–255.

  • 32. Gillis C, Sharkey N, Stover SM, et al. Effect of maturation and aging on material and ultrasonographic properties of equine superificial digital flexor tendon. Am J Vet Res 1995; 56: 1345–1350.

    • Search Google Scholar
    • Export Citation

  • 33. Lewis G, Shaw KM. Tensile properities of human tendo achillis: effect of donor age and strain rate. J Foot Ankle Surg 1997; 36: 435–445.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 34. Karamanidis K, Arampatzis A. Mechanical and morphological properties of different muscle-tendon units in the lower extremity and running mechanics: effect of aging and physical activity. J Exp Biol 2005; 208: 3907–3923.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 35. Onambélé GN, Burgess K, Pearson SJ. Gender-specific in vivo measurement of the structural and mechanical properties of the human patellar tendon [Erratum published in J Orthop Res 2007; 25:1681]. J Orthop Res 2007; 25: 1635–1642.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 36. Moffat PA, Firth EC, Rogers CW, et al. The influence of exercise during growth on ultrasonographic parameters of the superficial digital flexor tendon of young Thoroughbred horses. Equine Vet J 2008; 40: 136–140.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 37. Kubo K, Kanehisa H, Fukunaga T. Gender differences in the viscoelastic properties of tendon structures. Eur J Appl Physiol 2003; 88: 520–526.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 38. Crevier-Denoix N, Ruel Y, Dardillat C, et al. Correlations between mean echogenicity and material properties of normal and diseased equine superficial digital flexor tendons: an in vitro segmental approach. J Biomech 2005; 38: 2212–2220.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 39. Cherdchutham W, Becker C, Smith RKW, et al. Age-related changes and effect of exercise on the molecular composition of immature equine superficial digital flexor tendons. Equine Vet J Suppl 1999;(31): 86–94.

    • Search Google Scholar
    • Export Citation

  • 40. Birch HL, McLaughlin L, Smith RKW, et al. Treadmill exercise-induced tendon hypertrophy: assessment of tendons with different mechanical functions. Equine Vet J Suppl 1998;(30): 61–64.

    • Search Google Scholar
    • Export Citation

  • 41. Firth EC, Rogers CW, Anderson BH. Musculoskeletal responses of 2-year-old Thoroughbred horses to early training. 4. Morphometric, microscopic, and biomechanical properties of the digital tendons of the forelimb. N Z Vet J 2004; 52: 285–292.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 42. Gillis C, Meagher DM, Pool RR, et al. Ulrasonographically detected changes in equine superficial digital flexor tendons during the first months of race training. Am J Vet Res 1993; 54: 1797–1802.

    • Search Google Scholar
    • Export Citation

  • 43. Steiner M. Biomechanics of tendon healing. J Biomech 1982; 15: 951–958.

  • 44. Li Y, Snedeker JG. Elastography: modality-specific approaches, clinical applications, and research horizons. Skeletal Radiol 2011; 40: 389–397.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 45. Dakin SG, Jespers K, Warner S, et al. The relationship between in vivo limb and in vitro tendon mechanics after injury: a potential novel clinical tool for monitoring tendon repair. Equine Vet J 2011; 43: 418–423.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 46. Walker P, Amstutz HC, Rubinfeld M. Canine tendon studies II: biomechanical evaluation of normal and regrown canine tendons. J Biomed Mater Res 1976; 10: 61–76.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 47. De Zordo T, Chhem R, Smekal V, et al. Real-time sonoelastography: findings in patients with symptomatic achilles tendons and comparison to healthy volunteers. Ultraschall Med 2010; 31: 394–400.

    • Search Google Scholar
    • Export Citation

  • 48. De Zordo T, Lill SR, Fink C, et al. Real-time sonoelastography of lateral epicondylitis: comparison of findings between patients and healthy volunteers. AJR Am J Roentgenol 2009; 193: 180–185.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • 49. Wu C-H, Chang K-V, Mio S, et al. Sonoelastography of the plantar fascia. Radiology 2011; 259: 502–507.

  • 50. Sonfienza LM, Silvestri E, Cimmino MA. Sonoelastography in the evaluation of painful Achilles tendon in amateur athletes. Clin Exp Rheumatol 2010; 2010: 373–378.

    • Search Google Scholar
    • Export Citation

  • 51. Wu C-H, Chen W-S, Park G-Y, et al. Musculoskeletal sonoelastography: a focused review of its diagnostic applications for evaluating tendons and fascia. J Med Ultrasound 2012; 20: 79–86.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement